Status: Settled non-respite GUIDE scope; additional-value priorities are recommendations, not activated offers. Date: 2026-10-04 Scope: Eight GUIDE service domains, supporting programme work and candidate additional results. No new service, provider contract, price or clinical capacity is approved here.
Decision in plain language#
Proxi supplies one complete non-respite GUIDE operating service. The commercial obligation is to maintain, staff and furnish all eight domains when applicable, through paid employees or approved contracts. It is not a menu in which the GUIDE Participant must buy or supply the clinical, navigator, caregiver or administrative pieces separately. It does not require every beneficiary to receive every domain every month.
Two priorities apply to that base:
- Deliver the required service reliably. Obtain the assessment and actual clinical decisions; build the person-led plan; maintain human access and the appropriate contact cadence; furnish caregiver support, coordination, referrals and medication work; and complete actual reporting/billing obligations.
- Make that work easier for the family and staff. Ask once when possible, use authorized existing records, prepare each exact question, combine related work, help with real practical barriers and return an understandable next action. A minimum requirement is not a reason to provide a poor experience.
The additional-value shortlist below is a recommendation for owner selection under O-052. It is not an included service, a marketed commitment, a scheduled programme or a funded capacity claim. Required care, accessibility and urgent response remain available when an optional extension is declined or unavailable. A draft manual does not establish field readiness; actual Agreement, Partner, workforce, clinical, release and availability approvals remain necessary.
For required/elected residence visits, D-028 selects a paid approved social worker/home-safety specialist physically onsite and an appropriately scoped Proxi clinician joining through permitted telehealth. Onsite observations and the actual clinical assessment are different acts. Remote participation alone is not onsite presence, and neither title nor connection proves every clinical procedure is suitable. Actual fees/travel and shared work are recorded once.
What the operating words mean#
These are business meanings, not new workflow states or software fields.
- Available: an accepted staffed capability and working route exist. An advertisement, roster entry or software button is not enough. Availability costs money but alone is not furnished care.
- Applicable: current need, request, due window, event or accepted plan makes the act relevant. Unknown caregiver/clinical status is not absence or normality.
- Offered: the person receives the purpose, intended result, burden, actual delivery mode and limits; explanation is not delivery.
- Accepted, declined or deferred: the person's choice. Acceptance is not performance; decline does not cancel independent base care.
- Arranged: logistics or an accepted appointment/order/referral exist. They do not prove a professional delivered the service.
- Furnished: the actual authorized person or permitted care action supplies the substantive service. A reminder, attempted call, forwarded packet or available app does not by itself prove it.
- Completed: the owning procedure's endpoint is evidenced, including truthful unresolved/declined/unavailable outcomes where appropriate. It is not automatically resolution of the broader need.
- Helpful: the beneficiary/caregiver's own reported experience. It can guide the next action, but it is not a diagnosis or a billing result.
Five different questions about whether work is done#
| Question | Actual source of the answer | What is needed | Review |
|---|---|---|---|
| Was a service furnished? | The record of the actual paid navigator, clinician, accepted provider or permitted care action | Performer/capacity, date, substantive content and result; not a function named Service owner | |
| Was that work completed? | The owning SOP's approved evidence rule and any required actual human return | That procedure's endpoint, limitations and still-open work | |
| Is the broader need resolved? | All applicable professional/nonclinical returns plus the person's report | Current result, remaining barrier, actual next worker and agreed follow-through; closing one referral is not the whole case | |
| Is the month claim-ready? | Approved qualification rules; Billing/Revenue Cycle performs only an actual manual/authorized financial act | Alignment, tier/contact window, qualifying furnished service and PO-122 evidence; no invented service | |
| Did it help? | Beneficiary or caregiver | Their own report; not a model's interpretation of engagement or silence |
A real service can coexist with an outside waitlist or unfinished referral. A helpful interaction can still be in a non-claim-ready month. Whole-plan completion/release requirements remain O-003 and the actual class decisions; do not invent an RN blessing, anonymous Participant approver or signature.
