The engine is not handing the rep a list of the prescriber's individual patients — that's a patient-privacy and PhRMA-Code line the field organization shouldn't be near. What it does hand over is a well-defined set of archetypes, the clinical signature that identifies each one, and the exact prompts a rep can use to ask the prescriber to check their own EHR against the pattern. The prescriber sees their panel. The rep sees the conversation.
Right-Patient Segmentation
Not a claims-data patient list. A shared vocabulary of the patient types Brekiya was built for — so a rep and a prescriber can name who they're actually talking about, and the prescriber can look at their own EHR and see how many of them they have.
The Cluster Escalator
Highest-yieldEpisodic or chronic cluster patient whose current bout is landing them in acute care.
- Cluster diagnosis, currently in an active bout
- ≥2 ED or urgent-care visits inside the last 12 months
- Rescue stack of O2 + SQ sumatriptan is not holding the bout
- Often already tolerated IV DHE at least once in an ED setting
Verapamil bridge, home O2, SQ sumatriptan, and a follow-up card handed out on ED discharge that rarely gets booked.
Subspecialty headache clinic (known to the specialist), ED at 2 a.m. (invisible to the specialist until the note flows back), occasionally an infusion center for scheduled IV DHE.
Same active agent (DHE) they have already tolerated in the ED, moved to a home autoinjector before the next 2 a.m. escalation. This is the archetype where the counterfactual ED visit is most defensible.
Highest per-patient avoided cost. The ED visits are frequent, expensive, and directly measurable — and on MA plans they touch the Star ED-utilization measure.
- 01“Which of your cluster patients have shown up in your inbox with an ED note in the last quarter?”
- 02“For the ones currently in a bout — how many are you comfortable are actually controlled on their rescue plan?”
- 03“Are any of them ones you've sent for scheduled IV DHE infusions?”
- Cluster or trigeminal autonomic cephalalgia diagnosis in the problem list
- Any ED encounter with a headache/migraine chief complaint in the last 12 months
- Active Rx for O2, verapamil, or SQ sumatriptan
- Prior DHE administration documented in the medication history