In the US, before performing surgery on a patient, a doctor first requests the patient’s insurance provider to approve the cost of surgery. To do so, the insurance company asks an expert to decide whether the surgery is necessary (make a “go/no-go decision”). Sandra is the CEO of RW Health (RWH), a startup that brokers a product (decisions on whether to authorize medical procedures) between suppliers (professors at partner medical schools) and clients (insurance companies). The demand for RWH’s service is growing rapidly, and Sandra’s biggest challenge is to deliver enough decisions. To increase its capacity, RWH recently signed an agreement with Major Medical School.
However, last night, the director of MMS, informed Sandra that MMS would not be able to provide what it had contractually agreed to. What should Sandra do?
- Structure the decision process
- Identify a better overarching question for the decision
- Generate innovative options
- Identify appropriate criteria to evaluate the options
Health and Medical Services, Insurance
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