One of the most vital needs in healthcare is helping health systems identify and collect revenue and reduce waste. Jorie Healthcare is a revenue cycle management business using AI tools to automate cumbersome tasks, which helps hospitals operate more efficiently. In just a few short years, it has added Walmart Health as a customer. In an interview, CEO Sal Lo talked about how the company has navigated the sector and why it’s beginning to attract attention from major healthcare stakeholders.
Tell us a bit about your company and your role
I am the CEO and co-founder of Jorie Healthcare. Here in Chicago where my headquarters is, we have 50 people and 1,400 people worldwide. My family is Filipino. My brother’s a neurosurgeon down in Texas and my sister and I are co-founders in the company. We’re on the business side. My youngest sister is on the healthcare side – she’s a nurse and she works with our organization as well. In the past 10 years we’ve developed into a global technology organization, but we’ve had several companies— and still do to this day— in the healthcare space.
What was your background in healthcare prior to Jorie?
I’m an investment banker by trade – I’ve been a hospital operator, developer, builder and owner for the last 30 years, including clinics and surgery centers. My natural progression wasn’t to create a big hospital system. I built dialysis centers, and then we sold those to Vita in Chicago. Later on, we built a hospital in Beaumont, Texas. We later sold that hospital to Steward Health Care, which is the largest privately held for profit health system in the U.S.
What do you need to succeed in revenue cycle management?
Revenue cycle management is the process of billing and collecting for the health system. When you think about it, the complexities require a great deal of skill to navigate. A payer wants to pay a provider. Those rules are tremendously complex as to how much they should pay you and how much your benefits will be able to cover that. Meanwhile, the patient has a healthcare insurance card and every expectation the insurance company should be able to afford their care. Then it’s up to the provider to go back and forth with the payer.
In order to be a successful revenue cycle organization, you have to know the thousands and thousands of rules to do your job to ensure you’re getting paid correctly. That sounds like an impossibility. But that’s why we have this issue with the revenue cycle where you have lots of people trying to collect these bills. It’s about a 20% loss in administrative burden today – 20% of the trillion being spent on healthcare is used just for payment collection. We use automation to analyze these rules and to affect the rules engine of the technology to ensure proper collection. Imagine if you had to memorize a million rules. Now you have automation that can memorize all those rules, and be able to file the claim with the insurance company.
How can a small business like yours leverage technology to win over a partner like Walmart Health?
We were chosen to be the RCM provider for Walmart health because of three things.
First, we’re a healthcare provider by trade. We’re a trilingual healthcare provider, we know how to run hospitals. We know healthcare lingo. We know what the patient’s pain points are, and the evolving issues around reimbursement services.
Second, we’re a global revenue cycle organization. We have people that build and collect and have a global infrastructure of collectors out there that know those rules for the insurance companies.
Third, we are a global technology company. We develop processes and automation combining our revenue cycle expertise and have healthcare provider experience. Combining that with artificial intelligence tech we created, we were able to deliver savings for the health system. So we did this with our own hospitals and saved ourselves 20% to 30% off of our bottom line.
When we brought it out to the market, the likes of Walmart health and the VA and other large organizations like GI Alliance signed on. In the past two months alone, we signed nine hospitals to use the savings model of strategically using automation and that’s how we won the Walmart Health partnership. We’re a company with 1,400 staff, but that’s still a small company and we’ve only been around for three years. The idea that Walmart Health would choose a company like ourselves over much larger companies showed us that our automation and our ability to save them money was impactful. Walmart believed in that strategy.
How does your technology work?
Chat GPT is the new buzzword right now. Before that it was Siri and Alexa. It’s just a program with several layers of thinking/processes – a virtual human, so to speak. Let’s say that I’m entering information and I find out that my health insurance company declined to reimburse a service I want. I’d call them up and see if I can submit some documentation that they need so they could approve the service. Our automation mimics humans and takes action. Instead of you calling up the insurance company, it automatically pulls the information, submits it and files a claim to the insurance company. If the company denies the claim again, our tech finds out why it denied again, and then it goes after the claim.
When I say we’re the data connector, our AI tech is at the point now where it could make a difference in healthcare. In our panel discussion at INVEST in May, everyone was talking about putting processes around trying to find the person that needs help and creating care teams. The bottom line is that we’re really excited to be able to take this automation and put it in place where it needs to be.
What pain points does your tech solve?
How the tech actually finds and saves money. There’s specific processes in automation that a human cannot do. For example: short balances. When you file a claim to the insurance company and there is an amount of money that’s still outstanding, it doesn’t balance out and it’s $2,500 or or less, we call them short balances. And this money is either owed to the insurer, owed to the provider by the insurance company, or a part of it might be owed by a patient, but the hospital doesn’t bother collecting it because it costs too much money. So our technology is a perfect case study to find that money 24/7 and file the claims with insurance and bring that money back. Hospitals are underpaid or not paid at all for a lot of the services they provide. And so the ability for the bot to go back in time and find those underpayments is also key.
Photo: Andranik Hakobyan, Getty Images