The beneficiary and caregiver journey#
This is a non-executable business overview. Detailed source procedures supply exact authority, accepted individuals, due windows, communication, failure and completion. D-030 selects Philippine factual/logistical human help and PR relationship/distress/required navigator work for waiting, welcome and transfer/goodbye; clear routine updates remain software. D-032 places the accepted primary navigator's first family meeting during initial assessment/planning, inside useful existing work. Actual assignment, working coverage/backup and mode/evidence acceptance remain O-053, not an invented actor or another welcome call.
| Stage | Useful experience | Actual work and conditional human entry | Return | Review |
|---|---|---|---|---|
| First contact | Understand whether GUIDE may fit without repeated forms or a promise of alignment | Software presents approved information/captures clear responses; Philippine L1 obtains inaccessible administrative facts; PR navigator performs actual requested/required relationship help | Current eligibility facts/unknowns and the person's wish to proceed | |
| Explanation and choice | Voluntary informed participation, exclusivity and right to stop | The person/decision-specific representative chooses; software records the approved choice route. L1 clarifies literal facts and L2 handles actual nonclinical human questions; neither decides capacity or diagnosis | Attributable consent/permission or respectful refusal; clinically protected or uncovered legal questions keep their proper author | |
| Assessment | Existing records prepare the encounter; the clinician does not hunt the chart | L1 prepares objective sources; L2 performs accepted nonclinical participation. US RN performs nursing domains, US behavioral clinician the licensed psychosocial component, and eligible dementia-proficient medical clinician medical/staging/reconciliation work only as actually assigned; not a mandatory three-person chain | Actual authored assessment products or identified gaps; qualified E/M capability is not supplied by an ordinary RN license | |
| CMS waiting and alignment | Honest dated status rather than false enrollment certainty | Software processes approved submissions/results/notices. L1 pursues missing administrative facts; L2 supplies actual needed person-facing support. Clinical attestation remains the qualified clinical author's paid act; institutional/signature powers are not inferred | Final authoritative result or truthful pending/non-alignment status; D-032 introduction occurs during initial assessment/planning, without pretending CMS confirmation | |
| Welcome and activation | Retain the known primary navigator, contact route and next useful step | Software supplies approved logistics; L1 corrects actual factual/access failures and L2 performs actual required/requested relationship work. Do not repeat the D-032 first introduction merely because alignment is confirmed | Working contact/help route and applicable plan; actual person/coverage acceptance remains O-053 | |
| Care Plan | Goals in the person's words, useful owned actions and attributable medical content | Software drafts from accepted choices/products; L2 performs the actual person-led planning/facilitation. Each clinical author owns their exact protected contribution; current applicable products are reused, new/due work is not waived | Person-reviewed plan, approved completion and class-specific release; O-003/O-014 remain distinct | |
| Ordinary months | One primary navigator remembers prior work and addresses a useful current matter | L2 furnishes due/accepted human contact. Software prepares facts/actions; L1 performs actual administrative pursuit. A clear choice needs no additional L2 blessing | Actual addressed/declined/not-asked content, useful result and next agreed action | |
| When something happens | Live human help and no unnecessary retelling | Philippine L1 supplies the 24/7 first answer; the exact clinical/emergency recipient handles protected urgency/treatment; L2 supplies actual nonclinical navigation/support, not a gateway before every clinician | Accepted response/result or truthful pending/failed handoff and actual backup; ringing is not acceptance | |
| Annual renewal | One current assessment/plan review instead of duplicated visits by topic | Actual assigned assessment professionals and L2 perform their own due work; software prepares records, deadlines and permitted submissions | Actual annual assessment/plan products and submission; no generic assessment team performs the act | |
| Transfer, stopping or exit | A neutral ending and usable continuity information | Software performs approved mechanics; L1 resolves factual transmission/status failures; L2 performs required/requested continuity/relationship work. Protected authors/releasers and retained acts keep their actual authority | Required notice, permitted transfer, unresolved work and next actual recipient; D-030 per-act division applies; actual transfer/receipt and accepted backup remain required |
An unknown Participant-retained/nondelegable act is a design dependency under O-PA-001, outside the performer list. Identify the controlling provision and accepted person/body before operating it. It is not a free customer click, a clinical staffing substitute or an excuse to omit Proxi's full service.
Monthly service-load rule#
Use the current tier/contact window and the person's actual need—not eight services per month or a target talk time. The order is need or due cadence → specific service → useful person result → actual human work → qualification. A required stable contact can confirm that one current goal still fits and no more help is wanted; unasked medicine, safety or caregiver domains remain unasked.
