Before & After: Governed vs. Ungoverned Agent¶
The same patient case, the same drug request, the same AI model. The only difference: one agent has governed context delivered by SCP; the other doesn't.
Before — No Governed Context¶
Agent response:
APPROVE. This patient with stage 3 non-squamous NSCLC has progressed following first-line carboplatin and pemetrexed chemotherapy and has high PD-L1 expression (60%)... Based on current evidence and clinical guidelines, pembrolizumab is an appropriate, evidence-based treatment option in this setting, therefore the prior authorization request should be approved.
What's missing:
| Gap | Why It Matters |
|---|---|
| No policy citations | Cannot be audited — which guidelines was this based on? |
| No approval duration | How long is the authorization valid? |
| No monitoring plan | When does clinical response get reassessed? |
| No HIPAA compliance mention | No documented compliance posture |
| "Current evidence" = training data | The agent is applying its own knowledge, not your policies |
After — With Governed Context¶
Agent response:
APPROVE. This patient fully meets the pembrolizumab prior authorization criteria per [Formulary v2.1] and [Clinical Guidelines v1.2], including documented Stage 3 NSCLC, high PD-L1 expression, failure of platinum-based chemotherapy, ECOG 1 performance status, no contraindications, and qualified prescriber. Approve pembrolizumab for an initial 6-month period with a required clinical response assessment at 3 months for continuation review. Audit trail established per HIPAA compliance.
What changed:
| Improvement | Evidence |
|---|---|
| Policy citations | Cites [Formulary v2.1] and [Clinical Guidelines v1.2] |
| Approval duration | 6-month initial period |
| Monitoring plan | 3-month clinical response assessment required |
| HIPAA compliance | Documented in the decision |
| Fully auditable | SCP logged the exact bundle versions and SCDs active at time of decision |
The Point¶
The agent didn't change. The context changed. That's the control.
When a regulator asks what your AI knew at the time of a prior auth decision, SCP has the answer: the exact policy version, the specific clinical guidelines, the formulary version — all logged, hash-chained, and replayable.