{"schema_version":1,"experiment_id":"eoa_inverse_innovation_exp03_full320_20260801","cell_id":"deadweight_loss_reduction__speech_language_pathology","trajectory_id":"R","attempt_index":0,"archetype_slug":"deadweight_loss_reduction","domain_slug":"speech_language_pathology","decision":"CANDIDATE","problem_id":"administrative_interruption_of_indicated_speech_language_therapy","causal_lever_id":"risk_tiered_continuation_authorization","proposal":{"problem":"Prior-authorization steps, fixed visit caps, and repeated eligibility reviews can interrupt clinically indicated speech-language or swallowing therapy even when a qualified clinician and appointment capacity are available. The independently recognizable problem is avoidable treatment discontinuity caused by coarse utilization rules, not the general shortage of speech-language pathologists.","actors_substrate":["patients receiving speech, language, voice, fluency, or swallowing therapy","caregivers","speech-language pathologists and clinics","referring clinicians","payers or utilization-review bodies","disability and access advocates"],"observable_state":"HYPOTHESIS: Patients stable enough for protocolized continuation experience authorization-related gaps, while reserved treatment slots go unused or are filled only after clinically disruptive delay; interruption rates may differ by payer, language, disability, or caregiver capacity.","consequence":"Potential therapeutic benefit is forgone, clinicians repeat documentation and reassessment work, families pursue appeals or substitutes, and available treatment capacity may be allocated by administrative endurance rather than clinical need.","affected_objective":"Improve timely continuity of indicated therapy while preserving clinical appropriateness, patient safety, equitable access, and responsible use of finite treatment capacity.","structural_mapping":[{"archetype_element":"value-blocking wedge","domain_realization":"Repeated approvals and coarse visit thresholds stand between an existing treatment recommendation and continued sessions.","claim_kind":"HYPOTHESIS"},{"archetype_element":"blocked mutually beneficial activity","domain_realization":"Patient and clinician would continue an indicated care plan, and the payer seeks effective care, but authorization discontinuity prevents delivery.","claim_kind":"INFERENCE"},{"archetype_element":"protected purpose","domain_realization":"Utilization review protects against inappropriate, duplicative, unsafe, or indefinitely ineffective treatment and preserves pooled resources.","claim_kind":"INFERENCE"},{"archetype_element":"less-distortive redesign","domain_realization":"Automatically continue low-risk, stable plans for a bounded interval while reserving clinician review for safety flags, material changes, or weak progress.","claim_kind":"HYPOTHESIS"},{"archetype_element":"incidence and rebound control","domain_realization":"Track continuity, outcomes, utilization, adverse events, denials, subgroup effects, gaming, and displacement of higher-need patients.","claim_kind":"HYPOTHESIS"}],"component_map":[{"component":"Distortion Map","status":"direct","domain_realization":"Trace each authorization rule to delayed, canceled, substituted, or abandoned indicated sessions."},{"component":"Protected Constraint Safeguard","status":"direct","domain_realization":"Retain swallowing-risk escalation, clinical review triggers, documentation standards, and appropriateness checks."},{"component":"Surplus Estimate","status":"adapted","domain_realization":"Estimate recovered treatment time, avoided repeat work, reduced gaps, and capacity use without monetizing clinical benefit falsely."},{"component":"Affected-Party Incidence Map","status":"direct","domain_realization":"Compare effects on patients, caregivers, clinicians, payers, and groups with unequal appeal capacity."},{"component":"Redesign Lever","status":"adapted","domain_realization":"Use risk-tiered continuation authorization with bounded duration and exception review."},{"component":"Distributional Review","status":"direct","domain_realization":"Test whether easier continuation advantages well-resourced clinics or displaces new and higher-need patients."},{"component":"Behavioral Response Model","status":"direct","domain_realization":"Anticipate longer treatment requests, coding changes, demand expansion, reviewer substitution, and slot displacement."},{"component":"Implementation Boundary","status":"direct","domain_realization":"Limit eligibility by condition stability, care-plan status, risk flags, payer, clinic, and pilot duration."},{"component":"Monitoring and Rebound Check","status":"direct","domain_realization":"Monitor gaps, utilization, outcomes, adverse events, complaints, subgroup incidence, and wait-list spillovers."