The 8/15/25-minute direct-contact bands follow the agenda, never fill it. Current total-active episode/capacity scenarios include actual preparation, own documentation and follow-through. Clinical work uses its own authorized professional, not PR minutes. One interaction may furnish several separately evidenced services, with its labor counted once. Use qualifying inbound work to avoid a redundant contact; leave a no-service month unbilled rather than manufacture a review, reconciliation, lesson or call. Low-burden planning controls the detail.
Who completes the task#
The specific act determines the performer and return—not a department, queue or vague owner.
Provider transport is not clinical or release authority. D-031 assigns Philippine L1 the manual send of already-approved coordination provider packets and clinician-approved recommendations to the selected authorized PCP/specialist when automated transmission is unavailable. Existing clinical authorship, permission and required human release precede transport. No regimen change, clinical agreement, new patient order, O-014 Care Plan sending or other destination is delegated by that choice; actual administrative minutes are recorded once.
| Actual performer/component | What is made true | Boundary | Review |
|---|---|---|---|
| Proxi software and bounded AI | Approved factual retrieval, comparison, calculation, drafting, scheduling, content presentation and tracking | AI prepares/presents; it does not choose clinical outcomes, disclose on its own or approve unresolved authority | |
| Beneficiary/caregiver/authorized representative | Their own lived report, goal, participation, choice or decision-specific consent | Not Proxi payroll; participation and representative powers remain separate | |
| Philippine L1 | Actual nonclinical human first answer, literal capture/connection, manual office/vendor facts and permitted administrative transactions | Not clinical triage or the default formal navigator contact | |
| PR GUIDE navigator | Actual human navigator contact, nonclinical planning/coaching/support, needed relationship/choice help and assigned §6.3 referral/initiation/D-007 release | Not medical/legal judgment, automatic factual approval or blanket release authority | |
| US RN, behavioral clinician, medical clinician selected for the act | Their actual examination/clinically necessary history, interpretation, disposition, assessment, treatment or authorized medication/order act | No generic RN/L2/CMO prereview; actual clinical subject/current location, provider-location rules, scope/modality and accepting individual apply | |
| Paid approved contractor in the actual professional/onsite category | The specific Proxi-contracted clinical, therapy, trainer, field or other qualified service | Paid Proxi fulfillment, not excluded outside labor; exact competence and capacity are required | |
| Real corporate job | Its concrete technical, HR, billing, Medicaid, business-commitment or legal/clinical-leadership correction | No generic Programme/Quality/Privacy/Data/Compliance case specialist; routine corrections stay with the original worker/lead | |
| Independent outside endpoint | Its own records, diagnosis/treatment, dispensing, community activity, payer/CMS decision or emergency service | Proxi coordinates that act; it does not claim outside performance or use an uncontracted endpoint as free promised staff |
Each paid person records their own act. Software applies the approved completion/evidence rule; any specifically required human approval/release remains with its actual assignee. Delivery, receipt, professional agreement, actual implementation, broader need resolution and payment are different results.
How much Proxi can do#
Current task-level bands classify components, not contacts, people, payroll or hours.
| Proxi component band | Base inventory | Enhanced inventory | Total | Review |
|---|---|---|---|---|
| Definitely software | 86 | 2 | 88 | |
| Deterministic + AI | 238 | 64 | 302 | |
| Gray area | 57 | 0 | 57 | |
| Unquestionably human | 116 | 40 | 156 | |
| Total | 497 | 106 | 603 |
390 of 603 work types (64.7%) have a principally automatable Proxi component. This is not 390 staff-free tasks or 64.7% of labor. Required release, attestation, human service, physical work and genuine exceptions retain their actual paid act even in a D row. Zero Enhanced gray means sub-acts are defined, not that offers, authority or capacity are accepted. Occurrences and actual role-minutes—not labels—determine payroll.
