{"schema_version":1,"experiment_id":"eoa_inverse_innovation_exp03_full320_20260801","cell_id":"deadweight_loss_reduction__medicine_healthcare","trajectory_id":"R","attempt_index":0,"archetype_slug":"deadweight_loss_reduction","domain_slug":"medicine_healthcare","decision":"CANDIDATE","problem_id":"repetitive_prior_authorization_gaps_in_stable_maintenance_therapy","causal_lever_id":"risk_tiered_auto_renewal_with_exception_review","proposal":{"problem":"HYPOTHESIS: Repetitive prior-authorization renewals for clinically stable maintenance therapies can interrupt treatment when unchanged, previously approved cases must repeatedly clear a coarse permission rule whose avoidable delay exceeds its incremental utilization-control or safety value.","actors_substrate":["patients receiving stable maintenance therapy","prescribing clinicians and staff","pharmacies","health-plan or pharmacy-benefit authorization teams","payer medical directors","caregivers and dependents"],"observable_state":"HYPOTHESIS: Eligible patients show renewal-pending days, medication gaps, abandoned fills, repeated document requests, and staff rework despite unchanged therapy and prior approval.","consequence":"HYPOTHESIS: Some indicated treatment is delayed or abandoned, clinical and administrative capacity is consumed, and patients substitute urgent contact or less suitable therapy without an offsetting protective benefit in every case.","affected_objective":"Maintain clinically appropriate continuity of therapy while preserving review for changed risk, contraindications, misuse, fraud, nonresponse, or materially altered eligibility.","structural_mapping":[{"archetype_element":"Value-blocking wedge","domain_realization":"A time-limited authorization expires and blocks dispensing until a repeated permission process is completed.","claim_kind":"HYPOTHESIS"},{"archetype_element":"Otherwise beneficial activity","domain_realization":"Continuation of an unchanged, previously approved maintenance therapy for a stable patient.","claim_kind":"INFERENCE"},{"archetype_element":"Protected purpose","domain_realization":"Review of appropriateness, safety, coverage, utilization, and misuse when clinically material conditions change.","claim_kind":"INFERENCE"},{"archetype_element":"Avoidable distortion","domain_realization":"Full re-review of low-risk unchanged cases rather than exception-triggered review.","claim_kind":"HYPOTHESIS"},{"archetype_element":"Redesign","domain_realization":"Automatic time-bounded renewal for narrowly eligible cases, with explicit change triggers and clinician override routing cases to substantive review.","claim_kind":"HYPOTHESIS"},{"archetype_element":"Incidence and monitoring","domain_realization":"Measure continuity gains and workload changes alongside inappropriate continuation, adverse events, inequitable eligibility, gaming, and displaced review burden.","claim_kind":"INFERENCE"}],"component_map":[{"component":"Distortion Map","status":"direct","domain_realization":"Trace expiration, submission, review, pharmacy rejection, and treatment-gap points."},{"component":"Protected Constraint Safeguard","status":"direct","domain_realization":"Retain substantive review for clinical or eligibility changes and exception signals."},{"component":"Surplus Estimate","status":"adapted","domain_realization":"Estimate recovered therapy-days, patient time, and staff capacity with uncertainty."},{"component":"Affected-Party Incidence Map","status":"direct","domain_realization":"Record effects on patients, caregivers, clinicians, pharmacies, reviewers, and plan members."},{"component":"Redesign Lever","status":"direct","domain_realization":"Risk-tiered auto-renewal with exception-triggered review."},{"component":"Distributional Review","status":"direct","domain_realization":"Test whether eligibility excludes complex, disabled, rural, or otherwise burdened patients."},{"component":"Behavioral Response Model","status":"direct","domain_realization":"Anticipate prescriber behavior, coding changes, demand expansion, and reviewer displacement."},{"component":"Implementation Boundary","status":"direct","domain_realization":"Limit therapy classes, stability criteria, sites, duration, and enrollment."},{"component":"Monitoring and Rebound Check","status":"direct","domain_realization":"Track gaps, overrides, inappropriate continuation, harms, workload, and utilization."