Trilogy Care Portal : CMA- 2. Plan - PRD

Care Management Activities - Data-Triggered Communications System

Scope note: This PRD covers the Portal features and integrations needed to achieve Support at Home (SAH) compliance through automated, data-triggered care management communications with human-in-the-loop oversight.
Post-November GenAI personalisation of messages and SMS are explicitly out of scope for MVP.

Document Information


Field	Entry
Document Status	Handover to Dev: 07 Oct 2025
Jira ID	TP-1880 - [CMA] CM Activities [TP-1880] To Do
Internal / SharePoint Links	https://miro.com/welcomeonboard/czZhaUNXWlRHeUVmemVjL0ZMNTVNYlUxcWMzbHc3a3hjT2xsRHoxRUNKY1R3OWc3Sm5mS3EveHVhMHViWGRCNk9abzVTZy9XcWtPTFZOVk9SaGs4cXpsSFNhcm1RVUxMNXRERFpnZ3IzQWVYQlhTeDZScFlNMExrbWpud1lSQmh0R2lncW1vRmFBVnlLcVJzTmdFdlNRPT0hdjE=?share_link_id=726269574778
Document Owner	Romy
Designer	Beth
Tech Lead	Matt
QA	TBD
Target Release	1 November 2025 for SAH readiness

Executive Summary

We will build a data-triggered care management communication system that automatically identifies clients requiring outreach and generates draft communications for care partner approval. The system addresses the reality of our self-management model where natural monthly contact doesn’t occur with all clients, whilst ensuring SAH compliance through proactive, intelligent engagement.

Key Components:

Databricks Integration - Receives data triggers and generates draft communications
Portal Alert Dashboard - Surfaces client alerts to care partners for review/action
Multi-channel Communications - Email and SMS delivery options
Activity Logging - Auto-captures all communications as care management activities
Human Oversight - Care partners review, edit, and approve all communications

Regulatory Context & Business Requirements

Direct Care Management Requirements

Per Support at Home program manual and business rules ( Page 90 of Program Manual V3 )

When the CMA’s occur AND they are meet the minimum requirement AND evidence is collated, THEN claims for funding are possible.

CMA Definition: Direct communication with participant and/or registered supporter about care-related matters
CMA Minimum Requirement: At least one direct care management activity per client each month (minimum 15 minutes)
Evidence: Must be documented in care notes with purpose, duration, origin, and timestamp
Claims: Submitted in arrears, itemised by participant/date in 15-minute increments
Calculation of care management funding will be based on:
- Care management funding = care management quarterly base rate + care management quarterly supplement.
- Care management quarterly base rate = 10% from each participant’s ongoing quarterly budget.
- Care management quarterly supplement = 12 hours of care management divided by 4 quarters multiplied at the hourly rate of $120 (subject to indexation revisions).
- Funding: Billed at $120/hour from pooled 10% of quarterly budget

Self-Management Model Challenge

Unlike traditional providers, our self-management model empowers consumers to operate independently. However, this means we don’t naturally have monthly direct contact with all clients, creating compliance risk whilst delivering on our value proposition of reduced management fees and increased client autonomy.

Solution Approach

Intelligent, data-triggered communications that:

Identify clients requiring care management attention through data analysis
Generate contextually relevant draft communications
Maintain human oversight and personalisation
Provide multi-channel delivery (email/SMS) based on client preference
Automatically log activities for compliance evidence

Solution Overview

1. Data Integration Layer (Databricks)

Data Sources:

CRM Incident Data: Falls, health episodes, service disruptions, complaints
Budget/Utilisation Analytics: Underspend patterns, service gaps, payment issues
Service Delivery Metrics: Provider cancellations, unused services, quality concerns
Risk Indicators: Hospital admissions, medication reviews, safety assessments

Processing Logic:

Fortnightly batch analysis of client data against trigger criteria
Template selection based on client situation and communication history
Queue management with care partner assignment

2. Portal Alert Dashboard

Features:

Client alert queue by care partner
Trigger reason and recommended action
Draft communication preview
One-click approve/edit/reject functionality

3. Communication Templates (MVP - 4 Scenarios)

https://trilogycare.atlassian.net/wiki/x/EYDtGw

Task name (appears on dashboard)	Data Source	Template Example	Due date	Expiry Date
Service Gap Analysis and Budget Review	Budgets v2 + Invoice data	"Hi [Name], we notice your gardening service hasn't commenced. Would you like support organising this?"	Initially the 20th of month, but then updated to the Initial date plus the number of days snoozed. No later that last day of month	Last day of month. Once the last day of the month has passed, the alert expires and this needs to be captured in a report.
Incident Follow-up	Incident reports (CRM) + Funding streams	"Following your recent fall, you may be eligible for restorative care pathway funding..."
Well-being check -in (aka Vulnerability Monitoring (social isolation and/or risk of homelessness)	ACAT/IAT data scrape OR Portal needs/risks	"Hello [Name], as your care partner, I like to check in regularly about all aspects of your wellbeing, including staying socially connected. Are you finding enough opportunities to chat with friends, family, or neighbours? If you'd enjoy more social contact, I have some lovely options I could share with you..”
Spending Alert	Budget utilisation + Package funding	"Your current spending suggests a care plan review would be beneficial to review your package level funding..." (Template need to be sent to Beth, Romy Blacklaw )
Care Management Activity needed		This is a catch-all template to contact clients.

