{"schema_version":1,"assessment_id":"eoa_inverse_innovation_exp03_opportunity320_20260801","source_experiment_id":"eoa_inverse_innovation_exp03_full320_20260801","cell_id":"deadweight_loss_reduction__speech_language_pathology","archetype_slug":"deadweight_loss_reduction","domain_slug":"speech_language_pathology","title":"Risk-Tiered Continuation Authorization for Speech-Language Therapy","opportunity_summary":"For stable, currently authorized speech-language or swallowing therapy plans, permit bounded automatic continuation while retaining clinical, safety, equity, and utilization triggers for substantive review. The candidate directly changes the continuation rule rather than merely accelerating existing review, but the sealed packet does not establish that authorization-attributable interruptions are locally frequent or that low-risk cases can be classified reliably.","adopter_authorizer":"The payer or utilization-review body that owns the authorization rule, acting with accountable clinical leadership and patient-access representation.","scores":{"meaningful_impact":{"score":4,"rationale":"Avoiding administrative gaps could preserve indicated therapy, reduce repeated documentation and appeals, and improve allocation by clinical need. Impact magnitude remains uncertain because the packet supplies no observed interruption prevalence or treatment-effect data."},"stakeholder_pull":{"score":3,"rationale":"Patients, caregivers, clinicians, clinics, and access advocates have plausible reasons to favor fewer avoidable gaps, while payers may value reduced duplicate review. No stakeholder demand, payer interest, complaints, or local baseline evidence is present."},"incremental_advantage":{"score":4,"rationale":"The proposal changes the coarse continuation rule for bounded low-risk cases, unlike the named rival of portal automation, reminders, or added reviewer staffing that retains the same criteria. Whether this produces better continuity than faster ordinary review is untested."},"distinctiveness_plausibility":{"score":3,"rationale":"The risk-tiered rule change is conceptually distinct from transaction-speed improvements and is coherently adapted to clinical safeguards. Prior-art status is explicitly unsearched, so distinctiveness in actual utilization-management practice cannot be established closed-book."},"technical_implementability":{"score":3,"rationale":"A one-clinic, 12-week pathway with monitoring and rollback is operationally conceivable, but stability criteria, safety flags, progress criteria, outcome denominators, classification performance, and quantitative thresholds are unspecified."},"adoption_authority_feasibility":{"score":3,"rationale":"The rule-owning payer or utilization-review body is clearly identified and can in principle authorize a bounded pathway. Feasibility is limited by unverified payer willingness and the need for clinical, access, privacy, and utilization governance."},"evidence_readiness":{"score":3,"rationale":"The packet supplies separate problem and intervention falsifiers, a usual-review comparison, subgroup monitoring, and rollback categories. Readiness is constrained by the absence of a local baseline, prespecified definitions, validated eligibility rules, and decision thresholds."},"safety_net_benefit":{"score":4,"rationale":"The candidate preserves clinician judgment and consent, excludes unstable and diagnostically uncertain cases, retains swallowing-safety escalation, monitors crowd-out and inequity, and includes immediate rollback and sunset. Protection is weakened by unspecified measurable halt thresholds."},"scalability":{"score":3,"rationale":"A protocolized continuation pathway could potentially be repeated across clinics governed by the same authorization owner, but payer-specific rules, workflow integration, classifier reliability, monitoring capacity, and effects on scarce appointment capacity are unresolved."}},"score_confidence":"MODERATE","costs":{"first_evidence":{"band_2026_usd":"10K_TO_50K","scope":"A bounded pre-enrollment pathway audit at one clinic, classifying continuation-checkpoint gaps by authorization, clinical, supply, documentation, and attendance causes and reporting available-capacity and subgroup incidence.","confidence":"MODERATE","assumptions":["Existing scheduling, authorization, and clinical records are usable with limited manual abstraction.","The audit requires privacy review, analyst and clinician time, prespecified definitions, and data-quality checks but no live rule change.","The clinic and payer can supply necessary records without purchasing a new data platform."]},"initial_deployment_startup":{"band_2026_usd":"50K_TO_250K","scope":"Design and configure a one-clinic, one-payer 12-week pilot, including eligibility logic, safety escalation, workflow changes, governance, compliance review, staff training, measurement definitions, and rollback procedures.","confidence":"LOW","assumptions":["No major replacement of payer or clinic information systems is required.","Clinical, legal, compliance, patient-access, and technical personnel participate in design and approval.","The eligibility rule and monitoring thresholds require development and validation before enrollment."]},"operational_launch":{"band_2026_usd":"50K_TO_250K","scope":"Operate and evaluate the authorized 12-week pilot at one clinic with contemporaneous usual-review comparison cases, subgroup reporting, safety oversight, utilization monitoring, and wait-list displacement measurement.","confidence":"LOW","assumptions":["Enrollment is limited to stable, currently authorized plans reaching a continuation checkpoint.","Existing therapy capacity is used; the estimate does not assume hiring additional treating clinicians.","Evaluation includes data management, clinical adjudication, complaints review, and independent decision analysis."]