CareMap

For system leaders

Fund What Matters

CareMap gives system leaders infrastructure to align rules, tools, and resources around what matters most—the outcomes people want for their own lives. It connects lived experiences, professional practice, organizational capacity, and system intelligence around the same person-defined outcomes.

Explore the System ModelExplore the Movement

  • Rules

    Set expectations for quality, accountability, rights, access, and professional practice.

  • Tools

    Give people, professionals, and organizations the capabilities to meet those expectations.

  • Resources

    Direct funding, workforce investment, technology, and capacity toward what the system values.

Person-Defined Outcomes

Voice • Choice • Control

  1. Person

    Voice • Choice • Control

  2. Professional

    Connect • Understand • Share

  3. Organization

    Develop • Equip • Reinforce

  4. System

    Rules • Tools • Resources

Aligned around Person-Defined Outcomes

Effective accountability requires the person’s perspective to help define what a successful outcome actually is for them.

Who defines the outcome?

Let the Person Define Success

HCBS supports people to live their own lives. Voice, choice, control, relationships, employment, community, independence, safety, and quality of life mean different things to different people. Person-centered quality begins with the person’s ability to define what matters and express whether services and outcomes are working for them.

Medical Outcomes

Medical science can define success for a specific clinical condition.

  1. Broken leg
  2. Restore alignment and function
  3. Measure healing and mobility
  4. Evaluate treatment quality

Person-Defined Outcomes

For lifelong disability and daily life, the person defines what success means.

  1. What matters to me?
  2. What outcomes do I want for my life?
  3. Are my services and supports helping me achieve them?
Who defines a successful outcome changes how quality must be measured.

  1. Person Defines

    What matters to me?

  2. Person Experiences

    What is happening in my life?

  3. Person Assesses

    Is this working for me?

  4. Person Expresses

    What do I want to continue, change, or pursue next?

  5. System Learns

    Are services, practices, and investments producing outcomes the person values?

System learning informs the next opportunity for the person to define what matters.

Cognitive Access + Self-Reporting + Person-Owned Information

CareMap gives people tools to understand, assess, and express their own experiences while preserving their perspective across services, providers, settings, and time.

Build around the person

Build Capacity Where It Changes the Trajectory

System leaders allocate resources across populations with different needs, risks, and definitions of quality. For people who depend on lifelong home- and community-based services and supports, stability is shaped every day across the person, natural supports, professionals, providers, and the systems responsible for those supports.

Group A

Community

People whose needs can generally be supported without institutional-level long-term services and supports.

Group B

Prevention & Stability Opportunity

HCBS

People with lifelong disabilities or institutional-level needs who depend on stable home- and community-based services and supports.

Group C

Institutional LTSS

People receiving institutional long-term services and supports.

  • Family & Natural Supports

    Relationships and continuity in everyday life.

  • Service Providers

    Programs, staffing, and service infrastructure.

  • Medical Providers

    Health expertise connected to the broader support system.

Person

Voice, choice, control, and community stability.

  • Professionals

    Skilled support around the person’s goals.

  • Care Management & Support Coordination

    Coordination across services and priorities.

  • Payers & System

    Funding, standards, accountability, and incentives.

Community stability depends on the strength and continuity of the support system around the person.

System

Rules • Tools • Resources

Funding, standards, infrastructure, accountability, and incentives.

  1. People

    MyGuide + CareMap Profile

    Cognitive access, self-reporting, person-owned information, and continuity.

  2. Workforce

    CareMap Pro + GuideKit + PCIF + Framework

    Professional tools, shared interaction practice, training, workforce development, and AI support.

  3. Organizations

    Workspaces + Learning + Knowledge + Workflows + Quality

    Organizational implementation, supervision, workforce intelligence, administrative support, and quality improvement.

Cognitive Access

Support people in understanding information, assessing experiences, expressing perspectives, and exercising voice, choice, and control.

Workforce Capacity

Equip professionals with evidence-informed tools, training, AI support, and shared professional practice.

Provider Capacity

Give organizations configurable infrastructure for workforce development, knowledge, workflows, supervision, and quality improvement.

Information Continuity

Preserve person-owned information across providers, programs, services, settings, and transitions.

System infrastructure becomes person-centered when every level has the capabilities it needs while the person’s own perspective remains connected across them.

Bounded by roles and permissions

Put AI to Work for the System

CareMap uses responsibly governed AI to increase capacity at every level while keeping human judgment, person meaning, permissions, and accountability in the appropriate human hands.

AI Across the System

  1. 1. Person

    AI supports applicable MyGuide and CareMap capabilities according to the person’s access, permissions, and preferences.

  2. 2. Professional

    AI supports information access, interaction preparation, GuideKit tools, documentation, and administrative work.

