Project Overview

Business Context

Industry Background

CareHub operates in the California Workers' Compensation mental health space, providing psychological evaluation and therapy services to injured workers. This is a regulated industry governed by:

• California Labor Code 3208.3 (psychiatric injury claims)
• Division of Workers' Compensation (DWC) requirements
• Medical Provider Network (MPN) regulations

Market Gap (from Kaiser Legal Consultant Analysis)

Key vendor gaps identified:

1. Causation analysis - Clinicians need to document industrial vs. non-industrial causation percentages
2. MMI (Maximum Medical Improvement) tracking - Claims adjusters need clear MMI documentation
3. Compliance reporting - Standardized reports for claims processing
4. Integrated care coordination - End-to-end case management

Business Model

• B2B: Contracts with claims administrators, TPAs, employers
• Per-case pricing: Revenue tied to case volume and session counts
• Value proposition: Faster claims resolution through better documentation and compliance

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Objectives

Primary Goals

1. Streamline Case Management

   • Reduce time from referral to first session
   • Automate administrative tasks
   • Centralize case information

2. Improve Clinical Documentation

   • AI-assisted session notes
   • Standardized care plans
   • Automated document generation

3. Ensure Compliance

   • Causation analysis workflow
   • MMI tracking
   • Audit-ready documentation

4. Enhance Member Engagement

   • Easy intake process
   • Progress tracking
   • Appointment reminders

Success Metrics

Metric	Target
Time to first session	< 7 days from referral
Intake completion rate	> 90%
Session documentation time	< 10 minutes
Member check-in compliance	> 70% weekly
Document generation automation	> 95%

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Stakeholders

Internal Users

Role	Primary Needs
Care Coordinator	Case visibility, staff assignment, member communication
Psychologist	Evaluation tools, AI summaries, care plan builder
LPCC	Session management, progress tracking, authorization monitoring
System Admin	User management, reporting, configuration

External Users

Role	Primary Needs
Member (Injured Worker)	Easy intake, appointment visibility, progress tracking
Claims Adjuster	Compliance reports, causation analysis, MMI documentation

Integration Partners

Partner	Purpose
Twilio	SMS notifications
SendGrid	Email notifications
OpenAI/Claude	AI analysis
Calendar Systems	Appointment sync (future)

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Constraints

Regulatory

• HIPAA Compliance required for all PHI handling
• California Privacy Laws (CCPA)
• DWC Documentation Requirements

Technical

• Must support mobile access for Members
• High availability during business hours (PT)
• Data retention per CA regulations (minimum 5 years)

Business

• Budget constraints favor managed services
• Small team requires maintainability
• Rapid iteration needed for compliance changes

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Domain Terminology

Term	Definition
BH	Behavioral Health
Causation	Determination of industrial vs. non-industrial factors
DFR	Daily Focus Report
GAF	Global Assessment of Functioning (1-100 scale)
LPCC	Licensed Professional Clinical Counselor
MMI	Maximum Medical Improvement
MPN	Medical Provider Network
PHI	Protected Health Information
PR-2	Progress Report (per session)
PR-4	Discharge Report
RFA	Request for Authorization
RTW	Return to Work
TPA	Third Party Administrator
WC	Workers' Compensation
WPI	Whole Person Impairment

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Claim Types

Physical-Mental (Compensable Consequence)

• Member has compensable physical injury
• Psychological condition is consequence of physical injury
• Example: Depression following severe back injury
• Less stringent proof requirements

Mental-Mental (Pure Psyche)

• Psychological injury from workplace stress
• Requires 6 months employment (with exceptions)
• Subject to Rolda analysis for personnel actions
• Must prove 51%+ industrial causation

Mental-Physical

• Psychological condition causing physical symptoms
• Less common, similar requirements to Mental-Mental

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Compliance Requirements Summary

For All Claims

1. Intake Documentation

   • Comprehensive history
   • PHQ-9 / GAD-7 screening
   • Employment history
   • Non-industrial stressors

2. Session Documentation

   • PR-2 after each session
   • Progress notes
   • Treatment plan updates

3. Discharge Documentation

   • Final GAF
   • Treatment summary
   • MMI determination
   • Work status

For Mental-Mental Claims

1. 6-Month Employment verification
2. Personnel Action Analysis (Rolda)
3. Causation Breakdown
   • Pre-existing impairment %
   • Non-industrial factors %
   • Personnel actions %
   • Work exposure %
4. 51% Industrial Threshold

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Project History

Key Dates

• 2025-12-06: Blaze implementation began
• 2025-12-07: Phase 1 (Foundation Tables) completed
• 2025-12-09: Phase 3 (Intake Form) styling completed
• 2025-12-14: Phase 3 restructure completed (12→19 steps)
• 2025-12-17: Phase 10 (Causation/Compliance) requirements added
• 2025-12-22: Industry context from Kaiser consultation added
• 2025-12-23: Decision to pivot to Next.js + Azure

Lessons Learned from Blaze

1. Low-code limitations: Complex forms and workflows are tedious
2. UI configuration overhead: Too many clicks for simple changes
3. Automation constraints: Limited workflow capabilities
4. Testing challenges: Hard to iterate quickly

Decisions for Next.js Build

1. Full control over UI/UX
2. Direct database access
3. Custom workflow engine
4. Easier AI integration
5. Faster development cycles