Business Growth Roadmap

A clear, outcomes‑first path to value with AI and data—built for healthcare and adaptable to other industries. We blend human expertise, deterministic rules, and LLMs under strong governance to deliver results that stick.

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Who this is for

  • Healthcare providers & imaging centers
    Prior auth readiness, denial reduction, operational efficiency (PET/CT, MR, oncology workflows).
  • Payers & TPAs
    Policy‑aware automation, FWA analytics, explainable decisioning.
  • Other industries
    Finance, public sector, manufacturing—where compliance, reliability, and scale matter.

Roadmap at a glance

0

Align & Frame Value (1 week)

Clarify business goals, constraints, and success metrics. Define PHI/PII boundaries and data access model.

  • Deliverables: Value hypothesis, KPI baseline plan, risk & compliance checklist.
1

Data & Compliance Readiness (2–3 weeks)

Map data sources; set up secure access; validate ICD‑10, CPT/HCPCS, payer policies (healthcare) or domain equivalents.

  • Deliverables: Data catalog, policy table (versioned), security plan (HIPAA/BAA, SOC2/ISO as applicable).
2

Prototype: Rules + LLM (2–4 weeks)

Build a guardrailed assistant that pairs deterministic rules with LLM drafting for human‑in‑the‑loop decisions.

  • Deliverables: Web form or API, header/decision engine, prompt templates, audit logging.
3

Pilot & Measurement (4–6 weeks)

Run with real users. Measure denial rate, time‑to‑scan/order, rework, and user satisfaction.

  • Deliverables: KPI dashboard, error analysis, user feedback loop, go/no‑go criteria.
4

Production & MLOps (4–8 weeks)

Harden the stack: CI/CD, model/Prompt registry, policy updates, monitoring, rollbacks, and documentation.

  • Deliverables: Prod deployment, runbooks, governance pack, SLA/SLOs, incident playbooks.
5

Scale & Enablement (ongoing)

Extend to new sites, service lines, or business units. Train staff and embed change that sticks.

  • Deliverables: Training, playbooks, expansion roadmap, quarterly value reviews.

What “good” looks like

  • Measurable impact: Denials ↓ 50–70% (target), faster throughput, fewer resubmissions.
  • Explainability: Every recommendation has a rationale and policy reference.
  • Compliance by design: PHI minimization, tiered access, immutable audit trails.

Reference architecture

  • Frontend
    Jekyll/Next.js; form UX; role‑based access; ADA/WCAG.
  • Services
    FastAPI/Firebase Functions; rules engine; LLM with guardrails; PDF/EMR export.
  • MLOps/Gov
    GitHub Actions CI/CD; registry & prompts; monitoring; policy versioning; logs & lineage.
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