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Outcomes
A shared scorecard across revenue, efficiency, clinical adoption, and compliance — reviewed at pilot checkpoints and carried forward when you scale. Every KPI links to a live dashboard or evidence surface so sponsors can verify, not just read.
Scorecard
Typical baselines reflect industry bands; ARKA targets are co-defined at pilot kickoff. Modeled economics are labeled honestly until your cohort produces measured trend.
| KPI | Definition | Typical baseline | ARKA target | Reported via |
|---|---|---|---|---|
| Advanced-imaging denial rate | Share of advanced-imaging PA requests or claims initially denied on medical-necessity or documentation grounds for the scoped cohort. | 20–40% | Material reduction vs. rev-cycle baseline on scoped service line / payer (pilot); modeled pre-contract in ROI narrative | INS ROI dashboard |
| First-pass clean-claim rate | Claims paid on first submission without denial, rework, or appeal for advanced imaging tied to the pilot population. | 75–85% on high-cost imaging | Material improvement vs. baseline on scoped cohort | INS ROI dashboard |
| Recovered revenue ($/yr) | Annualized dollars from fewer denials, faster clean pays, and avoided appeal labor — conservative modeled estimate until live cohort matures. | Varies by volume and denial mix | Positive modeled ROI at conservative assumptions; validated against pilot cohort trend | INS ROI dashboard |
| KPI | Definition | Typical baseline | ARKA target | Reported via |
|---|---|---|---|---|
| Auto-clear rate (orders never queued) | Orders that pass in-flow appropriateness and payer-side checks without entering the manual reviewer queue. | 0% | 35–40% of clearly appropriate orders auto-cleared | INS payer dashboard |
| Prior-auth turnaround time | Elapsed time from PA submission to disposition, compared against CMS-0057-F expedited (72h) and standard (7 calendar days) SLAs. | Manual queue; often beyond CMS SLAs | Within simulated CMS-0057-F decision windows (72h expedited / 7 calendar days standard) | INS reviewer queue |
| Rework touches per denied claim | Average staff touches (resubmit, appeal draft, peer-to-peer) required to resolve a denied advanced-imaging claim. | 2–4 touches per denied claim | Reduction vs. baseline through upstream appropriateness and specific denial reasons | INS ROI dashboard |
| KPI | Definition | Typical baseline | ARKA target | Reported via |
|---|---|---|---|---|
| Clinician clicks added | Net new in-workflow clicks attributable to ARKA CDS cards — measured against zero-added-workflow design intent. | N/A — design target is zero added workflow | 0 — silent unless a guideline fires | CDS Hooks demo |
| Guideline-concordant order rate | Share of orders whose AIIE appropriateness score aligns with first-party evidence registry guidance for the clinical scenario. | Varies by service line; often suboptimal without in-flow CDS | Improvement vs. baseline on scoped cohort; tracked against evidence-backed thresholds | Evidence library |
| Override / feedback rate | Share of CDS card deliveries where the ordering clinician accepts, dismisses, or overrides the recommendation — conformance and adoption signal. | N/A without in-flow CDS | Low override on high-confidence appropriate orders; feedback captured for model governance | CDS validation dashboard |
| KPI | Definition | Typical baseline | ARKA target | Reported via |
|---|---|---|---|---|
| CMS-0057-F decision-time conformance | Share of PA decisions completed within expedited (72h) and standard (7 calendar days) timelines per the final rule. | Often below target without automation | ≥95% within simulated SLA for scoped volume (demo conformance checks) | CMS-0057-F matrix |
| Specific-denial-reason completeness | Denials that cite AIIE-aligned, non-boilerplate reasons tied to documented clinical factors — required for appeal readiness and public reporting. | Frequently generic or incomplete | 100% specific reasons on ARKA-routed denials in pilot cohort | CDS validation dashboard |
Patient safety
Harm prevention is implicit in appropriateness and turnaround KPIs — here is how quality leaders connect revenue metrics to radiation stewardship, time-to-diagnosis, and QI signal.
Guideline-concordant CDS at order entry defers or redirects studies that add radiation, contrast, or incidental findings without clinical benefit — the same appropriateness KPI tracked on this scorecard.
Evidence libraryPediatric radiation stewardshipConservative care before imagingPregnancy & contrast selection
In-flow scoring keeps order entry fast; upstream documentation and auto-clear reduce queue time so indicated studies reach the modality sooner — measured latency on retrospective evaluation, turnaround targets modeled against CMS-0057-F SLAs.
ARKA is silent when no guideline fires, cannot place, cancel, or block orders, and explicitly excludes time-critical alerts and triage from intended use — if ARKA is unreachable, the EHR proceeds exactly as before.
