Pathways operate as guided sequences that respond to what the CHW learns during each interaction with the member. The branching logic within a Pathway ensures that CHWs only see the questions and follow up steps relevant to the specific case. Each Pathway ends with a closure process that reflects PCHI requirements and determines what type of Supervisor Review Request is created based on the closure status the CHW selects for that Pathway.

Pathways differ in structure depending on the type of need being addressed. Some require full assessments, some move directly to referrals, and others provide education. The following sections outline the four categories of Pathways used in PCHI workflows.

Main Pathways are used for broad, multifaceted needs such as food, housing, transportation, or employment. These categories require deeper assessment because the member’s situation may involve several contributing factors or barriers.

How Main Pathways Function

A Main Pathway begins with a full needs assessment. The Pathway guides the CHW through structured questions and decision points that help identify the root cause of the need and determine the appropriate support. Depending on what the CHW learns, the Pathway may branch into follow up flows, resource coordination, tasks, or referrals.

The CHW selects the appropriate closure status when they are ready to close the Pathway based on the work completed with the member. This can occur in either activity of the Main Pathway, the Needs Assessment or any Follow Up. Once the CHW indicates that they are ready to close the Pathway, the branching logic presents the PCHI criteria for a completed closure status for that specific Pathway type. When the CHW submits the closure from within the activity they are working in, a Supervisor Review Request is automatically created and routed to the Supervisor user group. After the supervisor completes the review, the Pathway closure becomes available for reporting and, if applicable, billing.

Medical Referral Pathways address specific medical needs that are already known at the time the Pathway is opened. These Pathways are designed for direct referrals rather than broad assessment.

How Medical Referral Pathways Function

Medical Referral Pathways skip broad intake questions and focus on confirming the specific need and documenting the required referral or resource. Examples include specialist referrals, durable medical equipment, or therapy services. The CHW documents the referral and then follows up to confirm whether the member successfully connected to the recommended care.

The CHW selects a closure status for the Medical Referral Pathway based on whether the member was able to gain access to the resource or attend the appointment associated with the referral documented in the Pathway. The type of Supervisor Review Request that fires is based on the closure status the CHW gives the Pathway. A corresponding Supervisor Review Request is created when the CHW submits the closure from within the current activity. After the supervisor completes the review, the Pathway closure becomes available for reporting and, if the Pathway was completed, for PCHI billing.

Social Service Referral Pathways operate similarly to Medical Referral Pathways but support non medical needs that are already known when the Pathway is opened.

How Social Service Referral Pathways Function

The CHW uses these Pathways when the member needs a specific resource or service such as childcare, clothing assistance, legal support, or corrections related resources. The Pathway focuses on capturing the details of the need, documenting the referral or resource, and confirming whether the member successfully accessed the support.

The CHW selects a closure status for the Social Service Referral Pathway based on whether the member was able to gain access to the resource or attend the appointment associated with the referral documented in the Pathway. They include direct steps for referral documentation, follow up, and closure based on whether the referral successfully connected the member to the resource and the member’s need was met.

The type of Supervisor Review Request that fires is based on the closure status the CHW gives the Pathway. A corresponding Supervisor Review Request is created when the CHW submits the closure from within the current activity. After the supervisor completes the review, the Pathway closure becomes available for reporting and, if the Pathway was completed, for PCHI billing.

Learning Pathways provide education on specific topics that support PCHI goals. These Pathways have no expectation of delivering a resource or referral unless the CHW discovers a new need during the discussion.

How Learning Pathways Function

A Learning Pathway contains one activity that holds PCHI provided educational content. The CHW reviews the material with the member, documents the interaction, and determines whether the conversation uncovered any additional needs. If a new need emerges, the CHW opens a Main or Referral Pathway to address it. Learning Pathways do not require extended follow up unless the CHW identifies new work during the interaction.