The base Proxi service by work family#
| Work family | Concrete Proxi contribution | Actual human/protected work | Review |
|---|---|---|---|
| Programme operations | Approved model information, factual checks, choice capture, roster/deadline/evidence tracking and permitted PAAF/notices/claims | L1 actual manual facts; the qualified medical clinician's real attestation; Billing's actual financial act; HR/technical jobs for actual failures; Administrative Manager's D-027 business commitment only. Actual retained signature remains O-066/O-PA-001, never generic Participant staff | |
| Comprehensive assessment | Source-linked intake, records, direct questions and the exact clinical packet | L2 actual nonclinical participation; each qualified nursing/behavioral/medical assessment act; D-028 paid onsite worker plus scoped telehealth clinical work | |
| Person-centered care plan | Accepted goals/choices/products, action plan, prepared permitted distribution and return tracking | L2 actual human planning; person leads choices; actual clinical authors supply protected content, not a blanket plan blessing; whole-plan completion and release are their own approved acts | |
| Ongoing monitoring/support | Current due windows, prepared useful agenda, promises and change reports | L2 actual qualifying human contact/support. Exact clinician interprets a clinical change/question or due review; fax/status uncertainty goes to L1, not automatically to a clinician | |
| 24/7 access | Continuously staffed nonclinical first answer and actual approved connection/return | Philippine nurses in L1; substantive caregiver support uses accepted care-team capacity; exact licensed/emergency recipient supplies protected response. D-026 does not prove all-hour membership/arrangement or mandate an automatic PR/clinical shift | |
| Coordination/transitions | Authorized records/requests, source comparisons, logistics, prepared clinical questions and actual returns | L1 administrative pursuit; L2 actual needed human navigation; qualified professional decides clinical necessity/urgency, interprets findings and reconciles/treats. Required transition care never depends on an extra package | |
| Community services/supports | Current factual offerings, disclosed hard constraints/preferences, clear choice, prepared referrals and four distinct returns | L1 only actual manual facts/transactions; L2 performs actual required HRSN navigator referral/connection and narrow D-007 release, plus requested relationship help. Clinical suitability and Medicaid/legal questions use the actual appropriate professional/job | |
| Medication management | Current attributed sources/use reports, discrepancies, regimen questions, approved logistics/reminders and follow-through | Proxi's paid qualified prescribing/reconciliation authority performs the required clinical act. RN/pharmacist/other contributions use actual scope; L1/L2 practical help does not change a regimen or prove adherence | |
| Caregiver education/support | Approved selectable material/AI questions, scheduling, accessibility and one prepared D-019 application touchpoint | Accepted care-team/provider routes furnish training, diagnosis information, facilitation and direct support. L2 performs verified nonclinical teaching/support; exact clinician supplies a protected medical/physical-technique/mental-health act. AI alone is not assumed accepted human service |
Programme operations supports the eight domains; it is not a ninth pillar. The detailed source SOPs—not this overview—control service content, evidence, authority and failure.
Full-service fulfillment boundary#
Proxi supplies the people/contracts required for its own promise. An independent PCP, hospital, pharmacy, payer or community provider still performs its own care/decision. If Proxi contracts that provider to fulfill a Proxi service, the work becomes paid contracted fulfillment with actual scope, capacity and evidence; it is not free because the actor directory calls it External party.
- Direct Proxi/contracted fulfillment: name the specific act and actual accepted employee/contractor, competence/licensure, subject/location/provider authority, modality, service area, hours/backup, payer and result. Actual field work/travel and availability are separately funded where not already included.
- Coordination-only around independent care: promise preparation, access, barriers, permitted communication and truthful follow-through. The outside organization furnishes the appointment, therapy, fitting, treatment or activity. A referral/order does not mean it occurred.
- Institutional accountability: the GUIDE Participant remains accountable under its actual Agreement. A retained/nondelegable signature or approval needs its controlling provision and accepted person/body; no abstract Participant family performs it and no free participant clinician/navigator is assumed.
The company may furnish clinical work through authorized paid professionals; Proxi software/AI may not perform their judgment. Staff in PH L1 and PR L2 remain nonclinical even if personally credentialed. Current approved instructions can be explained faithfully; new diagnosis, medical cause, urgency/safe waiting, prescribing/reconciliation, treatment, individualized clinical suitability, legal capacity or unsupported restriction is not theirs to decide.
Recommended enhanced service offer#
These are candidate additional-value priorities for owner selection, not activated commitments. First provide required GUIDE work well. Extra labels never gate or resell a required assessment, clinical response, caregiver service, accessible interaction, medication support, transition or referral. Detailed candidate acts and professional selection remain the source.
