COMPASS™
Keck Medicine of USC  |  G. Erickson — Director, Post-Acute Care Services
🔔
3
GE
Sign Out
12
Active Referrals
↑ 3 today
31h
Avg Placement Time
↓ 18h vs. baseline
2
SLA at Risk
Needs attention
94%
Payer Match Rate
↑ 12% vs. manual
$74K
Savings This Month
↑ 23.6 bed days freed
100%
IMPACT Act Coverage
All cases documented
Referral Queue
Medicare Medi-Cal Commercial MA Plans
Rodriguez, Maria T.
MRN: KC-2026-00344
⚠ 0h 47m
SLA breach risk
→ Valley Skilled Care · Monterey Park
Sent+ Backup ActiveMedicare Part A · DRG 193
Kim, David S.
MRN: KC-2026-00343
2h 15m
Escalated
→ Eastside Rehab Center · Boyle Heights
EscalatedMedicare Advantage · DRG 871
Johnson, Patricia A.
MRN: KC-2026-00342
18h 30m
→ Sunrise SNF · East Los Angeles
ReviewingMedi-Cal · DRG 470
Martinez, Rosa L.
MRN: KC-2026-00341
✓ Placed
✓ Sunrise SNF · East LA · Apr 6 2:00pm
AcceptedMedicare Part A · DRG 871
Thompson, Robert W.
MRN: KC-2026-00340
6h 20m
→ Pacific Home Health · Silver Lake
SentCommercial · Anthem PPO
Okafor, Emmanuel C.
MRN: KC-2026-00339
Declined
✕ Valley Care · No Medi-Cal bed
DeclinedBackup SentMedi-Cal · DRG 291
Chen, Wei-Lin
MRN: KC-2026-00338
✓ Placed
✓ Sunrise Memory Care · Alhambra
AcceptedPrivate Pay · Memory Care
COMPASS™ · CareMatch LLC · Prepared for Keck Medicine of USC

How COMPASS™ Makes
Matching Decisions

A plain-language explanation of the clinical matching process — how decisions are made, what drives them, and what COMPASS will never do.

Prepared ForShannon Bradley, Head of Health Equity
Document TypeAI Explainability Statement
DateApril 2026
ClassificationConfidential — Stakeholder Review
Founding Principle
"No facility pays for a higher placement ranking. Ever. The match belongs to the patient — not the highest bidder."

What COMPASS Is — and What It Is Not

COMPASS™ is a discharge coordination operating system. It connects hospital case managers, post-acute care facilities, and patient families in real time — replacing stacks of calls, faxes, and voicemails with a documented, auditable workflow.

COMPASS does not make discharge decisions. Clinical teams make discharge decisions. COMPASS surfaces the best-matched facilities based on the patient's documented clinical needs, insurance coverage, geographic preferences, and equity criteria — so the case manager can act with confidence, and the patient and family can understand why a recommendation was made.

The One-Sentence Explanation

COMPASS is a matching system that ranks post-acute care options based on five transparent clinical and equity signals — and documents every step so the hospital, the family, and the facility all share the same picture.

The Five Signals That Drive Every Match

Every facility recommendation COMPASS produces is the result of five weighted signals applied to the patient's profile. These signals are fixed, transparent, and reviewed by the clinical team before any referral is sent. No signal can be purchased, suppressed, or overridden by a facility.

01
Clinical Acuity Match

The patient's documented care needs — wound care, physical therapy, memory support, ventilator dependency — are matched against the verified clinical capabilities of each facility. A facility that cannot serve the patient's acuity level does not appear in results.

Clinical
02
Payer & Insurance Compatibility

Medicare, Medicaid, commercial insurance, and managed care plan acceptance status is verified for each facility before a match is surfaced. No family is sent to a facility that will not accept their coverage — eliminating one of the most common discharge failures.

Financial
03
CMS Quality & Star Rating

Every facility in the COMPASS network carries its Centers for Medicare and Medicaid Services overall quality rating, health inspection results, and staffing score. These are published public data — COMPASS surfaces them transparently alongside every recommendation.