  3. 3. Organization

    AI supports workflows, knowledge access, quality assurance, supervision, workforce intelligence, and administrative processes.

  4. 4. System

    AI supports authorized program workflows, quality intelligence, oversight, resource planning, and system-defined processes.

Human review and decision-making remain explicit at every level.

EligibilityApply defined criteria, organize authorized information, and preserve the human determination.

Eligibility

Synthetic system workflow example

  1. System Requirement
  2. Defined Process
  3. Professional or Organizational Activity
  4. AI & Administrative Support
  5. Human Review & Decision
  6. Completed Result

Apply defined criteria, organize authorized information, and preserve the human determination.

AuthorizationMove a request through required evidence and review while keeping approval with an accountable person.

Authorization

Synthetic system workflow example

  1. System Requirement
  2. Defined Process
  3. Professional or Organizational Activity
  4. AI & Administrative Support
  5. Human Review & Decision
  6. Completed Result

Move a request through required evidence and review while keeping approval with an accountable person.

Care CoordinationBring permitted updates, responsibilities, and follow-up into one coordinated process.

Care Coordination

Synthetic system workflow example

  1. System Requirement
  2. Defined Process
  3. Professional or Organizational Activity
  4. AI & Administrative Support
  5. Human Review & Decision
  6. Completed Result

Bring permitted updates, responsibilities, and follow-up into one coordinated process.

Provider AdministrationSupport repeatable enrollment, documentation, and oversight activity across providers.

Provider Administration

Synthetic system workflow example

  1. System Requirement
  2. Defined Process
  3. Professional or Organizational Activity
  4. AI & Administrative Support
  5. Human Review & Decision
  6. Completed Result

Support repeatable enrollment, documentation, and oversight activity across providers.

Workforce InitiativesConnect learning priorities, assignments, completion, and capacity signals.

Workforce Initiatives

Synthetic system workflow example

  1. System Requirement
  2. Defined Process
  3. Professional or Organizational Activity
  4. AI & Administrative Support
  5. Human Review & Decision
  6. Completed Result

Connect learning priorities, assignments, completion, and capacity signals.

Quality ReviewOrganize evidence and patterns for accountable human review and follow-up.

Quality Review

Synthetic system workflow example

  1. System Requirement
  2. Defined Process
  3. Professional or Organizational Activity
  4. AI & Administrative Support
  5. Human Review & Decision
  6. Completed Result

Organize evidence and patterns for accountable human review and follow-up.

Program MonitoringFollow defined program requirements while surfacing issues that need human attention.

Program Monitoring

Synthetic system workflow example

  1. System Requirement
  2. Defined Process
  3. Professional or Organizational Activity
  4. AI & Administrative Support
  5. Human Review & Decision
  6. Completed Result

Follow defined program requirements while surfacing issues that need human attention.

Outcome MeasurementConnect lived-experience information to the outcomes people define and the decisions systems make.

Outcome Measurement

Synthetic system workflow example

  1. System Requirement
  2. Defined Process
  3. Professional or Organizational Activity
  4. AI & Administrative Support
  5. Human Review & Decision
  6. Completed Result

Connect lived-experience information to the outcomes people define and the decisions systems make.

Person-Owned Information Stays Person-Owned

CareMap Profiles remain person-owned. System workflows, organizational records, and person-owned information maintain appropriate boundaries while authorized information can support coordination, quality, and administration when permitted.

A continuous learning system

Turn Outcomes Into System Intelligence

Person-defined outcomes give systems a foundation for learning what works, identifying where additional capacity is needed, and aligning future rules, tools, resources, and quality incentives with changes that matter in people’s lives.

  1. Rules & Resources

  2. Organizational Capacity

  3. Professional Practice

  4. Human Interactions

  5. Lived Experiences

  6. Person-Defined Outcomes

  7. System Intelligence

System intelligence informs future rules and resources.

Uncover What Works

Identify professional practices, organizational approaches, programs, and services associated with stronger person-defined outcomes.

Identify Vulnerabilities

Surface patterns requiring additional workforce development, resources, coordination, oversight, or investigation.

Direct Resources

Use better information to inform workforce investment, program design, infrastructure, funding priorities, and system capacity.

Reinforce Quality

Strengthen the professional practices and organizational capabilities associated with value in people’s lives.

A Foundation for Value-Based HCBS

Person-defined outcome information can strengthen quality improvement, program evaluation, accountability, and the future development of value-based approaches grounded in outcomes that matter to people receiving services.

This is a direction for system learning—not a claim that every program, measure, or purchasing model is currently available through CareMap.

Quality improvement becomes meaningful when systems can connect what they fund and require to what changes in people’s lives.

What Could CareMap Help Your System Accomplish?

Tell us about the population, outcome, challenge, program, or system priority you are working on. We’ll explore how CareMap can support it.

Start a System ConversationOpen CareMap