Before an optional enhancement becomes a promise#
O-052 needs the baseline interface and distinct incremental result; exact direct-furnished versus coordination-only mode; actual paid/accepted person and competence/clinical authority; area/hours/backup; payer; occurrence and low/ordinary/high incremental minutes/fees/travel/availability; agreed added cadence and burden; source/population/instrument fit; and truthful decline/non-success/withdrawal/return. D-027 Administrative Manager approves the actual company commitment; clinical/professional authorities approve their protected content, and O-066 supplies any required company signer.
Aligned patients may not be charged for GUIDE services. Calling covered work an enhancement does not create payment authority. Independent non-GUIDE care has its own actual lawful benefit/payer terms, not an assumed patient fee or duplicate claim. CMS FAQ supports this boundary. Nothing here changes respite's exclusion from Proxi delivery.
Priority 1: caregiver skill-in-use coaching#
Useful result: the caregiver safely tries one chosen practical strategy, corrects misunderstanding and decides whether it helped. LC and the nonclinical BD application belong in one pathway, not two overlapping contacts.
- Capture the caregiver's current situation, desired result, previous attempt and relevant existing professional instructions. Software presents approved choices; no L2 fit blessing for a clear choice.
- Prepare the selected lesson/action and actual missing or protected question. A new medical cause, clinical urgency, treatment or caregiver-own licensed-care question goes directly to its proper professional; required response remains base.
- The paid, topic-competent PR navigator performs the selected safe rehearsal/application, corrects the practical misunderstanding and agrees one home action/help route. It is not diagnosis or psychotherapy.
- At the agreed useful opportunity, collect tried/helped/not-tried/unknown and the caregiver's continue/change/stop choice. Digital clear feedback can be 0 new staff; actual coaching adaptation is paid.
What is additional: a selected repeated skill-in-use sequence beyond the already-required accepted education/support episode—not the required lesson/menu or unmet base need itself. Additional cadence, acceptance, event overlap and minutes remain O-052. The source caregiver episode bands are planning references, not free extra capacity. WHO iSupport supports selectable lesson/exercise design, not Proxi/AI efficacy or AI-only GUIDE completion.
Priority 2: targeted wandering preparedness#
Useful result: the family can find a current permitted response packet and follow the agreed steps in a safe rehearsal. This is not a promise to prevent wandering, locate the person, monitor GPS or guarantee rescue.
- Assemble attributable incidents, current photo/description, permitted contacts/likely places and the actual local response route; show source/date and unknowns.
- Software captures the person's choices and prepares approved identification/response materials. A lock, tracking disclosure, egress change, restriction or clinical cause question keeps its own actual qualified authority.
- The paid PR navigator conducts one selected hypothetical rehearsal, corrects contact/action confusion and records remaining help. No live disappearance or unsafe patient demonstration.
- Update only for actual changed facts or the agreed additional review; record plan access, rehearsal and later usefulness separately.
What is additional: a selected structured preparedness/rehearsal/update service after the required current safety plan is already supplied. If safety preparation is required by the person's base need, it remains base. Physical work/devices, legal authority, clinical work and public-safety response are not furnished by the packet; Proxi contracts and pays the actual provider if promising them. NIA design evidence and access limits do not authorize tracking/restrictions. Current missing-person help never waits for this extension.
Priority 3: meaningful activity that actually happens#
Useful result: the beneficiary chooses something enjoyable, gets past a real practical barrier, tries it and chooses continue/change/stop. Ordinary activity is not cognitive therapy or a claim to slow dementia.
- Capture interests/dislikes, desired company, practical constraints and applicable current instructions. Software prepares realistic options and accepts a clear person choice without a clinician gate.
- Resolve actual access: supported booking/information can be digital; L1 handles a manual fact/transaction and L2 only requested relationship/navigation help.
- Attribute the activity to who actually delivers it. The Daily Companion can support approved at-home routines under D-023; a community programme supplies its own activity. Neither is clinical therapy merely because a dementia goal is involved.
- Ask at a useful agreed time whether it was tried/enjoyed/burdensome and honor the person's next choice. An actual therapy or individualized safety question uses its exact qualified professional.