},{"component":"Rollback or Adjustment Rule","status":"direct","domain_realization":"Suspend automatic continuation or narrow eligibility when safety, inequity, or excess-use thresholds are crossed."},{"component":"Cost–Benefit Assessment Frame","status":"direct","domain_realization":"Compare recovered continuity and administrative capacity with added utilization, implementation cost, and safety exposure."},{"component":"Price-Wedge Diagnostic","status":"incompatible","domain_realization":"The proposed wedge is an approval and eligibility rule, not an access price."},{"component":"Friction Source Breakdown","status":"direct","domain_realization":"Separate substantive clinical review from duplicate forms, serial handoffs, arbitrary thresholds, and decision latency."},{"component":"Compensating Adjustment Plan","status":"omitted","domain_realization":"No price-control removal creates a monetary loss requiring compensation; access and workload safeguards are handled separately."},{"component":"Legitimacy and Authority Review","status":"direct","domain_realization":"Confirm payer authority, clinical accountability, coverage terms, appeal rights, and patient-consent requirements."},{"component":"Sensitivity Analysis","status":"direct","domain_realization":"Vary assumed avoidable-gap share, treatment benefit, utilization response, capacity scarcity, and subgroup effects."},{"component":"Pilot or Sunset Path","status":"direct","domain_realization":"Run a time-limited pilot that expires unless predefined continuity and protection criteria are met."}],"mechanism_dispositions":[{"slug":"congestion_or_capacity_pricing_adjustment","disposition":"incompatible","contribution_type":"NONE","adaptation_or_rejection":"Charging more for scarce therapy would ration by ability to pay and does not repair authorization discontinuity.","counterfactual_removal":"No change to the proposed causal chain."},{"slug":"cost_benefit_assessment_protocol","disposition":"selected_supporting","contribution_type":"TEST_DESIGN","adaptation_or_rejection":"Compare continuity gains with utilization, workload, access, and safety costs under uncertain assumptions.","counterfactual_removal":"The pilot could still operate, but its welfare and distributional verdict would be materially weaker."},{"slug":"distortion_reduction_review","disposition":"selected_load_bearing","contribution_type":"CORE_CAUSAL","adaptation_or_rejection":"Distinguishes avoidable procedural interruption from clinically protective review.","counterfactual_removal":"The proposal could mistakenly remove necessary oversight or target a true capacity shortage."},{"slug":"impact_assessment_table","disposition":"selected_supporting","contribution_type":"SAFETY_GUARDRAIL","adaptation_or_rejection":"Record effects and halt signals for each affected group.","counterfactual_removal":"Aggregate improvement could conceal concentrated access or safety harm."},{"slug":"matching_improvement_program","disposition":"considered_rejected","contribution_type":"NONE","adaptation_or_rejection":"Applies only if compatible supply and demand fail to pair; this candidate requires an already identified clinician and plan.","counterfactual_removal":"No change to the proposed causal chain."},{"slug":"permit_or_approval_streamlining","disposition":"selected_load_bearing","contribution_type":"CORE_CAUSAL","adaptation_or_rejection":"Adapt permission-path streamlining to therapy continuation while ring-fencing substantive clinical checks.","counterfactual_removal":"The specific authorization wedge remains unchanged."},{"slug":"price_control_redesign","disposition":"incompatible","contribution_type":"NONE","adaptation_or_rejection":"No administered treatment price is the diagnosed cause.","counterfactual_removal":"No change to the proposed causal chain."},{"slug":"quota_or_allocation_rule_review","disposition":"selected_supporting","contribution_type":"CORE_CAUSAL","adaptation_or_rejection":"Review fixed visit caps separately from legitimate limits on ineffective or unsafe care.","counterfactual_removal":"Coarse visit thresholds could continue interrupting care despite faster paperwork."},{"slug":"regulatory_simplification_pilot","disposition":"selected_load_bearing","contribution_type":"OPERATIONAL","adaptation_or_rejection":"Use a walled-off, expiring test with live protection metrics.","counterfactual_removal":"Viability would be hard-gated because an unbounded rollout would expose patients and pooled capacity to uncertain risk."},{"slug":"sunset_clause_review","disposition":"selected_supporting","contribution_type":"TEST_DESIGN","adaptation_or_rejection":"Make the pilot pathway expire unless evidence supports renewal or revision.","counterfactual_removal":"The intervention would lose its automatic reversion safeguard."