4. Multi-Channel Delivery

Email Delivery:

Delivery confirmation and bounce handling

SMS Delivery (Future requirement):

Client preference detection and routing
Character limit optimisation
Delivery status tracking
Same automatic logging as email

5. Activity Logging and Compliance

Automatic Documentation:

Creates care note with trigger reason, communication sent, and timestamp
Pre-populates 15-minute care management activity entry
Links to original data trigger for audit trail
Flags for care partner confirmation/completion

Technical Architecture

Data Flow

Interval Batch Processing (Databricks)
- Analyse client data against trigger rules
- Generate priority alerts and draft communications
- Push alerts to Portal via API
Portal Processing
- Receive alerts and queue by care partner
- Present dashboard with review/action options
- Handle care partner approvals and edits
Communication Delivery
- Route to email/SMS based on client preference
- Send approved communications
- Capture delivery confirmations
Activity Logging
- Auto-create care management notes
- Update compliance dashboard
- Prepare data for claims processing

Key Integrations

Databricks API: Trigger data and template generation
Portal Backend: Alert management and approval workflow
Email Service: Branded communication delivery
SMS Gateway: Multi-channel messaging capability
CRM Integration: Incident data and client preferences
Care Notes System: Activity logging and compliance evidence

User Stories (with MoSCoW prioritisation)

https://trilogycare.atlassian.net/browse/TP-1880

The working document with a matrix of CMAs is saved here:

https://trilogycare.sharepoint.com/:x:/s/SupportatHomeProgram/ETMgqvSQDjNNheqrH33p7ZgBXQnZxB2Qj_AcZDh3H64ySA?e=iLpS3F

Success Metrics

Compliance Metrics

100% Monthly Coverage: All active clients receive ≥1 direct CM activity per month
Documentation Completeness: 100% of activities logged with required evidence
Claims Accuracy: Zero compliance issues in Services Australia audits

Operational Metrics

Alert Processing Time: <2 hours from trigger to care partner action
Communication Approval Rate: >85% of generated communications approved
Multi-channel Delivery: >95% successful delivery rate (email/SMS combined)
Care Partner Efficiency: 50% reduction in manual outreach identification time

Quality Metrics

Client Satisfaction: Positive feedback on proactive communication relevance
Escalation Rate: <10% of automated communications require urgent follow-up
False Positive Rate: <15% of alerts deemed irrelevant by care partners

Implementation Timeline


Phase	Deliverable	Owner	Timeline	Notes
Phase 1	Databricks integration and trigger rules	Data/Dev	Aug 15 - Sep 15	4 trigger scenarios, API development
Phase 2	Portal alert dashboard and workflow	Dev/UX	Sep 1 - Sep 30	Care partner interface, approval workflow
Phase 3	Communication templates and delivery	Dev	Sep 15 - Oct 15	Email/SMS integration, logging system
Phase 4	Testing and compliance validation	QA/Ops	Oct 1 - Oct 25	End-to-end testing, audit preparation
Phase 5	Training and go-live	Ops	Oct 26 - Nov 1	Staff training, production deployment

Risk Mitigation

Technical Risks

Integration Complexity: Phased approach with fallback to manual processes
Data Quality: Validation rules and alert quality monitoring
Performance: Load testing and scalable architecture design

Operational Risks

Staff Adoption: Comprehensive training and change management support
Client Acceptance: Opt-out mechanisms and feedback collection
Compliance Gaps: Robust audit trails and monitoring dashboards

Quality Risks

Over-communication: Frequency caps and client preference respect
Irrelevant Alerts: Trigger rule refinement and feedback loops
Human Oversight: Mandatory approval processes and quality checks

Post-MVP Evolution

November 2025+ GenAI Enhancement

AI-personalised communication drafting with confidence scoring
Dynamic template optimisation based on client response patterns
Predictive trigger refinement using machine learning
Advanced natural language generation for contextual communications

Extended Capabilities

Integration with wearable devices and smart home sensors
Proactive care plan updates based on communication outcomes
Family/carer notification workflows
Advanced analytics and outcome prediction
Add further templates (in addition to the 4 above) after MVP - Sept 24th meeting

Assumptions & Dependencies

Databricks Platform: Available and configured for real-time trigger processing
Client Communication Preferences: Data available and current in CRM
Portal Infrastructure: Sufficient capacity for alert dashboard and workflows
Email/SMS Services: Reliable delivery partners with appropriate SLAs
Staff Training: Adequate time allocation for change management and adoption
Regulatory Stability: No major changes to SAH requirements during implementation
Assume that Care Circle contacts are up to date and that all of the contacts in portal, related to a package are up to date. Therefore we have a structured way of having all contacts connected.

Notes

Sept 15th mention - This must be functioning by 3rd week of November at the very latest.

Sept 24th meeting - In this CCU meeting - https://app.fireflies.ai/live/01K5AK3CQRB1RZME87DD12WHAT?ref=copied the team discussed the need to have the Care Circle contacts up to date.
Future requirements collated here: https://trilogycare.atlassian.net/wiki/spaces/TC/pages/572391460/CMA2+-+With+AI+generated+communications?atlOrigin=eyJpIjoiMzdiMDI0ODY2ZDVjNGJjOWEyYTBkZDUzYjE0ZjVkOWMiLCJwIjoiYyJ9

old CMA 2. Plan PRD 492470275