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For CMS GUIDE Programs

Working care-navigation operations plus a proposed evidence layer for programs that need to know whether intended care was actually delivered.

Design-partner validation · not a live product claim

Start with one care pathway and one costly evidence question.

We propose linking versioned pathway rules to source records, surfacing supported, missing, contradictory, and indeterminate components, and requiring qualified human review. The compiler will be built only if programs validate the problem and a clinical-methodology partner approves the measurement approach.

Nine Required Domains

The CMS GUIDE Model requires nine care delivery domains. GentleNext tracks workflows across all nine today. Maturity labels below are honest about what ships versus what still needs partner validation.

Comprehensive Assessment

In product

Built-in caregiver-burden (ZBI) and dementia-staging (CDR/FAST) assessments, plus guided intake flows.

Care Planning

In product

Person-centered plans with 'Next Step' family views after navigator publish.

24/7 Access

In product

Human-staffed helpline routing and escalation. Programs attest the helpline is human-staffed; AI does not resolve urgent contacts.

Ongoing Monitoring

In product

Tier-based cadence tracking, overdue flags, and home-visit status on the caseload.

Care Coordination

In product

Secure messaging and task management between navigator and family.

Respite

In product

Tracks respite utilization against the annual benefit cap and records G-codes on utilization.

Medication Management

In product

Flags high-risk medication names from a curated token list and supports visit-level reconciliation. Not a full Beers-criteria engine.

Caregiver Education

In product

Navigator-delivered support and training-domain coverage in navigator CE / training records.

Social Needs

In product

Standardized HRSN screening with community resource referral, including semantic resource search.

Built to validate before scaling

The first engagement should be an 8–12 week paid design-partner pilot, not a platform replacement. Our tenant-scoped architecture can support later expansion, but PHI work remains blocked until required agreements, controls, and partner approvals are complete.

Interoperability

SMART-on-FHIR import/export is scaffolded in the platform and ready for partner sandbox validation. Initial pilots can operate standalone or with CSV-based data import. Bulk reporting export for CMS is available from the navigator reports surface.