ClinicalBox Improves Surgery through Enhanced Prior Authorization and Clinical Coordination

Chris Muir and Brett Coughlin | August 19, 2019

One in an occasional series of ‘Where-are-they-now?’ posts about ONC Challenge Winners

We recently checked in with  ClinicalBox  and Lowell General Hospital about their progress since being selected as one of six winners of ONC’s 2015 Market Research and Development (R&D) Pilot Challenge in 2015.* This challenge broke down the barriers between promising start ups and healthcare stakeholders by helping early stage health information technology (health IT) companies connect with healthcare organizations that were willing to host pilot programs.

ClinicalBox offers a tool for surgical practices that improves coordination on three fronts: clinical, payment, and patient engagement. Among the company’s clients are surgical groups, hospitals, surgery centers, health plans, and patients.

Since winning the ONC challenge, ClinicalBox expanded its focus to digitizing prior authorizations, automating proof of medical necessity for claims processing, and integrating health plans (based on cost and quality) at the site of surgical care.

According to ClinicalBox CEO, Farbod Hagigi, it’s not only about digitizing an antiquated paper-based process, it’s streamlining surgeons’ experience by helping them automate their electronic health records (EHRs) by integrating their clinical notes into insurance prior authorizations. In addition, ClinicalBox uses richer and deeper sources of clinical data for health plans to direct patients to the highest quality and lowest cost sites of care, Hagigi says. Simply, the ClinicalBox platform closes the loop by systematically collecting and analyzing pre and post-surgery outcomes data.

After an initial pilot program in 2015, ClinicalBox entered into a contract with Lowell General Hospital in Lowell, MA. Using data from over 15,000 surgeries per year across two hospital campuses and a surgery center, Hagigi says they are making progress to improve care. Since then, ClinicalBox has been expanding to other hospitals and surgery centers across the country.

‘Clinical and Administrative Leadership’ Perspective from Lowell General Hospital

“For surgeons, every minute counts,” says Dr. David Prybyla, an orthopedic surgeon who operates at Lowell General Hospital and is the Medical Director of their joint replacement program. “We’ve been at the mercy of poorly designed and expensive software and broken processes for years,” says Prybyla, who is also Medical Director at an ambulatory surgery center. Prybyla said that ClinicalBox software helps him maximize his time, improve outcomes for patients, and boosts the financial performance of his practice.

For surgeons, every minute counts

Lowell General Hospital’s Vice President of Patient Care Services and Chief Nurse Executive Cecelia Lynch, emphasized how the strong technology backbone that ClinicalBox has created enables the hospital to take on more risk-based contracting in the years ahead. Robust, objective and reproducible risk stratification enables this strategy, added the Hospital’s Chief of Anesthesiology, Dr. Harohalli Vijayakumar.

Hagigi said that part of ClinicalBox’s success can be attributed to its flexibility.

“If there is an application programming interface (API), we use an API,” he said, “but really we’re ready to use whatever is there: API, custom HL7 interface to FHIR, etc.” For ClinicalBox, he added, the focus is not on how they get access to the data but on delivering value to the customer.


2011 – 2012 – ClinicalBox company formation

2012 – 2014 – Initial product development and engaging with early customers

2015 – Wins ONC Market R&D Challenge* ($300K to six winners including ClinicalBox and Lowell General Hospital).

2015 – Present – Business expansion in target markets and now across the nation.

2018 – Present – Development and launch of prior authorization and site-of-care optimization solutions.

Share your interoperability story on the Interoperability Proving Ground (IPG) or sign up for ONC’s weekly email updates for upcoming challenge announcements.

*Applications were received from 78 host-innovator teams from across the nation. Most of the proposed pilots focused on technological tools to help with care coordination, patient-generated health data, medication management, and/or underserved communities.