Cardiorenal Access Ratification Memo (Redacted Excerpt)

1) Concrete problem framing

Prior-authorization criteria in [payer region A] are still aligned to legacy evidence and are now misaligned with the current risk profile in [high-risk cohort]. Delay is visible as slower appropriate starts and avoidable acute utilization leakage.

2) Explicit recommendation

Approve a bounded local override for exactly three accounts. Apply updated entry criteria from the governance packet and leave all non-pilot account criteria unchanged during the window.

3) Decision-owner path

Owner initiates packet sign-off through Brand Strategy → HEOR → Medical/MLR → Legal → Procurement. Activation requires written approval from Medical/MLR and Legal plus executed pilot procurement terms.

4) Safeguards and rollback

Safety and utilization guardrails are reviewed weekly. If any guardrail breaches twice in a rolling 14-day period, pilot logic is paused within one business day and reverts to legacy criteria until committee re-review.

5) What changes next week vs later

Next week: finalize signers, lock pilot accounts, run checklist training, and adjudicate first cases.

Later (day 45–120): review leakage, cycle-time, and safety outcomes to scale, narrow, or sunset.