Quality
04
Healthcare Equality Index Score

COMPASS integrates the HRC Foundation's Healthcare Equality Index — scoring facilities on LGBTQ+ nondiscrimination policies, staff training, patient services, and community engagement. Every match surfaces a facility's verified equity designation.

Equity
05
Geographic & Family Proximity

Distance from the patient's home ZIP code and family members' locations is factored into every match — prioritizing placements that keep families involved in the recovery process.

Community

What COMPASS Will Never Do

Transparency requires not just explaining what the system does — but making explicit commitments about what it refuses to do. These are not aspirational guidelines. They are structural constraints built into the platform architecture.

COMPASS Will Never
Rank a facility higher because it paid a fee or subscription premium
Suppress a lower-cost facility to protect a facility partner's revenue
Route patients by race, ethnicity, or national origin
Share a patient's protected health information without documented consent
Remove an equity signal to simplify results
Allow a facility to opt out of equity scoring to improve their ranking
COMPASS Will Always
Surface the HRC Healthcare Equality Index score for every facility
Document the rationale for every match in an immutable audit trail
Allow the case manager to override any recommendation with documented reason
Give families visibility into why a facility was recommended
Flag when a match is limited by payer restrictions
Retain all placement decisions for CMS audit readiness

Equity Is Not a Filter — It Is a Foundation

Most discharge tools treat equity as an optional add-on — a checkbox layer applied after the core match is already made. COMPASS is structured differently. The Healthcare Equality Index score is a primary matching signal, not a post-hoc filter. It shapes which facilities appear in results from the first calculation.

Why This Matters for Keck

Keck Medicine of USC is an HRC Healthcare Equality Leader — the highest designation awarded by the HRC Foundation. Keck Pride and the TransLatin@ Coalition partnership reflect a genuine institutional commitment to equitable care. COMPASS operationalizes that commitment at the precise moment it matters most: the discharge decision. When an LGBTQ+ patient leaves Keck, they are matched to a facility with a verified, documented equity record — not whoever happens to have an open bed.

The IMPACT Act requires hospitals to document that post-acute referrals reflect patient goals, preferences, and clinical need. COMPASS creates a timestamped, provider-attributed record of every equity consideration applied during the matching process — satisfying the documentation standard and creating a defensible record if a placement decision is ever questioned.

The Audit Trail — Every Decision, Documented

Every action taken inside COMPASS is written to an immutable audit log. This is not a reporting feature — it is the core architecture. The audit trail cannot be edited, deleted, or selectively filtered by any user, including system administrators.

01
Discharge Order Triggered

The moment a discharge order is entered, COMPASS creates a timestamped case record. The patient's clinical profile, payer status, and documented preferences are captured — establishing the baseline for all subsequent matching decisions.

02
Five-Signal Match Calculated

COMPASS runs the five-signal matching process and generates a ranked list of facilities. Every facility's score on each signal is recorded — so the rationale for every ranking is preserved in full, not summarized.

03
Case Manager Reviews and Selects

The case manager reviews the matched options and selects the referral destination. If they choose a facility that was not the top match, the audit trail records the reason. Clinical judgment always has the final word — and that judgment is documented.

04
Referral Sent and Tracked

The referral package is transmitted to the facility with a documented timestamp. Facility response — accept, decline, or counter — is recorded with time-to-response. Every communication between hospital, facility, and family is logged to the case record.

05
Outcome Recorded — Loop Closed

At 30 and 90 days post-discharge, COMPASS flags cases for outcome documentation. Readmission events, length of stay, and family satisfaction signals are recorded — closing the loop that most discharge systems leave permanently open.

The Human Is Always in the Loop

COMPASS is a decision-support system, not a decision-making system. The distinction is not semantic — it is architectural. No placement is ever initiated by COMPASS without an explicit action by a credentialed clinical team member.