What is additional: a selected recurring participation/usefulness loop beyond the already-required goal/referral support. Proxi furnishes that defined support, not an uncontracted outside activity. Inventory quality, actual provider/access costs and added cadence/time need O-052. NICE's activity recommendation supports tailored preferences; its structured therapy/rehabilitation recommendations have distinct professional/population limits and do not prove Proxi efficacy.
Position of all twelve candidate groups#
| Group | Base that stays included | Distinct candidate result / delivery posture | Review |
|---|---|---|---|
| Longitudinal coaching | Required caregiver menu, training/application and support | Priority 1 repeated skill-in-use; paid L2 actual application/adaptation | |
| Behavior/distress | Assessment, actual cause/urgency/treatment and needed caregiver support | A module within priority 1 for approved response coaching; not separate duplicate clinical care | |
| Falls | Required risk/acute response/coordination | Actual additional professional intervention/field teaching only through funded qualified capacity; otherwise honest coordination | |
| Wandering | Current safety assessment/plan and immediate missing-person response | Priority 2 additional structured preparedness/rehearsal; no monitoring/rescue or restriction claim | |
| Hearing/vision | Accessible care and appropriate assessment/referral | Device-use/access follow-through; direct diagnosis/fitting requires actual contracted professional | |
| Medication use | Required reconciliation, instructions and practical support | Improve base execution first; only separately defined physical/support service can be extra, with actual funding | |
| Transitions | Required coordination, clinical response/reconciliation and practical return | Conditional next recovery pilot only for a truly additional accepted conversation/result; O-051/O-052 and clinical receiving capacity first | |
| Future planning | Required assessment/plan preferences and needed referral | Voluntary added readiness/document-follow-through; actual legal execution/medical orders remain their authors | |
| Activity/social connection | Goals, required referral and caregiver activity education | Priority 3 defined recurring participation support; outside programme/therapy delivery is separate | |
| Functional reablement | Required function assessment and ADL/IADL support/referral | Funded accepted OT/rehabilitation assessment, plan, teaching and reassessment if sold; otherwise coordination only | |
| Acute change/pain/delirium | Human access, actual urgency/clinical response and safe follow-through | Base quality—not an optional emergency or clinical-response product; additional education/reporting never replaces care | |
| Nutrition/swallowing | Required assessment, acute response, support and referral | Additional professional plan/teaching only with exact medical/dietetic/dental/SLP components and funding; otherwise coordination only |
Priority reflects concrete family results, controllable recurrent work and current paid capabilities—not votes, efficacy scores, task counts or measured ROI. Professional-heavy options can have substantial value; they need case-specific clinical fit and real provider terms. Do not delay a necessary base referral/response while waiting for an optional furnished-care contract. AHRQ RED is a clinical-staff discharge call; a nonclinical Proxi conversation plus separate licensed acts is an adaptation, not demonstrated RED equivalence.
Minimum practical workforce#
Use the canonical roster. One category can perform many permitted tasks; a coach, trainer, intake helper or quality lead is a function in that real job, not a new person.
| Actual category | Expected work | Limit | Review |
|---|---|---|---|
| Software/AI surfaces | Approved facts, choices/options, preparation, execution and tracking | No autonomous clinical/legal/unsupported authority decision | |
| Philippine L1 nurse/support | Nonclinical first answer, actual connection and administrative pursuit | No US clinical authority from the Philippine credential; manual work is paid and must fit actual coverage | |
| PR navigator | Qualifying contact, relationship, nonclinical assessment/planning, accepted teaching/coaching/support and assigned referral/release | $22 per scheduled paid hour under D-029; current certification/topic capability; no clinical cross-deployment | |
| US RN / behavioral clinician / dementia-proficient medical professional selected for the act | Actual nursing/psychosocial/medical assessment and judgment; necessary personal clinical collection; attributable decisions/instructions | No chart-hunting job or universal RN blessing. Regular RN alone is not the required E/M slot; nonphysician dementia-proficient clinician needs the additional part-time physician director | |
| Paid approved onsite/trainer/specialty contractor | The exact qualified contracted act and return | Proxi expense when fulfilling its promise; licence/method/capacity accepted before delivery | |
| Real enabling/corporate job | Billing/Revenue Cycle, Medicaid Program Specialist, HR/Workforce, System Administrator/Engineering, Administrative Manager or actual same-lane/clinical leadership/Legal work on its trigger | No Programme/Privacy/Quality/Data/Compliance case-worker category; no blanket review; no authority from access alone | |
