Clinical Outcomes

1. Patient Status

• PHQ-9 score trend

• GAD-7 score trend

• Sleep quality index

• HRV baseline to current

2. Environmental Metrics (Category 2)

• “Green Exposure Minutes / Day”

• “Blue-Water Proximity Exposure”

• ESS (Environmental Stability Score)

• Thermal comfort + light exposure

• Nature-based behavioral activation index

3. Metabolic Panel (Category 3)

• HbA1c (baseline → delta → goal)

• Fasting glucose trend

• CGM glucose variability index

• Resting insulin + HOMA-IR

• Nutrition adherence score

4. Biobank / Epigenetics Panel (Category 5)

• Sample status (collected / processed / stored)

• Epigenetic resilience marker (β-value change)

• Inflammatory markers

• Population-Level longitudinal trends

5. Cost & Utilization

• PMPM savings

• ED visits avoided

• Medication reductions

• ROI estimator

6. Risk Flags

• Severe depressive episode alert

• Glucose > 220 pattern flag

• Environmental instability pattern

Experience & Access Outcomes (CMS Required)

• Patient Activation Measure (PAM) ↑

• Patient-Reported Outcomes (PROMIS Anxiety/Stress) improved

• Timely Access to Care through blended outdoor + telehealth model

• Care Coordination Score ↑

Equity & Environmental Outcomes (VBOHC-specific)

• ↑ Nature-dose minutes/week

• ↑ Green/blue-space exposure

• ↓ Allostatic load index (environment-first stress scoring)

• ↑ Community-level health equity indicators

Cost & Utilization Outcomes (CMS Value Benchmarks)

• ↓ ED visits related to anxiety + hypertensive symptoms

• ↓ Medication escalation

• ↑ Longitudinal adherence & engagement

• ↓ Total cost of care (TCOC) in depression–diabetes cohorts