Override Architecture

Every COMPASS recommendation can be overridden by the case manager. The system does not resist or flag overrides as errors — it documents them as legitimate clinical judgment. A case manager who selects a facility outside the top match is not circumventing COMPASS. They are using it correctly. The system exists to surface options and document decisions — not to constrain the clinician's authority over the patient's care.

This architecture reflects a core conviction: the value of COMPASS is not that it replaces clinical expertise. It is that it gives clinical expertise a documented, defensible, auditable foundation — so that the right decision is also the recorded decision.

Founder & CEO, CareMatch LLC25 years in post-acute care and senior living · Irvine, California
Patricia Ways, JD/RNRegulatory & Payer Strategy · Advisory Board · Document Under Review
Prepared for Keck Meeting 2 · April 2026
COMPASS™ · IMPACT Act Compliance · Keck Medicine of USC
Audit Trail — Martinez, Rosa L.
MRN: KC-2026-00341 · Case: CMP-44C1-8A2B · DRG 871 · Septicemia w/ MCC · Placed Apr 6, 2026
✓ 100% IMPACT Act Coverage 🏳️‍🌈 HEI Applied 47/47 SHA-256 Verified
HSC § 1262.5 Compliant
📋CMS Conditions of Participation Met
🏛️IMPACT Act Documentation Complete
🔒Immutable Record · Tamper-Evident
⚖️Equity Scoring Applied
🔐 Immutability Notice: This audit record cannot be edited, deleted, or selectively filtered by any user, including system administrators. Every entry is SHA-256 hashed and timestamped at write time.
Five-Signal Match Record
Signal 01
Clinical Acuity
SNF — Sepsis Recovery
✓ Matched
Signal 02
Payer Verification
Medicare Part A
✓ Verified
Signal 03
CMS Star Rating
★★★★★ · 5.0
✓ Documented
Signal 04
HEI Equity Score
HRC Leader 2025
🏳️‍🌈 Leader
Signal 05
Geographic Proximity
2.1 mi · Family ZIP
✓ Optimized
Complete Audit Timeline
Event Log — CMP-44C1-8A2B
8 EVENTS · ALL VERIFIED
08:14 AM
Apr 6, 2026
Discharge Order Entered — EHR Trigger
Discharge order entered in Oracle Health by Dr. Chen, MD. COMPASS case record created automatically via ADT feed. Patient clinical profile captured: DRG 871, Septicemia with Major Complication, LOS 8 days.
System EventEHR Triggered
Complete
08:15 AM
Apr 6, 2026
Payer Verification — Medicare Part A Confirmed
Real-time eligibility check confirmed Medicare Part A active. 3-day qualifying stay met (8 inpatient days). SNF benefit: 100 days, Days 1–20 at $0 copay. Prior authorization not required for traditional FFS Medicare.
Payer VerifiedAuto-Check
Complete
08:16 AM
Apr 6, 2026
Five-Signal Match Calculated — 14 Facilities Evaluated
COMPASS evaluated 14 facilities in the Keck network. 5 facilities qualified across all signals. Match scores applied: Clinical Acuity (35%), Payer (25%), CMS Stars (15%), HEI (15%), Proximity (10%). Top match: Valley Skilled Care — Score 96.
HEI Applied5-Signal Match14 Evaluated
Complete
08:31 AM
Apr 6, 2026
Patient Consent Documented — Verbal + Written
J. Chen, RN CCM documented patient consent to share protected health information with post-acute facilities. Patient confirmed understanding of right to choose facility. Consent form signed, uploaded, SHA-256 hash recorded.
Consent ActiveHIPAA Compliant
Complete
08:47 AM
Apr 6, 2026
Primary Referral Sent — Sunrise SNF
Referral package transmitted to Sunrise SNF (Match Score 94, HEI Leader). Clinical summary, payer verification, and IMPACT Act documentation included. Case manager: J. Chen, RN CCM. Referral ID: REF-44-00341-A.
Referral SentHEI Leader