| Independent outside endpoint | Its own record, treatment, dispensing, community service or official result | Its act is not automatically Proxi-furnished care or payroll; actual Proxi pursuit remains paid |
How clinical capacity should enter#
| Pattern | Actual examples and correct work | Review |
|---|---|---|
| Due clinical/professional act | The appropriate initial/annual clinical assessment, staging/synthesis, required prescribing-authority reconciliation or actual professional reassessment. Prepared records reduce administrative work; the professional performs necessary clinical history/examination and judgment | |
| New protected question | New symptom/acute change, medication conflict/dose question, treatment alternative, genuine therapy/safety suitability or caregiver-own licensed-care need. Identify the actual subject/current location, provider authority, exact question and accepting professional; no routine L1/L2/RN queue before the medical clinician | |
| Nonclinical matter | Clear ordinary preference or factual choice can proceed directly under approved rules; L1 obtains missing admin facts, L2 does actual required/requested human support. A fax-number error, ordinary choice or missing appointment status is not automatically clinical review; uncovered legal, billing, technical or workforce questions use their real jobs |
Current applicable professional products are reused only for the unchanged actual question. New/due/conflicting work is not waived. RN, behavioral, medical, pharmacy, therapy and legal conclusions have distinct authority; one title cannot sign every component. Human need, clinical need, service credit and payer qualification are different questions.
Workload and staffing model#
Use Human Workload, not 603 labels multiplied by handling time.
| Demand/cost occasion | What to account for | Review |
|---|---|---|
| Initial and annual | Actual assessment/plan/clinical/field/entry work, including pre-staging preparation once and annual role work actually inside the selected horizon | |
| Scheduled recurring | Current exposed tier/contact windows and accepted human/extra work; one shared interaction once | |
| Event-driven | Transition, clinical question, caregiver need, referral, failed handoff and actual corrected/partial work | |
| Standing availability | Actual staffed 24/7 clocks, relief/reserve/lead, interval/concurrency and clinical/caregiver receiving hours/backup—not active case minutes alone | |
| Back-office periodic | Actual shared, per-Participant, employee, claim, partner, variable/scale-step and incident work by real jobs |
Active role demand includes actual completed, partial, attempted/failed and correction work, with shared time once. Paid case capacity uses scheduled hours and accepted productive load; PR retains 160 hours/month at provisional 70% and D-029 pays every scheduled hour. PH standing coverage has its own declared hours/shrinkage/reserve; do not divide already-paid availability by utilization again. Different actual cost pools can have different cohorts/multiplicity.
Use explicit scenario assumptions until operating data exist, then replace them with actual exposure, occurrences, active prep/direct/own-record/follow-through, paid roster hours, hires/learning/shift overlap, receiving/field availability and real quote/payout units. Clinical incidence and extra capacity are not inferred from task counts. Unknown RCC caregiver terms, provider rates/retainers, programme scaling and field/extra fees remain unknown or unpriced, not 0. Neither a mathematical caseload nor low average call occupancy proves availability.
Settled operating points#
- Full non-respite GUIDE scope is settled under D-012. Necessary base work is not conditioned on an extra selection.
- Real actors, preparation before judgment, direct clear choices and scoped clinical/professional acts remain D-015/D-021/D-022. A function or unresolved family does not perform work.
- Paid Proxi/contractor work is separated from household choices and independent outside care. Count actual shared labor once, but retain distinct real service/clinical results.
- D-023 Companion prepares/helps/routes; it is not monitoring, human contact, clinical care, completed service or payment evidence. Cadence/activation remains O-061.
- Extra recommendations stay unselected under O-052. D-027 business approval does not confer a clinical/legal decision or O-066 signature.
- D-028 hybrid onsite delivery and D-029 scheduled-paid-hour basis remain; actual authority, Partner/Agreement/release/availability and quantitative inputs still need their own approval.
- Contacts require a useful person-specific purpose; use inbound/shared work and honor choice/stop. No billing-filler contact or minute quota.
Next owner choice is whether to prioritize the candidate extensions for actual scope/occurrence/capacity calibration. That choice does not activate a service or change the core obligations. The final whole-goal audit must separately verify every required GUIDE, customer-value and clinical-thinking statement against its actual source and current procedure.