Case study

Four specialty programs on one routing architecture

Put four specialty-care programs — Surgery, everyday urgent care, Behavioral Health, and Oncology — on one shared system instead of four custom ones, so a nurse and a navigator worked from the same facts and every case had someone whose job it was to own it.

Transcarent care navigation app — public app store visual — Transcarent public app visual for care-navigation context.

Four specialty-care programs launched on one shared architecture.

Context

High-acuity specialty cases (Surgery, Oncology, Behavioral Health) were stalling in exception queues, limiting how fast programs could deploy across employer partners. The challenge was scaling four clinical domains at once — each with different protocols, benefit structures, and partner integrations — without building four separate products. 1

The decision

Built shared decision infrastructure instead of per-program products: a unified, role-based responsibility model that tied routing rules to clinical accountability, letting four programs scale on one architecture. The tradeoff was explicit — slower to build, faster to scale.

Four programs, one routing architecture
Program	Acuity and protocol	Partner integration	What the shared routing decides
Surgery	High-acuity; its own protocols, benefit structure, and compliance requirements	—	Which clinical role owns the case, and when an exception escalates
Oncology	High-acuity; its own protocols, benefit structure, and compliance requirements	Healthwise content in CancerCare v1; second opinion handed off to Nurse Ally through Consumer Medical	Which clinical role owns the case, and when an exception escalates
Behavioral Health	High-acuity; its own protocols, benefit structure, and compliance requirements	—	Which clinical role owns the case, and when an exception escalates
Everyday urgent care	Everyday acuity; its own protocols, benefit structure, and compliance requirements	—	Which clinical role owns the case, and when an exception escalates

The routing column is the same in every row on purpose: one rule set, tied to clinical accountability, was the decision.

What happened

Designed unified member records and tied routing rules to clinical roles, with exception handling and escalation protocols behind them. Led the Cancer & Decision Support pod: shipped CancerCare v1, a symptom-checking triage tool with Healthwise content integration and an in-app second-opinion experience with automated handoff to Nurse Ally through Consumer Medical. The tool inferred a care pathway from reported symptoms, including pediatrics, and handed off to a clinical role rather than terminating; operational dashboards monitored exceptions in real time.

Four specialty-care programs launched on shared infrastructure. Routing-related delays dropped as a primary bottleneck, and operational variance between the highest- and lowest-performing service lines narrowed. 1

Specialty cases at Transcarent before routing was tied to clinical accountability. The queue was not a backlog to be worked down — it was the absence of a rule saying whose case this now was. The same path after the change is below.

After: the same case, with ownership explicit at every decision point. The rule does not decide the medicine. It decides whose case this is — the question the queue never answered. One architecture then carried all four programs.

The shared decision architecture, drawn from the case study rather than from a surviving document: four programs with four sets of protocols enter one routing layer, and the layer's job is to assign the case to a clinical role. The alternative on the table was four products, one per lane. The record beneath is what let a nurse and a navigator see the same case.

What I’d keep

Assigning responsibility at every decision point is what let this scale. At Andwise, I carried that accountability pattern into a founder role and learned that building the product is necessary but insufficient.

Sources

1 Oncology Care launch

Transcarent launched Oncology Care during this specialty-care product period.

Public program context for Oncology Care.

BusinessWire