Sent
10:22 AM
Apr 6, 2026
Family Portal Notification Sent
Family member (daughter, Rosa Martinez Jr.) notified via COMPASS Family Portal. Facility details, address, visiting hours, and contact information shared. Family confirmed receipt at 10:34 AM.
Family NotifiedPortal Delivery
Complete
11:58 AM
Apr 6, 2026
Referral Accepted — Bed 214-B Confirmed
Sunrise SNF accepted referral. Bed 214-B assigned. Admission confirmed for Apr 6, 2026 at 2:00 PM. Time from discharge order to placement confirmation: 3h 44m. DRG 871 baseline: 2.1 days. Actual: 3h 44m.
Accepted3h 44m placement
Placed
2:00 PM
Apr 6, 2026
Discharge Complete — Record Sealed
Patient transported and admitted to Sunrise SNF Bed 214-B. IMPACT Act documentation sealed. 30-day outcome follow-up auto-scheduled for May 6, 2026. Audit record marked immutable — no further edits permitted.
Case Closed30-Day F/U: May 6Record Sealed
Sealed
PLACEMENT CONFIRMED — Sunrise SNF, East Los Angeles · Bed 214-B · Admission Today 2:00 PM
Sent via COMPASS™ · Keck Medicine of USC
The Communication Gap — Solved
Before COMPASS, families heard nothing.
A phone call. Maybe a fax. Then silence.
This is what Rosa Martinez's daughter sees the moment her mother is placed. Real-time. On her phone. Without making a single call. The placement decision, the facility details, the equity record, the next steps — all in one place, documented and transparent.
RM
Rosa L. Martinez
74 years old East Los Angeles, CA DRG 871 · Septicemia Recovery Medicare Part A
SNF — Post-Sepsis Care Skilled Nursing Required 🏳️‍🌈 HEI-Matched Facility
Placement Time
3h 44m
✓ Confirmed
What Happens Next — Your Roadmap
Discharge Order
Today 8:14 AM
Facility Matched
Today 8:16 AM
Placement Confirmed
Today 11:58 AM
Transport Today
2:00 PM
5
30-Day Check-In
May 6, 2026
Sunrise SNF
East Los Angeles
✓ PLACED
Bed Available
★★★★½
CMS Rating
🏳️‍🌈
HEI Leader
2.1mi
From Home
214-B
Bed Assigned
Specialized respiratory unit, Medicare Part A certified, LGBTQ+ inclusive policies verified by HRC Foundation 2025.
What to Bring Today
Photo ID and Medicare card
Medication list (COMPASS generated)
3–5 days of personal items
Advance directive (on file with Keck)
DNR order if applicable
Family Discussion 2 members
RJ
Rosa Jr. (Daughter)
I'm so relieved — 2.1 miles is perfect. I can visit on my lunch break. The HEI rating was the first thing I checked.
12:15 PM · Today
CM
Carlos M. (Son)
Finally someone told us what's happening in real time. This is everything we needed 3 years ago when dad was in the hospital.
12:32 PM · Today
Why This Facility Was Recommended
Every match in COMPASS is explained. Your family can see exactly why Sunrise SNF was selected — and verify it independently.
🏥
Clinical Match
Respiratory Unit
Sepsis recovery specialist
💳
Payer Verified
Medicare Part A ✓
No surprise billing
CMS Quality
4.5 Stars
Top 10% in LA County
🏳️‍🌈
Equity Score
HEI Leader
Verified inclusive policies
📍
Proximity
2.1 miles
Near family ZIP
The Research Opportunity
Without COMPASS, Rosa's family would have received a phone call. Maybe a fax. Then silence — while her case manager worked through stacks of calls trying to find a bed.
Without COMPASS
2–5 days
Average placement time
With COMPASS
3h 44m
Rosa's actual placement time
Family Communication
Real-Time
vs. zero before
This is the data we need to collect at scale. Every placement, every family notification, every equity signal applied. That's the AHRQ research question — and Keck is the institution positioned to answer it first.