},"annual_recurring":{"band_2026_usd":"50K_TO_250K","scope":"Resource equivalent for maintaining the pathway for one payer-clinic implementation, including monitoring, exception review, audits, subgroup and capacity reporting, rule maintenance, compliance, and governance.","confidence":"LOW","assumptions":["The pathway remains limited in scale and uses existing authorization and scheduling systems.","Recurring costs exclude the underlying cost of therapy sessions and any material expansion in clinical capacity.","Monitoring intensity can decline from pilot levels only after eligibility and safety performance are demonstrated."]}},"research_burden":"MODERATE","earliest_credible_horizon":"3_TO_12_MONTHS","pipeline_gates":{"recognizable_externally_supportable_problem":{"status":"UNCERTAIN","reason":"The packet clearly defines authorization-attributable interruption as distinct from clinician scarcity, attendance, and clinical reassessment, but labels its occurrence as a hypothesis and provides no observed local baseline."},"identifiable_adopter_or_authorizer":{"status":"YES","reason":"The payer or utilization-review body owning the continuation rule is specifically identified as the authorizer, with clinical leadership and patient-access representation assigned governance roles."},"distinct_testable_incremental_claim":{"status":"YES","reason":"The candidate claims that changing the continuation rule for bounded low-risk cases will reduce authorization-attributable gap days and improve completed-session continuity relative to usual review, without exceeding safety, equity, utilization, wait-time, or displacement bounds."},"bounded_next_evidence_step":{"status":"YES","reason":"A one-clinic pre-enrollment pathway audit can safely compare authorization-attributable interruptions with supply, clinical, documentation, and attendance causes and can falsify the diagnosed problem without changing care."},"no_unresolved_safety_or_authority_stop":{"status":"YES","reason":"The candidate assigns authority to the rule owner, excludes unstable and diagnostically uncertain cases, preserves consent and clinician judgment, retains swallowing escalation, and specifies rollback and sunset protections; thresholds still require operationalization before deployment."},"implementation_cost_scope_and_range":{"status":"UNCERTAIN","reason":"The one-clinic, 12-week scope is bounded, but the sealed candidate contains no labor, integration, data-access, compliance, evaluation, or recurring-resource information from which an implementation range can be affirmatively supported."}},"blocking_evidence":["A local pathway audit establishing that authorization or visit-cap rules cause a nontrivial share of gaps among indicated plans with willing patients, available clinicians, and usable appointment capacity.","Operational definitions and measured performance for identifying stable low-risk continuation cases while detecting deterioration, swallowing risk, insufficient benefit, and diagnostic uncertainty.","Prespecified safety, inappropriate-utilization, inequity, complaint, total-wait-time, and wait-list-displacement measures and halt thresholds.","Evidence that the rule-owning payer, clinic leadership, and patient-access representatives are willing and able to govern a bounded evaluation.","A scoped prior-art and current-practice review before making any distinctiveness or novelty claim."],"next_evidence_step":"Conduct a time-bounded, non-interventional pathway audit at one candidate clinic covering plans that reach continuation checkpoints. Compare authorization-attributable gap days and completed-session continuity with gaps caused by clinician supply, clinical reassessment, incomplete documentation, lack of benefit, and nonattendance, stratified by payer and relevant access subgroups. Do not launch the pathway if clinically indicated plans with willing patients and usable capacity are almost never interrupted by authorization or visit-cap rules.","research_questions":["What proportion of continuation-checkpoint gaps is attributable to authorization or visit-cap rules after separating supply, clinical, documentation, benefit, and attendance causes?","Can stable low-risk continuation cases be defined with acceptable sensitivity to deterioration, swallowing risk, diagnostic uncertainty, and low-benefit therapy?","Does risk-tiered continuation outperform usual review and a faster-review rival on authorization-attributable gap days and completed-session continuity?","What effects occur on safety, appropriateness, pooled utilization, subgroup access, total wait time, and displacement of new or higher-need patients?","Which measurable thresholds should trigger case reversion, enrollment pause, pathway rollback, or nonrenewal?","Do comparable risk-tiered continuation waivers, visit-cap exceptions, or authorization pathways already exist in relevant practice?","What implementation resources and governance commitments would the rule-owning payer and clinic actually require?"],"recommendation":"VALIDATE_PROBLEM_FIRST","uncertainty_constraints":["The prevalence and magnitude of authorization-attributable interruption are unmeasured.","No realized clinical, continuity, workload, equity, utilization, or capacity effect is established.","Low-risk classification validity and measurable eligibility criteria are unknown.","Pilot outcome definitions, denominators, subgroup plans, and halt thresholds are not operationalized.","Payer willingness, clinic participation, data accessibility, and workflow integration are unverified.","Prior art and world novelty are unsearched.","Cost bands are resource-equivalent planning ranges based on stated scope assumptions, not observed implementation costs.","The proposal does not generalize to gaps predominantly caused by clinician scarcity, clinical necessity, or nonattendance."],"closed_book_prior_art_boundary":"No novelty, prevalence, market-size, realized-impact, or exact-cost claim is made. The packet explicitly marks prior art as unsearched; therefore any judgment of distinctiveness is limited to the internal contrast with unchanged-criteria workflow automation and requires external research."}