> For the complete documentation index, see [llms.txt](https://docs.lucernahealth.com/guide/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://docs.lucernahealth.com/guide/consumer-360/consumer-profile.md). # Consumer Profile The Consumer Profile brings together everything LEAP knows about a member: demographics, clinical history, utilization, panel assignment and engagement, in one view. ### Finding a consumer * Open Consumer 360 and you'll land on a blank screen with a search bar. Search by name, or by date of birth, phone number or member ID. * Click into the search bar without typing to see your most recent searches.
**Pinning a profile.** To keep a consumer close at hand, open their profile and click the pin at the far right of the tab bar. Pinned profiles are available from Pinned Profiles in the top right.
*** ### The profile A member's record is organized into a side panel that stays on screen and five tabs. Each page below covers one part of the profile: what every field means, where its data comes from, and what its badge values indicate.
Cover image

Left Side Panel

Name, demographics, insurance, clinical and care continuityclinical--a-soft 6.pngLeft Side Panel

Clinical

Top opportunities, conditions, assessments, risk, care programs and care gapsclinical--a-soft 1.pngClinical

Utilization

Top opportunities, encounters and claimsclinical--a-soft 4.pngUtilization

Panel Management

PCP assigned, history and auditclinical--a-soft 2.pngPanel Management

Engagement

Appointments, surveys, sentiment and outreachclinical--a-soft 3.pngEngagement

Consumer Details

Insurance, facilities, demographics and identifiersclinical--a-soft 5.pngConsumer Details

Managing consumer records

Override golden record fields, merge duplicate profiles, and archive a consumerclinical--a-soft 16.pngManaging Consumer Profiles
*** ### Where the data comes from The Consumer Profile pulls from several systems. They differ in when data arrives and in what counts as evidence, which is worth knowing when two values don't line up. {% hint style="info" %} Payer claims include out-of-network care but arrive 30 to 90 days late, the EMR arrives sooner but only covers care inside your network, a blank on a self-reported field may mean never screened, and model output predicts rather than records. {% endhint %} #### From the payer **Payer eligibility and roster** Feeds coverage, roster status, roster tenure, plan and group detail. This is coverage as the payer reports it, and it is the system of record for whether someone is on the roster. **Payer population health analytics** Feeds All Conditions and Sensitive Diagnoses. A condition appears once the payer's analytics have identified it. Nothing here is read from the chart's problem list, so the EMR and this list can legitimately disagree, and a diagnosis made this morning will not appear until the next data cycle. **Payer claims** Feeds the visit count tiles and Visit Details on the Utilization tab. Claims are the most complete view of utilization, covering care both inside and outside your network. The trade-off is timing: a claim arrives 30 to 90 days after the visit it describes. **Payer quality and HEDIS engine** Feeds Care Gaps. A gap closes when the quality engine sees the evidence that closed it, which comes from an adjudicated claim rather than from the chart. This is why a test that was performed and documented can still show as Overdue. #### From the provider organization **EMR** Feeds MRN, Provider Encounters, appointments, and the Provider Data column on Consumer Details. EMR data arrives faster than claims but only covers care delivered inside the provider network, a visit elsewhere will not appear here at all. The Provider Data column specifically is what the front desk recorded at registration. **Provider directory and scheduling** Feeds provider profiles, facilities and weekly availability. Reference data about providers and facilities, plus open appointment slots. #### From the consumer **Self-reported screenings** Feeds HRA, SDoH, PHQ-9 and Experience Surveys. The consumer answered these questions themselves. The most important consequence: a blank means they were never screened, not that there is nothing to report. Absence of a social need is not evidence that no need exists. #### Calculated in LEAP **Golden record (CPS)** Feeds identity, demographics and contact detail. CPS merges the best-known value for each field across the payer roster, the EMR and outreach data. A value on the profile may not exactly match what any one source system holds, it is the resolved answer, not a copy. Consumer Data History shows which system supplied which value and when. **Model output** Feeds Likely to Engage, Risk and Cost Predictions, and the No Show, Retention and Detractor risk scores. These are predictions about what may happen. They are not observed history and they are not supplied by the payer: a High Likely to Engage score does not mean the consumer has engaged before. **Leap derived** Feeds Top Opportunities, Health Status, Closest Facilities, Sentiment Analysis, and the attribution behind Panel Management. Calculated inside LEAP rather than received from a source system. Top Opportunities is produced by rules run across care gaps, programs and assessments. Sentiment is inferred from survey free text: an interpretation, not something the consumer selected. #### From outreach **Redpoint** Feeds Patient Outreach. Outreach and campaign history, including what was sent, on which channel, and how the consumer responded.