Trust center — intended useModel limitationsImplementation rollback
Anonymized near-miss cards show where ARKA surfaced a likely denial or low-value order before it shipped — feeding monthly QI review alongside override/feedback KPIs during pilots.
Appropriateness at order entry reduces low-value radiation and contrast exposure (Evidence Library–cited); faster authorization shortens time-to-diagnosis on measured in-flow latency and modeled PA turnaround; non-blocking CDS cannot delay emergent care; and the near-miss library turns denial patterns into QI signal. See the patient-safety case on Outcomes for evidence links and provenance labels.
Governance
Time horizons, meeting cadence, and mutual obligations — who owns measurement, who acts on thresholds, and what each checkpoint produces.
| Horizon | Cadence | Owner | Content | Exit / deliverable |
|---|---|---|---|---|
| Days 0–90 (pilot) | Weekly readout | ARKA implementation engineer + your champion + rev-cycle lead | Pilot scorecard KPIs (co-signed before day 1), card volume/override review, issue log | Go/no-go against the co-signed success threshold; miss → month 1 of production free (existing guarantee) |
| Months 4–6 | Monthly ops review | ARKA CS + service-line + UM | KPI trend vs baseline, threshold tuning, expansion candidates (modalities/departments), payer-mix analysis | 6-month milestone report to the executive sponsor — a written document, not a meeting |
| Ongoing | Quarterly Business Review (QBR) | ARKA leadership + CMIO/CFO sponsors | Measured ROI vs the modeled case (variance shown explicitly, both directions), roadmap, model/rule-library change log review, subgroup/fairness monitoring summary, renewal economics | Published QBR minutes + next-quarter targets |
QBR agenda template available in the vendor portal (docs/customer-success/QBR_AGENDA_TEMPLATE.md) — 60-minute structure with measured-vs-modeled variance, change-control review, and action-with-owners format.
Pilot success is not implied by this framework alone — it is defined jointly up front on the metrics you select from this scorecard. Defined jointly up front; if the pilot misses it, month 1 of production is free (existing guarantee). See pilot success contract
Forward to sponsors
Every KPI, definition, and reporting surface — formatted for CFO, CMIO, and UM reviewers you can CC on one email.
Outcomes
A shared scorecard across revenue, efficiency, clinical adoption, and compliance — reviewed at pilot checkpoints and carried forward when you scale. Every KPI links to a live dashboard or evidence surface so sponsors can verify, not just read.
Scorecard
Typical baselines reflect industry bands; ARKA targets are co-defined at pilot kickoff. Modeled economics are labeled honestly until your cohort produces measured trend.
| KPI | Definition | Typical baseline | ARKA target | Reported via |
|---|---|---|---|---|
| Advanced-imaging denial rate | Share of advanced-imaging PA requests or claims initially denied on medical-necessity or documentation grounds for the scoped cohort. | 20–40% | Material reduction vs. rev-cycle baseline on scoped service line / payer (pilot); modeled pre-contract in ROI narrative | INS ROI dashboard |
| First-pass clean-claim rate | Claims paid on first submission without denial, rework, or appeal for advanced imaging tied to the pilot population. | 75–85% on high-cost imaging | Material improvement vs. baseline on scoped cohort | INS ROI dashboard |
| Recovered revenue ($/yr) | Annualized dollars from fewer denials, faster clean pays, and avoided appeal labor — conservative modeled estimate until live cohort matures. | Varies by volume and denial mix | Positive modeled ROI at conservative assumptions; validated against pilot cohort trend | INS ROI dashboard |
| KPI | Definition | Typical baseline | ARKA target | Reported via |
|---|---|---|---|---|
| Auto-clear rate (orders never queued) | Orders that pass in-flow appropriateness and payer-side checks without entering the manual reviewer queue. | 0% | 35–40% of clearly appropriate orders auto-cleared | INS payer dashboard |
| Prior-auth turnaround time | Elapsed time from PA submission to disposition, compared against CMS-0057-F expedited (72h) and standard (7 calendar days) SLAs. | Manual queue; often beyond CMS SLAs | Within simulated CMS-0057-F decision windows (72h expedited / 7 calendar days standard) | INS reviewer queue |
| Rework touches per denied claim | Average staff touches (resubmit, appeal draft, peer-to-peer) required to resolve a denied advanced-imaging claim. | 2–4 touches per denied claim | Reduction vs. baseline through upstream appropriateness and specific denial reasons | INS ROI dashboard |
| KPI | Definition | Typical baseline | ARKA target | Reported via |
|---|---|---|---|---|
