Your most expensive surgical complication claims are predictable & avoidable.
Your medical policies already require optimization before surgery. Hoopcare screens surgical requests for modifiable risk, routes flagged members to preoperative optimization and gives utilization teams an auditable view from request to OR readiness.
Payer concept preview. Not an offered product, and not for coverage,
payment, or prior-authorization decisions.
OUR UPCOMING PUBLICATIONS
Validated AI models trained on 1.3M+ procedures to predict complications.
Model development and analysis are complete. Final manuscript details are being prepared ahead of submission.
AI-Enabled Preoperative Chart Review for Surgical Complications Prediction
PRE-SUBMISSION - 2026
AUTOMATIC CHART REVIEW
AI-Enabled Preoperative Triage for ASC Eligibility Prediction
PRE-SUBMISSION - 2026
ASC ELIGIBILITY
Machine Learning Model to Predict RBC Transfusion Volume
PRE-SUBMISSION - 2026
TRANSFUSION RISK
Preoperative Prediction of Postoperative Hospital & ICU Length of Stay
PRE-SUBMISSION - 2026
LENGTH OF STAY PREDICTION
LLM driven M&M review: Cause, Mechanism, and Preventability
PRE-SUBMISSION - 2026
AI M&M REVIEW
Machine Learning Model to Predict VTE after Surgery and Guide Thromboprophylaxis
PRE-SUBMISSION - 2026
VTE RISK
Machine Learning Model to Predict High Pain Level after Surgery
PRE-SUBMISSION - 2026
PAIN RISK
AI-EKG Model to Predict Low Ejection Fraction before Surgery
PRE-SUBMISSION - 2026
CARDIAC EVALUATION
HOW IT WORKS
One objective. Two ways to operationalize it.
↳ Reduce post-op. complications
Preoperative optimization for your patients.
Every elective case at your in-network hospitals is screened by our models. Members with modifiable risk factors — anemia, uncontrolled diabetes, cardiac conditions, smoking — are flagged and routed into the hospital's preoperative optimization pathway. They arrive at surgery prepared instead of becoming your next complication claim.
Route patient to ASC and outpatient centers with confidence.
When a member carries specific unaddressed risk factors, the request is flagged — with the evidence — so your medical directors can make authorization conditional on optimization first. Not a denial: a documented path to a safer yes in the right environment.
Your medical policy already requires preoperative optimization. Now it can be enforced.
01. Screen
AI-powered risk analysis for every surgery request
Every prior-auth request is screened automatically: complication risk, predicted length of stay, modifiable risk factors. No chart pulls, no attestation checkboxes.
02. Authorize Conditional authorizationtied to specific optimization
Flagged members get a conditional authorization with the exact to-do list — treat the anemia, control the glucose — and the in-network hospital gets the workflow to run it, inside their EHR. Not a denial: a path to yes.
03. Better outcomes
Triple win for patients, providers & payers
The plan stops paying for preventable complications. The hospital gets paid to prevent them — optimization is billable care, and the case stays scheduled. The patient gets a safer surgery, prepared instead of cancelled.
Why it works
Risk-scored across the procedures that drive surgical spend.
Lung tumor
Bariatric surgery
Heart valve procedures
Hip replacement
Hysterectomy
CABG
Gastric Sleeve
Bunion
Colectomy
Breast cancer surgery
Appendectomy
Cardiac surgery
Orthopedic surgery
Spine surgery
Shoulder replacement
Brain tumor
Knee replacement
Vascular procedures
Colonoscopy
Cataract surgery
Hernia
C-section
Thyroidectomy
FIRST-CLASS EVALUATION
200+ risk factors surfaced — most of them fixable before surgery.
"Built by anesthesiologists who've seen what an unprepared patient costs" Dr. Richard Boyer, MD, PhD Anesthesiologist and Cofounder
Anemia & transfusion risk
Identified weeks out, treatable before the OR — an avoided transfusion is an avoided cost and a better outcome.
Cardiac risk
The conditions that turn outpatient cases into inpatient stays — caught in time to optimize.
Diabetes & metabolic risk
Glycemic control verified before surgery, fewer infections and readmissions after it.
Infection risk
Prevention protocols triggered before the incision, not after the readmission.
Respiratory risk
COPD, asthma, smoking: cessation and optimization windows, not day-of-surgery surprises.
Reduce avoidable surgical spend. Improve quality of care and outcomes .
A triple win, by design.
Screening finds the risk early. Optimization removes it. A patient who arrives prepared pays off three ways:
→ The plan wins — fewer complication claims, shorter stays, defensible UM with an audit trail behind every decision. → The hospital wins — the case stays scheduled, optimization is billable care, cancellations and readmission-penalty exposure drop. → The patient wins — risks fixed before the incision: safer surgery, shorter stay, no last-minute cancellation.
Let's explore the options or send your questions → contact@hoopcare.com
BAA signed, then we take your medical policy for 2–3 high-volume procedures and a de-identified extract of your surgical claims. Outcome: a defined scope, no integration required.
Weeks 2–3
Retrospective analysis
Our models run on your past data. Outcome: which complication claims were predictable — and which cases were ASC-eligible.
Week 4
Findings review
We present the results to your medical directors: predictable claims, site-of-service opportunity, ROI computed on your own data. Outcome: a business case you didn't have to build.
Week 5+
Prospective rollout
Screening goes live on new authorization requests with participating in-network hospitals — flag, optimize, re-score. Outcome: the mechanism, running on your book.
We handle the hurdles of bringing AI to payrs.
From security review to regulatory sign-off, our team has done this before — so yours doesn't have to learn it the hard way.
Forward-deployed engineers
Integration with your data environment workflow is our job, not another project on your roadmap.
HIPAA & BAA covered
BAA signed, HIPAA-compliant by design, and deployable in your own cloud tenant — your compliance team gets answers, not surprises.
Regulator-ready by design
Physician-in-the-loop, explainable flags, audit trails — built for the direction prior-auth rules are moving.
Evidence, not promises
Every model is headed for peer review — you'll see the publications before you see a contract.
Contact us
Curious about our solution or have inquiries? We're eager to assist! Just complete the form below, and we'll respond promptly.
THEY TRUST US
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