The Cadence Governance Standard (CGS) defines the minimum requirements for a structured, advisory-only continuation governance program. All Cadence governance cycles are conducted against this standard. All governance artifacts are produced under it. All Cadence Governance Certificates are issued against it.
This document is the executive summary. The full technical specification is available upon pilot engagement.
1
Cohort Definition
Minimum 2,500 specialty continuation members. Defined by therapy class, not cost threshold alone. ≥6 months continuous enrollment. De-identified claims CSV: 4 required fields (member_id, drug, dose, therapy_start), 6 optional enrichment fields.
2
Trigger Architecture
Seven required trigger categories: DUR12 (duration >12 months without reassessment), dose escalation without response, missing monitoring labs, comorbidity change, NOOUT (no measurable outcome data), BIOSIM (biosimilar available but not considered), LABGAP (monitoring labs overdue >90 days). Configuration owned by plan sponsor within required categories. Versioned and locked before review.
3
Reviewer Qualifications
Qualified clinical professionals (PharmD, MD, or clinical specialist). External to plan sponsor — no duty to act. Minimum two independent reviewers per cycle. Credentials documented in artifact.
4
Outcome Taxonomy
Four standardized outcomes: Continue (DAR) — documented appropriateness confirmed. Adjust — dose/frequency modification indicated. Taper — structured reduction indicated. Switch — alternative therapy indicated. All advisory. No outcome constitutes a clinical order or coverage determination.
5
Measurement Methodology
RIR (Reviewer Influence Rate) = trajectory changes ÷ reviewed cases. DAR (Documented Appropriateness Rate) = confirmed appropriate ÷ reviewed. RIR + DAR = 100%. GPR (Governance Persistence Rate) = persistent changes at Cycle 2 ÷ influenced cases. GSV = TAF-weighted economic value (Adjust × 0.25 + Taper × 0.50 + Switch × 0.30) × ATC.
6
Audit Trail Requirements
Immutable record per case: de-identified member ID, trigger(s), reviewer, date, outcome, rationale. Trail sealed at cycle close. No post-seal alteration, deletion, or selective exclusion. Audit trail is the evidentiary backbone of artifact and certificate.
7
Configuration Fingerprint
Versioned documentation of: active triggers, thresholds, cohort criteria, reviewer assignments, queue logic. Locked before first review. Published in artifact. Makes cycles directly comparable.
8
Cycle Requirements
Duration: 90–120 days. Review completion: ≥90% of flagged cases. Configuration locked before first review. Artifact delivered within 14 days of cycle close. Certificate issued upon delivery. Multi-cycle: GPR measurement required from Cycle 2.
Products governed under CGS v1.1
Governance Artifact — the cycle deliverable
Governance Certificate — stop-loss credential
Provider Mirror — panel governance view (2027)