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Organization
Transcarent
Period
2021–2022
Decided by
Accountability
Case study
4 of 5
Pressure
High-complexity cases in Surgery, Oncology, and Behavioral Health were getting stuck in exception queues.

Four care programs, one system, and an owner for every case

I put four specialty-care programs (Surgery, Everyday Urgent Care, Behavioral Health, and Oncology Care) on one shared system instead of four custom ones, so nurses and navigators worked from the same facts and every case had a named owner.

With clinical leaders, nursing operations, and two product managers across four specialty-care programs

Surgery high-complexity own protocols Oncology high-complexity own protocols Behavioral Health high-complexity own protocols Urgent care lower-complexity own protocols four programs, one architecture Shared routing role-based routing rules tied to who owns the case every case goes to a named clinical role Unified member record nurse and navigator working from the same facts Behind it exception handling · escalation protocols · real-time exception dashboards Surgery high-complexity own protocols Oncology high-complexity own protocols Behavioral Health high-complexity own protocols Urgent care lower-complexity own protocols four programs, one architecture Shared routing role-based routing rules tied to who owns the case every case goes to a named clinical role Unified member record nurse and navigator working from the same facts Behind it exception handling · escalation protocols · real-time exception dashboards
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 assigns each 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.

Four clinical domains, each with its own rules

The stalled cases limited how fast Transcarent’s Care Experiences programs could deploy across employer partners. I had to scale four clinical domains at once, each with different protocols, benefit structures, and partner integrations, without building four separate products. 1 2

One architecture or four products

My part

Director of Product, Care Experiences — an early product hire

  • Designed the shared system that assigns each case to a clinical role across four care programs.
  • Led product strategy and cross-functional delivery for the programs, managing two product managers.
The call
One shared system for four care programs, with a named clinical owner for every case.
Result
Four programs launched on one shared system.

Four care programs, one system, and an owner for every case · Kanav Jain · kanav.net

I built one shared system instead of a product per program: one member record, and one set of rules that assigned every case to a clinical role.

A product per program Not chosen

Four builds, one per specialty, each carrying its own protocols, benefit structures, and partner integrations. That would have shipped the first program soonest, and never made the clinical teams agree on who owned a case.

One shared system for all four programs Chosen

A unified member record and one rule set under all four programs. Slower to stand up, and forces four clinical teams to agree on who is responsible for a case at each step.

I stated the trade up front: slower to build, faster to scale.

Four programs, one shared system
ProgramComplexity and protocolPartner integrationWhat the shared system decides
Surgery High-complexity; its own protocols, benefit structure, and compliance requirements — Which clinical role owns the case, and when an exception escalates
Oncology High-complexity; its own protocols, benefit structure, and compliance requirements Healthwise clinical content in CancerCare v1; second opinions handed to the nurse line through the vendor ConsumerMedical Which clinical role owns the case, and when an exception escalates
Behavioral Health High-complexity; its own protocols, benefit structure, and compliance requirements — Which clinical role owns the case, and when an exception escalates
Everyday Urgent Care Lower-complexity, unlike the three above; its own protocols, benefit structure, and compliance requirements — Which clinical role owns the case, and when an exception escalates
The routing column is identical in every row: one rule set, tied to clinical roles, served all four programs.

Shared records, routing rules, and a triage tool

I designed shared member records and tied routing rules to clinical roles, with exception handling and escalation behind them. I also led the Cancer & Decision Support pod, which shipped CancerCare v1: a symptom-checking triage tool with Healthwise content and an in-app second-opinion flow that handed off automatically to the nurse line through ConsumerMedical. It inferred a care pathway from reported symptoms for adults and children, and every path ended with a named clinical role, not with the tool; dashboards showed exceptions as they happened.

× the owning role High-complexity case Surgery, Oncology, Behavioral Health Exception queue where the case stalls × the owning role High-complexity caseSurgery, Oncology, Behavioral Health Exception queuewhere the case stalls
Specialty cases at Transcarent before case ownership was tied to clinical roles. Cases stalled because no rule said whose case each one now was. The count was never the problem.
High-complexity case Surgery, Oncology, Behavioral Health Routing rule tied to a clinical role Named clinical role owns this case High-complexity caseSurgery, Oncology, Behavioral Health Routing ruletied to a clinical role Named clinical roleowns this case
After: the same case, with a named owner at every decision point. The rule makes no clinical decision; it assigns the case to a clinical role. One architecture then carried all four programs.

What happened to routing delays

Four care programs launched on shared infrastructure. Routing delays stopped being the primary bottleneck, and the gap between the best and worst service lines narrowed.

What I’d keep

One system can carry many programs once every decision point has a named owner.

Shared case ownership is the Epic escalation path at a larger scale. There, one route carried regulatory changes; here, every case in four programs had a named owner. I carried the pattern into Andwise as a founder, and learned there that a product physicians sign up for still does not settle who will pay for it.

Sources

Show sources and citations Hide sources 2 cited sources

1 Care Experiences lineup

Transcarent’s Care Experiences line comprised four programs in 2022: Everyday and Rx, MSK and Surgery, Oncology, and Behavioral Health.

The Care Experiences page as captured 8 August 2022, naming the four programs and linking each. The live page has since changed to a different lineup.

Internet Archive

2 Oncology Care launch

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

The launch announcement, on BusinessWire.

BusinessWire archived

Operating and project records

  • The four programs running on one shared system
  • The drop in routing delays and the narrowing between service lines

Public announcements document the Care Experiences lineup and Oncology Care launch; program routing and operational outcomes reflect internal platform metrics.

Next step

Advisory and fractional product leadership for healthcare and AI ventures, and founding partnerships with a co-founder or backer who runs sales and distribution. I take software from initial demo through hospital IT approval, clinical sign-off, and operational deployment.

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