},{"component":"Rollback or Adjustment Rule","status":"direct","domain_realization":"Suspend auto-renewal or narrow eligibility when prespecified harm triggers fire."},{"component":"Cost–Benefit Assessment Frame","status":"direct","domain_realization":"Compare continuity and capacity gains with safety, utilization, transition, and fiscal costs."},{"component":"Price-Wedge Diagnostic","status":"incompatible","domain_realization":"The proposed wedge is permission and delay, not an administered access price."},{"component":"Friction Source Breakdown","status":"direct","domain_realization":"Separate substantive clinical review from duplication, routing delay, and repeated data collection."},{"component":"Compensating Adjustment Plan","status":"adapted","domain_realization":"Provide rapid human escalation for excluded or adversely affected patients rather than monetary compensation."},{"component":"Legitimacy and Authority Review","status":"direct","domain_realization":"Confirm payer authority, contractual duties, clinical governance, and appeal rights."},{"component":"Sensitivity Analysis","status":"direct","domain_realization":"Vary estimates of preventable gaps, reviewer savings, excess use, and safety risk."},{"component":"Pilot or Sunset Path","status":"direct","domain_realization":"Use a bounded pilot whose lighter pathway expires unless evidence supports renewal."}],"mechanism_dispositions":[{"slug":"congestion_or_capacity_pricing_adjustment","disposition":"considered_rejected","contribution_type":"NONE","adaptation_or_rejection":"Delay is not caused by peak access being underpriced.","counterfactual_removal":"No material change."},{"slug":"cost_benefit_assessment_protocol","disposition":"selected_supporting","contribution_type":"TEST_DESIGN","adaptation_or_rejection":"Compare recovered continuity and labor with safety, utilization, equity, and fiscal effects.","counterfactual_removal":"The pilot could mistake cheaper processing for net benefit."},{"slug":"distortion_reduction_review","disposition":"selected_load_bearing","contribution_type":"CORE_CAUSAL","adaptation_or_rejection":"Separate repetitive procedural review from clinically protective review and size blocked continuity.","counterfactual_removal":"There would be no defensible basis for identifying an avoidable wedge."},{"slug":"impact_assessment_table","disposition":"selected_supporting","contribution_type":"SAFETY_GUARDRAIL","adaptation_or_rejection":"Register party-level effects, protected interests, and monitoring triggers.","counterfactual_removal":"Aggregate gains could conceal concentrated access or safety losses."},{"slug":"matching_improvement_program","disposition":"considered_rejected","contribution_type":"NONE","adaptation_or_rejection":"Patients and therapies are already paired; permission renewal is binding.","counterfactual_removal":"No material change."},{"slug":"permit_or_approval_streamlining","disposition":"selected_load_bearing","contribution_type":"CORE_CAUSAL","adaptation_or_rejection":"Replace full repetitive review with risk-tiered renewal while retaining substantive exception checks.","counterfactual_removal":"The approval wedge remains unchanged."},{"slug":"price_control_redesign","disposition":"incompatible","contribution_type":"NONE","adaptation_or_rejection":"No price cap, floor, or subsidy is the diagnosed cause.","counterfactual_removal":"No material change."},{"slug":"quota_or_allocation_rule_review","disposition":"considered_rejected","contribution_type":"NONE","adaptation_or_rejection":"The target is neither a fixed treatment quota nor stale slot allocation.","counterfactual_removal":"No material change."},{"slug":"regulatory_simplification_pilot","disposition":"selected_supporting","contribution_type":"TEST_DESIGN","adaptation_or_rejection":"Adapt to a payer-governed, narrow, expiring auto-renewal pilot with protected-outcome monitoring.","counterfactual_removal":"Initial implementation would lack bounded reversibility."},{"slug":"sunset_clause_review","disposition":"selected_supporting","contribution_type":"OPERATIONAL","adaptation_or_rejection":"Require the pilot pathway and affected renewal rule to be re-justified at a fixed review date.","counterfactual_removal":"Either pathway could persist without evidence-based reconsideration."},{"slug":"tariff_fee_or_toll_redesign","disposition":"incompatible","contribution_type":"NONE","adaptation_or_rejection":"An authority-imposed charge is not the proposed wedge.","counterfactual_removal":"No material change."