},{"slug":"tariff_fee_or_toll_redesign","disposition":"incompatible","contribution_type":"NONE","adaptation_or_rejection":"The packet provides no authority charge causing the interruption.","counterfactual_removal":"No change to the proposed causal chain."}],"causal_chain":["HYPOTHESIS: Repeated authorization and coarse visit thresholds interrupt some otherwise indicated treatment plans.","Risk-tiering separates stable continuation cases from cases requiring substantive review.","Automatic bounded continuation removes duplicate approval delay while clinical and safety triggers remain active.","INFERENCE: More scheduled indicated sessions occur with fewer administrative gaps and less repeated documentation.","Monitoring detects excess utilization, adverse outcomes, displacement, gaming, or unequal access and triggers adjustment or rollback."],"baseline":"Ordinary care uses fixed visit authorizations followed by repeated documentation, review, denial, or appeal before therapy continues; clinics and families manage gaps case by case.","nearest_rival":"Keep the same authorization criteria but add portal automation, reminders, or reviewer staffing. That may reduce transaction time, whereas the candidate changes the coarse continuation rule itself for bounded low-risk cases.","authority_safety":{"affected_parties":["patients and caregivers","speech-language pathologists and clinic staff","referring clinicians","payers and reviewers","patients waiting for initial access","groups with limited language, disability, or appeal support"],"decision_authority":"The payer or utilization-review body that owns the authorization rule, jointly governed with accountable clinical leadership and patient-access representation.","authorized_first_step":"Approve a 12-week pilot at one willing clinic for stable, currently authorized plans that reach a continuation checkpoint; compare with contemporaneous usual-review cases and report subgroup results.","excluded_actions":["waiving swallowing-safety escalation","overriding clinician judgment or patient consent","including unstable or diagnostically uncertain cases","system-wide permanent rule change","charging patients for expedited access","using aggregate gains to suppress subgroup harm"],"halt_rollback":"Immediately revert affected cases to ordinary review for a serious plausibly related safety event; pause enrollment if predefined adverse-event, inappropriate-utilization, inequity, complaint, or wait-list-displacement thresholds are exceeded. The pathway sunsets after 12 weeks without affirmative renewal."}},"negative_tests":{"strongest_counterevidence":"The apparent authorization loss may actually reflect insufficient clinician supply, clinically necessary reassessment, incomplete documentation, lack of demonstrated benefit, or appointment nonattendance. If so, lighter approval either has little effect or removes real protection.","analogy_break":"Unlike a market exchange, treatment value is uncertain, payer resources are pooled, clinician capacity is scarce, and patients cannot reliably self-assess clinical need. More sessions are not automatically surplus, so clinical appropriateness and access incidence cannot be reduced to willingness to transact.","failure_condition":"The approach fails if low-risk continuation cannot be identified reliably, substantive review cannot be separated from procedural drag, or added utilization materially crowds out higher-need care.","problem_falsifier":"A prospective pathway audit finds that clinically indicated plans with willing patients, available clinicians, and usable appointment capacity are almost never interrupted by authorization or visit-cap rules; observed gaps are predominantly supply, clinical, or attendance problems.","intervention_falsifier":"Within the bounded pilot, risk-tiered continuation does not reduce authorization-attributable gap days or completed-session continuity relative to usual review, or it worsens safety, appropriateness, subgroup access, total wait time, or displacement beyond preset bounds.","risks":["inappropriate continuation of low-benefit therapy","missed clinical deterioration or swallowing risk","coding or eligibility gaming","demand rebound and higher pooled cost","displacement of new or higher-need patients","unequal benefit for better-resourced clinics or families","clinician documentation incentives distorted by pilot eligibility","privacy loss from expanded monitoring"]},"null_rationale":null,"classification":{"candidate_kind":"DOMAIN_TRANSFER","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":0.78,"generator_notes":"Closed-book structural inference from the supplied packet. The fit depends on verifying coexistence of indicated demand, available clinician capacity, and an avoidable authorization or allocation wedge; it does not generalize to ordinary clinician scarcity."}