The Cost of
Not Watching.

CDQ · Clinical Deviation Intelligence

You don't have a reporting (most tools tell you what happened) problem. You have a surveillance (CDQ watches for pathway drift between encounters) problem.

Most health systems use the same guidelines — ADA, HEDIS, KDIGO. What they don't have is a system watching every patient, every day, flagging when they've drifted off the path before the ED visit, before the readmission, before the penalty.

The Situation

Discharged. Compliant. Gone.

A 64-year-old with HF is discharged on a Tuesday. She has a 7-day follow-up scheduled. The case manager closes the loop. Everyone did their job.

(Everyone did their job. The system still failed.)

The Drift

No one was watching the interval.

She misses her 7-day visit. Her weight check doesn't happen. Her GDMT titration stalls. No lab. No call. Day 22: back in the ED with a worsening ejection fraction.

(The interval is invisible to your EHR.)

The Reality

This happens thousands of times a year.

In a 400-bed system, hundreds of transitions-of-care patients are drifting from their pathways right now. All preventable.

(Scale it across your entire panel.)

The Root Cause

Not negligence. Architecture.

Your EHR tracks what happened. It doesn't flag what should have happened and didn't. That gap — the deviation gap — is where CDQ lives.

$500^M

CMS HRRP penalties levied annually across ~2,300 penalized hospitals

CMS FY2024 HRRP Impact File

72^hr

Post-discharge window where intervention most reduces HF readmission risk

ACC/AHA HF Guidelines; CMS TCM codes

$217–430^K

Average annual HRRP penalty per hospital by bed size

CMS HRRP aggregate analysis

The guidelines exist. The data exists.
The watching doesn't.

The EHR Trap

Epic, Cerner, and Oracle document care — they don't monitor pathways. An EHR alert fires during the encounter. CDQ works between encounters, where the deviation already started.

(EHR alerts fire at the encounter. The deviation starts after.)

The HEDIS Trap

Most systems discover measure gaps at year-end, when it's too late to close them. CDQ surfaces gaps while the window is open. Your quality teams report what happened; CDQ tells you what to do before it closes.

(CDQ works while the measurement year is still open.)

The Dashboard Trap

Population health dashboards show trends. They don't show which specific patients need a call tomorrow. CDQ produces a prioritized worklist — individual patients, individual gaps, individual actions.

(A worklist is actionable. A dashboard is informational.)

The Penalty Trap

CMS readmission penalties are levied retroactively — after the cost has already occurred. CDQ intervenes in the window, before the HRRP clock expires.

(The penalty clock starts at discharge — CDQ starts there too.)

42 pathways.
Every gap surfaced.
Before it costs you.

Tier 1 · High-Impact Core

10 Pathways

Diabetes (HBD)
Hypertension (CBP)
Heart Failure
CKD (KED/EED)
Colorectal Cancer Screening
Breast Cancer Screening
HF Transitions of Care
Major Depressive Disorder
AFib Anticoagulation
Dyslipidemia

Tier 2 · Population Health

14 Pathways

Cervical Cancer Screening
Lung Cancer LDCT
COPD / Asthma
Obesity / Tobacco Cessation
Pneumonia & Post-Surgical TOC
Adult Immunizations
OUD-MOUD
SDOH Screening
Prediabetes
SNF-to-Home Transitions

Tier 3 · Complex & Specialty

18 Pathways

Well-Child / Pediatric
Alcohol Use Disorder / Anxiety
Joint Replacement / Bariatric
Cardiac Cath / Colonoscopy
Gynecologic / Cataract Surgery
Frequent ED Utilizer
Complex Care / High-Risk
Advance Care Planning
Maternal / Prenatal
Comorbid Diabetes + Depression

Here's what changes on Day 1.

1

HF Readmission Prevention

CDQ flags a discharged HF patient who hasn't had a 7-day follow-up. The care coordinator calls. Weight is up 6 lbs. Diuretic is adjusted. Patient doesn't come back. HRRP clock stops.

(The 72-hour window is where the HRRP penalty clock is most sensitive.)

Per avoided readmission

$14–23K

AHRQ/KFF range for HF readmission cost

2

HEDIS Gap Closure — HbA1c

CDQ surfaces diabetic patients whose HbA1c is overdue in Q3 — while the measurement year is still open. Your care team runs targeted outreach. Gaps close before year-end. Your HEDIS vendor reports the improved score.

(CDQ closes gaps while the measurement year is still open.)

Value driver

Timing

Exact HEDIS impact depends on your baseline — quantify in the pilot

3

Frequent ED Utilizer

The TOC_ED_FREQ pathway activates within 72 hours of a patient's 3rd ED visit. Complex case management enrollment fires automatically. SDOH screen added. The 4th visit doesn't happen.

(Super-utilizers: one avoided readmission can offset months of platform cost.)

Annual cost per super-utilizer

$50–100K

CMS/AHRQ range; $80K mid-estimate

4

CKD Cross-Enrollment

A diabetes patient's eGFR drops to 52. CDQ detects it, auto-enrolls in the CKD pathway, and surfaces a nephrology referral — before the nephrologist ever sees a flag from the EHR.

(Cross-enrollment fires automatically — no manual re-entry.)

Clinical impact

2–5 yr

Median dialysis delay with early CKD referral; KDIGO/NKF

EHRs document. Analytics platforms report. CDQ watches.

Three verbs. Three different products.

The scarce asset isn't software access - it's operational discipline.

Are you ready?

Three steps to
operational clarity.

Step 01

90-Day Pathway Pilot

Deploy 3–5 Tier 1 pathways against your live patient panel. Connect ADT, labs, and ICD-10. Run the deviation queue for 90 days. No commitment beyond the pilot.

Step 02

Measure the Delta

At day 90: gaps detected, gaps closed, payer mix, projected HRRP impact at full scale. The pilot data makes the expansion case for you.

Step 03

Full Platform Deployment

Activate all 42 pathways. Onboard quality teams, care coordinators, and population health managers. CDQ becomes your system's real-time safety net.

The patients drifting from your pathways right now don't know they need to be found.
CDQ finds them. The only question is how long you wait to start looking.

Email info@preacthealth.com See CDQ in action ↓

The Cost ofNot Watching.