| Clinician clicks added | Net new in-workflow clicks attributable to ARKA CDS cards — measured against zero-added-workflow design intent. | N/A — design target is zero added workflow | 0 — silent unless a guideline fires | CDS Hooks demo |
| Guideline-concordant order rate | Share of orders whose AIIE appropriateness score aligns with first-party evidence registry guidance for the clinical scenario. | Varies by service line; often suboptimal without in-flow CDS | Improvement vs. baseline on scoped cohort; tracked against evidence-backed thresholds | Evidence library |
| Override / feedback rate | Share of CDS card deliveries where the ordering clinician accepts, dismisses, or overrides the recommendation — conformance and adoption signal. | N/A without in-flow CDS | Low override on high-confidence appropriate orders; feedback captured for model governance | CDS validation dashboard |
| KPI | Definition | Typical baseline | ARKA target | Reported via |
|---|---|---|---|---|
| CMS-0057-F decision-time conformance | Share of PA decisions completed within expedited (72h) and standard (7 calendar days) timelines per the final rule. | Often below target without automation | ≥95% within simulated SLA for scoped volume (demo conformance checks) | CMS-0057-F matrix |
| Specific-denial-reason completeness | Denials that cite AIIE-aligned, non-boilerplate reasons tied to documented clinical factors — required for appeal readiness and public reporting. | Frequently generic or incomplete | 100% specific reasons on ARKA-routed denials in pilot cohort | CDS validation dashboard |
Patient safety
Harm prevention is implicit in appropriateness and turnaround KPIs — here is how quality leaders connect revenue metrics to radiation stewardship, time-to-diagnosis, and QI signal.
Guideline-concordant CDS at order entry defers or redirects studies that add radiation, contrast, or incidental findings without clinical benefit — the same appropriateness KPI tracked on this scorecard.
Evidence libraryPediatric radiation stewardshipConservative care before imagingPregnancy & contrast selection
In-flow scoring keeps order entry fast; upstream documentation and auto-clear reduce queue time so indicated studies reach the modality sooner — measured latency on retrospective evaluation, turnaround targets modeled against CMS-0057-F SLAs.
ARKA is silent when no guideline fires, cannot place, cancel, or block orders, and explicitly excludes time-critical alerts and triage from intended use — if ARKA is unreachable, the EHR proceeds exactly as before.
Trust center — intended useModel limitationsImplementation rollback
Anonymized near-miss cards show where ARKA surfaced a likely denial or low-value order before it shipped — feeding monthly QI review alongside override/feedback KPIs during pilots.
Appropriateness at order entry reduces low-value radiation and contrast exposure (Evidence Library–cited); faster authorization shortens time-to-diagnosis on measured in-flow latency and modeled PA turnaround; non-blocking CDS cannot delay emergent care; and the near-miss library turns denial patterns into QI signal. See the patient-safety case on Outcomes for evidence links and provenance labels.
Governance
Time horizons, meeting cadence, and mutual obligations — who owns measurement, who acts on thresholds, and what each checkpoint produces.
| Horizon | Cadence | Owner | Content | Exit / deliverable |
|---|---|---|---|---|
| Days 0–90 (pilot) | Weekly readout | ARKA implementation engineer + your champion + rev-cycle lead | Pilot scorecard KPIs (co-signed before day 1), card volume/override review, issue log | Go/no-go against the co-signed success threshold; miss → month 1 of production free (existing guarantee) |
| Months 4–6 | Monthly ops review | ARKA CS + service-line + UM | KPI trend vs baseline, threshold tuning, expansion candidates (modalities/departments), payer-mix analysis | 6-month milestone report to the executive sponsor — a written document, not a meeting |
| Ongoing | Quarterly Business Review (QBR) | ARKA leadership + CMIO/CFO sponsors | Measured ROI vs the modeled case (variance shown explicitly, both directions), roadmap, model/rule-library change log review, subgroup/fairness monitoring summary, renewal economics | Published QBR minutes + next-quarter targets |
QBR agenda template available in the vendor portal (docs/customer-success/QBR_AGENDA_TEMPLATE.md) — 60-minute structure with measured-vs-modeled variance, change-control review, and action-with-owners format.
Pilot success is not implied by this framework alone — it is defined jointly up front on the metrics you select from this scorecard. Defined jointly up front; if the pilot misses it, month 1 of production is free (existing guarantee). See pilot success contract
Forward to sponsors
Every KPI, definition, and reporting surface — formatted for CFO, CMIO, and UM reviewers you can CC on one email.