outcome-capture

name	outcome-capture
description	Strategy and implementation for capturing appeal outcome data to build the flywheel
version	1.0.0
triggers	["appeal_completed","user_returns_after_appeal","outcome_followup_scheduled"]

Outcome Capture Skill

Purpose

Close the feedback loop on every appeal. Every outcome reported makes the system smarter for the next patient.

Why This Matters

The flywheel depends on real-world outcome data. Without outcomes:

• Coverage paths have no success/failure signal
• Appeal strategies can't be ranked by effectiveness
• Claude can't say "this appeal type has a 67% success rate"
• The product remains a commodity

Capture Channels

Channel	Mechanism	Expected Yield
Email followup (day 30)	Automated Resend email with one-click buttons	15-25% response rate
Email followup (day 60)	Second reminder if no response	10-15% response rate
In-chat prompt	Ask returning users about past appeals	30-40% response rate
Counselor reporting	SHIP counselors report outcomes as part of workflow	80-90% response rate
Provider reporting	Practices know outcomes from remittance	95%+ response rate

Data Captured Per Outcome

Field	Source	Stored In
outcome (approved/denied/partial)	User report	appeals.status
days_to_resolution	Calculated from appeal date	appeals.outcome_reported_at
icd10_codes, cpt_codes	From original appeal	appeals (already stored)
lcd_refs, ncd_refs	From original appeal	appeals (already stored)
carc_codes	From original appeal	appeals (already stored)

Outcome Incentive

"Report your outcome, get your next appeal free."

• Costs nothing (appeal is digital)
• Massively increases reporting rate
• Implementation: decrement usage.appeal_count by 1 when outcome reported

What Gets Updated on Outcome Report

1. appeals.status -> outcome value
2. appeals.outcome_reported_at -> timestamp
3. coverage_paths -> increment use_count, set outcome
4. symptom_mappings -> boost if approved (+0.1), penalize if denied (-0.05)
5. procedure_mappings -> boost if approved (+0.1), penalize if denied (-0.05)
6. outcome_followups.responded_at -> timestamp
7. usage.appeal_count -> decrement by 1 (incentive)

Implementation Files

File	Purpose
app/src/lib/conversation-service.ts	scheduleOutcomeFollowups() after saveAppeal
app/src/app/outcome/page.tsx	Token-based one-click outcome reporting page
app/src/app/api/outcome-report/route.ts	API for token-based outcome submission
app/src/skills/domain/outcome-prompting.ts	In-chat prompt for returning users
supabase/functions/send-outcome-followup/	Cron edge function for email reminders
app/src/lib/learning.ts	checkOutcomeIncentive(), applyOutcomeIncentive()