# Managed Authorization Operations

*/Opportunities/Managed_Authorization_Operations*

## Opportunity Overview

**Wedge**: Start exclusively with outpatient orthopedic clinics submitting imaging and joint replacement authorizations to regional Medicare Advantage plans. Orthopedics features high volume, standardized clinical pathways, and exceptionally stringent prior authorization requirements, yielding immediate ROI. Once established, expand horizontally into adjacent high-value specialties like gastroenterology and cardiology before targeting broader inpatient procedures.
**Timing**: Large language models with extended context windows now accurately extract specific clinical indicators from unstructured patient charts and match them against complex payer policy documents. Previously, this required rigid OCR and deterministic rules engines that failed on clinical nuance.
**Why This I C P**: Independent specialty clinics face high authorization volumes for expensive procedures but lack the administrative scale of massive health systems to absorb the labor cost. They feel the margin squeeze acutely and make purchasing decisions quickly without multi-year IT committee review cycles.
**Size Of Prize**: The US market contains roughly 200,000 independent specialty practices. Each spends an average of $30,000 annually on dedicated authorization specialist labor, creating a $6B addressable market for automated authorization operations.
**Gap Narrative**: Clinics and billing teams require prior authorizations completed accurately to secure reimbursement. Current software only provides workflow tracking, forcing human staff to manually read clinical notes and submit payer forms. The market demands a solution that ingests clinical documentation, maps it to payer rules, and executes the submission automatically.
**Defensibility**: The system builds proprietary mappings between unstructured clinical phrases and specific payer approval outcomes. As volume scales, the model learns the exact documentation thresholds required by specific regional payers to prevent denials, creating a shared knowledge asset unavailable from public policy documents. Switching costs become prohibitive once clinics eliminate their internal authorization staff entirely.
**Why This Thesis**: The Service-as-Software model fits exactly because clinics do not want another SaaS dashboard to manage; they want the authorization labor completely outsourced. Delivering the approved authorization rather than a workflow tool transfers the operational burden entirely, matching their goal to reduce administrative headcount.

## Opportunity Linked Thesis

**Thesis**: [Service-as-Software](/Theses/Service-as-Software)

## Opportunity Linked I C P

**Icp**: [Specialty Medical Practice](/CompanyTypes/Specialty_Medical_Practice)

## Opportunity Market Sizing

_Illustrative — target and order-of-magnitude estimate figures, not an achieved track record (this Thing is concept-stage)._

**S A M**: ~$1.5-2B (independent specialty groups with high prior-authorization volume, such as orthopedics, oncology, and cardiology)
**S O M**: ~$50-150M
**T A M**: ~100k US specialty medical practices × ~$50k/yr in prior-authorization labor and tools ≈ $5B
**Growth Rate**: ~12-18%/yr, driven by escalating payer prior-authorization requirements and chronic medical administrative staffing shortages
**Paid Comparable Spend**: ~$40k-80k/yr per practice spent on dedicated internal billing specialists, legacy clearinghouses, and outsourced RCM service fees

## Opportunity Incumbents

- [Microsoft Entra ID](/Products/Microsoft_Entra_ID) — Tool
- [Open Policy Agent](/Products/Open_Policy_Agent) — Open-Source
- [Custom In-House RBAC](/Products/Custom_In-House_RBAC) — DIY
- [Okta Identity Governance](/Products/Okta_Identity_Governance) — Tool
- [Hardcoded Application Logic](/Products/Hardcoded_Application_Logic) — DIY
- [Oso Cloud](/Products/Oso_Cloud) — Tool
- [Cerbos Authorization](/Products/Cerbos_Authorization) — Open-Source

## Opportunity Win Conditions

**Kill Thresholds**:
- Average API latency exceeds 50ms at the 99th percentile after 30 days
- Less than 20% of signups deploy a production policy within 14 days
- Customer churn exceeds 15% in the first 90 days due to compliance blockers
- CAC exceeds $10k for mid-market engineering teams after 90 days
**Leading Metrics**:
- Time-to-first-policy deployment in hours
- Average authorization request latency in milliseconds
- Daily permission checks processed per active account
- Percentage of policies generating syntax errors during testing
- Integration completion rate within first 14 days
**What Proves Right**: Engineering teams adopt the platform to replace in-house role-based access control and Open Policy Agent deployments. Users successfully integrate the authorization API into their core applications within the first 14 days and process over 10,000 permission checks daily. Cohorts retain at a 90 percent rate after six months because the system removes the overhead of managing custom authorization logic.
**What Proves Wrong**: Developers revert to hardcoded application logic or self-hosted Open Policy Agent because the managed service introduces unacceptable latency into their API calls. The platform fails to capture market share if security teams refuse to outsource authorization data due to strict compliance constraints. Implementation stalls past 30 days as teams struggle to map their complex domain permissions into the provided policy language.

## Opportunity Build Profile

**Hardest Part**: Building and maintaining reliable, state-aware read/write integrations with hundreds of long-tail SaaS applications that lack standard SCIM or API endpoints for granular permission management.
**Min Viable Scope**: Scope v1 strictly to read-only User Access Reviews (UAR) for SOC2 compliance, targeting only the core engineering stack. Deliberately exclude write-access auto-provisioning, just-in-time access requests, and HRIS-driven lifecycle management.
**Cold Start Problem**: The platform requires a critical mass of active SaaS integrations before an enterprise can abandon their manual access spreadsheets. Break this by targeting DevSecOps and building deep, read-only integrations for only the top 15 infrastructure tools to solve engineering compliance first.
**Time To First Value**: 1-2 weeks of onboarding to connect initial core systems via API and generate the first normalized access roster
**Data Moat Available**: true
**Technical Difficulty**: High

## Neighborhood

### Where the gap lives

- [Prior Authorization Specialist](/Agents/Prior_Authorization_Specialist) — latent gap · Agents

### Incumbent in

- [Microsoft Entra ID](/Software/Microsoft_Entra_ID) — incumbent in · Software
- [Open Policy Agent](/Products/Open_Policy_Agent) — incumbent in · Products
- [Oso Cloud](/Products/Oso_Cloud) — incumbent in · Products
- [Cerbos Authorization](/Products/Cerbos_Authorization) — incumbent in · Products
- [Custom In-House RBAC](/Products/Custom_In-House_RBAC) — incumbent in · Products
- [Hardcoded Application Logic](/Products/Hardcoded_Application_Logic) — incumbent in · Products
- [Okta Identity Governance](/Products/Okta_Identity_Governance) — incumbent in · Products

### Applies thesis

- [Specialty Medical Practice](/CompanyTypes/Specialty_Medical_Practice) — applies thesis · CompanyTypes

### Embodies

- [Service-as-Software](/Theses/Service-as-Software) — embodies · Theses

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