}],"causal_chain":["Repeated expiration subjects unchanged cases to a full permission pathway.","Submission, routing, and review create a period in which dispensing is blocked.","HYPOTHESIS: Some blocked patients experience avoidable treatment gaps or abandonment.","Risk-tiered auto-renewal removes that block for narrowly defined stable cases.","Exception triggers preserve substantive review where expected protective value is higher.","Pilot monitoring tests whether continuity improves without unacceptable safety, utilization, equity, or fiscal harm."],"baseline":"Ordinary baseline: every authorization expires on its existing schedule; clinicians resubmit required material, pharmacies await approval, and patients use normal appeal or escalation routes.","nearest_rival":"Electronic prior-authorization automation, a transaction-cost intervention. It speeds the same review; the proposal instead changes which stable cases require full re-review at all.","authority_safety":{"affected_parties":["patients and caregivers","prescribers and clinical staff","pharmacies","authorization reviewers","payer or benefit-plan members"],"decision_authority":"The payer or benefit-plan authority responsible for authorization policy, acting through accountable medical and pharmacy leadership and subject to applicable appeal and coverage obligations.","authorized_first_step":"Run an expiring pilot for one narrowly specified maintenance-therapy cohort with prior approval, documented stability, no material change triggers, rapid clinician escalation, and concurrent protected-outcome monitoring.","excluded_actions":["Removing authorization across all therapies","Overriding clinician judgment","Auto-renewing cases with new contraindications, material clinical change, suspected misuse, or changed eligibility","Reducing appeal, notice, privacy, or nondiscrimination protections","Treating lower administrative cost alone as success"],"halt_rollback":"Pause enrollment and revert affected cases to the ordinary pathway if prespecified serious harm, inappropriate-continuation, inequity, data-integrity, or escalation-failure thresholds are crossed; narrow or terminate the pilot after review."}},"negative_tests":{"strongest_counterevidence":"HYPOTHESIS: Repeated renewal may detect enough clinically important change, inappropriate continuation, or coverage error to justify its burden; observed medication gaps may instead be driven mainly by affordability, stock, adherence, or prescribing delays.","analogy_break":"Healthcare continuation is not an ordinary mutually beneficial exchange: information asymmetry, clinical uncertainty, third-party payment, and patient vulnerability can make an apparent wedge a legitimate safety or stewardship control.","failure_condition":"The redesign fails if exception triggers cannot reliably separate stable low-risk cases from cases needing substantive review, or if expedited cases create unacceptable harm, inequity, excess utilization, or displaced workload.","problem_falsifier":"After linking authorization, dispensing, and clinical workflow records, unchanged previously approved cases do not experience materially more gaps, abandonment, or avoidable work around renewal, or substantive review commonly changes management.","intervention_falsifier":"Within the bounded eligible cohort, auto-renewal does not reduce authorization-attributable gaps or total burden relative to baseline, or it worsens prespecified safety, appropriateness, equity, utilization, or fiscal outcomes beyond accepted margins.","risks":["Inappropriate therapy continuation","Missed contraindications or clinical deterioration","Gaming of stability criteria","Unequal access to auto-renewal","Privacy or data-linkage failures","Review burden displaced to appeals or clinicians","Utilization growth without patient benefit","Premature generalization from a low-risk pilot"]},"null_rationale":null,"classification":{"candidate_kind":"MECHANISM_COMPOSITION","prior_art_status":"UNSEARCHED","evidence_maturity":"HYPOTHESIS"},"revision_change_log":{"revision_kind":"ORIGINAL","prior_problem_id":null,"prior_causal_lever_id":null,"problem_changed":false,"causal_lever_changed":false,"conceptual_changes":[],"operational_changes":[],"repairs_addressed":[]},"confidence":0.83,"generator_notes":"Closed-book structural inference. Domain-specific prevalence, effect size, and safety claims remain hypotheses; the proposal requires linked baseline measurement before implementation."}