Automated AI Platform for Surgery Approval
A decision support platform for surgery approval based on a broad AI analysis of the clinical components under consideration
29% of surgeries are not clinically necessary (not including plastic surgeries). Any surgery can lead to further medical deterioration, mental burden and even death due to complications.
In addition, procedures that are performed without an acceptable clinical indication, expose the insurer to added costs, and both the insurer and physician to the risk of litigation, as well as a higher rate of bad outcomes and complications, with the associated costs.
Therefore, unnecessary surgery should be avoided.
Inventors
Contact info
Avital Pritz, Director of Medical Devices and Digital Health
For further information please contact:
avital@mor-research.comAn AI based pre-authorization platform for payers combining:
1. A structured online questionnaire for physicians in the case of surgeries with medical and financial significance
2. Medical guidelines and cumulative experience of tens of thousands of actual authorization committees in the Clalit Mushlam Insurance
3. A machine-learning algorithm developed to analyze the different clinical components of each application, that acts as an expert committee
Most insurers have a pre-authorization process performed by teams of non-physicians who screen requests manually according to rigid, predefined criteria. This process causes physicians and patients great frustration due to the long approval times and the lack of understanding of clinical nuances.
It is estimated that over $210 billion are wasted on unnecessary services and procedures.
Our system will make the approval process faster, less costly, and more consistent across the board. But more importantly, it will reduce the number of unnecessary procedures and shorten the patient’s time to therapy.
A first version of the system is under development