Illustration credit: A.E. Kieren
Upon entering healthcare after working in other verticals, finance professionals often express astonishment at the lack of transparency and analytic rigor applied to tracking reimbursement payments. Computer-assisted accounting strategies commonplace in the realms of banking, retail and manufacturing are all but unheard of in medical billing. Partly this is due to privacy issues and government regulations—but it's also an open secret that a shell game is being played, according to Brenkus.
“I've likened our industry to a Rube Goldberg machine,” he says. “We've made what should be a simple thing unnecessarily complicated by putting up incredibly high hurdles so that people can hold on to money a little longer or game the system to take advantage of that money flow.”
Brenkus first noticed this in 2007 when he worked at an insurance provider overseeing 14 call centers. There, thousands of employees fielded angry calls from physicians whose payments were delayed by a claims system built in the 1960s.
When the ACA arrived, Brenkus saw an opportunity to launch Aver, which provides software that automates bundled payments and, in the process, sheds light on the previously byzantine and opaque. “Recently we looked at knee replacements for a health plan and found they were paying anywhere from $14,000 to $168,000 per surgery. And they were like: ‘You've got to be kidding me!' Even they didn't realize the difference was that huge,” he says. “Now for the first time in our industry we can set a reference price, an average price, the minimum, the maximum, et cetera. It's a whole new measuring stick.”