Health Tech: Paul Shorrosh On How AccuReg’s Technology Can Make An Important Impact On Our Overall Wellness
You need a deep understanding of the problem and firsthand experience with it. You have to be the person down in the mud cleaning it up and trudging through it to get a deep understanding of the problem or you won’t solve it. You must be able to define that problem really well and achieve clarity around what it is.
In recent years, Big Tech has gotten a bad rep. But of course many tech companies are doing important work making monumental positive changes to society, health, and the environment. To highlight these, we started a new interview series about “Technology Making An Important Positive Social Impact”. We are interviewing leaders of tech companies who are creating or have created a tech product that is helping to make a positive change in people’s lives or the environment. As a part of this series, I had the pleasure of interviewing Paul Shorrosh.
Paul Shorrosh is the CEO and founder of AccuReg, a healthcare technology company that integrates with electronic health record systems to increase patient engagement by enabling digital intake, patient registration and price transparency across health systems, hospitals, ambulatory settings and telehealth applications. A solutions-oriented healthcare thought leader and entrepreneur, he has nearly 30 years of revenue cycle experience.
Thank you so much for joining us in this interview series. Before we dive in, our readers would love to learn a bit more about you. Can you tell us a bit about your childhood backstory and how you grew up?
I grew up in a minister’s home near Mobile, Ala., and my father was a missionary along with my mother, who was a registered nurse. Initially, my father wanted to become a physician, but felt the call to ministry so he attended seminary instead of medical school.
Growing up, my family went on mission trips all over the world, so I was exposed to a multitude of cultures. Our home often welcomed people of all nationalities and languages, and all the ministering to others provided me a sense of mission. I have always believed life is about making an impact in other people’s lives, not your personal wins.
As I prepared for college, I gravitated toward healthcare because it’s about taking care of other people. I started in social work, earned my Master of Social Work degree and landed my first job with Providence Hospital in Mobile as a discharge planner. Through that experience, more than 30 years ago, I started to realize a lot of healthcare was broken. The decisions being made by insurance companies and hospitals were not the most efficient, and not always geared toward what’s best for the patient. I was the advocate between the doctor, the insurance company and the hospital to get that patient home and take care of them medically. I did help a lot of people and that’s what got me hooked.
Can you share the most interesting story that happened to you since you began your career?
I never intended to start a business and started this incredible journey with a blank Excel spreadsheet.
When I went back to business school, I trained in IT and was particularly interested in systems, group dynamics and motivation. My first job out of business school was in Mobile running a brand-new inpatient rehab, hospice and assisted living facility. I realized I needed data to make sure we were getting paid according to our contract, and that’s when I started playing around with systems and used tools like Microsoft Access, stats packages and Excel, to create what I envisioned in my head.
I was the only one tracking and reporting performance of staff and all kinds of key performance indicators.
I began to work with payers, negotiating deals and leading the charge to get paid correctly based on our contracts. Over three years, I built databases to hold payers accountable to pay us correctly by regularly auditing them. I found hundreds of thousands of dollars in errors using these rudimentary data analytics. As a result, my organization started getting big checks back. As my CFO shared our results with other CFOs with similar contracts, I received calls to audit their contracts. That became my “side hustle” business before AccuReg, and I called it Managed Care Audit Services. It went so well I quit my job at the hospital and traveled the state to audit contracts for other hospitals. I recovered millions of dollars for six major hospitals in Alabama, paid off all my consumer and student debt and put my family in a great place financially, but I literally worked myself out of a job after the hospitals eventually renegotiated these contracts.
I realized the problems I was solving on this one contract were universal and shared by every hospital and patient. The heart of the problem was payer complexity and variability among the payers which made it impossible for any one employee to capture the information that would pay us correctly every time.
Based on my success with Managed Care Audit Services, Becky Crawford, the CFO of Springhill Medical Center asked me to be her new business office director, a job I had never done, but she trusted me. That’s where I invented AccuReg and began building a medical claim denials analytics tool. Most of the problems happening at the back end of our revenue cycle were avoidable and preventable because they resulted from problems at the front end — such as errors in registration around insurance eligibility verification, prior authorization, medical necessity and data quality. This rudimentary auditing tool took data out of the EHR through queries that would show financial mismatches. Each of these queries formed the basis of an automated rules engine that became AccuReg Quality Assurance, which prevents denials and write-offs by providing tools for registrars to catch their own errors, empowering them to fix mistakes on the front end, where problems could be corrected before submission.
At Springhill, I created a preregistration team, something I had never seen before. By focusing on fixing the front end, our claims denials came down by half. I spent a lot of time developing about 16 apps to extract information from our EHR and make front-end registration easier and less error-prone. Literally, through zero sales and marketing I had four hospitals that year sign up for what I had begun calling AccuReg, for “accurate registration.” I was suddenly making more money from my side hustle than from my day job, so in April 2005, I turned in my notice to focus on AccuReg full time. My first hire was a smarter guy than me on software development which got us into real-time auditing and that’s when our solution really started to get powerful. Since then, we’ve gone from two employees working out of my garage to 130 employees in Nashville, Orlando and Mobile.
None of us are able to achieve success without some help along the way. Is there a particular person who you are grateful towards who helped get you to where you are? Can you share a story about that?
In the year before I quit my day job, when I built those 16 gap apps to extract EHR information, a lot of people would say, “you have a business here.” My patient access director, Linda Sullivan, was one of those people and I give her a ton of credit because I built the registration audit tools for her. At the time, she was doing it manually, spending hours a day. She helped me figure out the rules and I coded it. I remember times she would come in and say these tools made it easier for her and her employees to do their jobs better and this is a universal need — you could do this for many others. She kept hammering me about that and was the voice that encouraged me to take the risk to start AccuReg as a small business. She was one of my first employees and managed implementation for our customers for the first few years before she retired.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
I rely on a quote attributed to Steve Jobs. It reads: “It doesn’t make sense to hire smart people and tell them what to do; we hire smart people so they can tell us what to do.”
When you get to a certain level in a small business, you’re wearing a lot of hats. To grow, as CEO and founder, I’ve had to take hats off and hire people better than me. And that’s hard for a young business owner because you have to relinquish control. It’s an emotional rollercoaster because I had to trust someone else to do a better job with sales, implementation, coding and other important functions. “People decisions” are the most important decisions I’ve made over the past 17 years.
You are a successful business leader. Which three character traits do you think were most instrumental to your success? Can you please share a story or example for each?
Commitment, dogged perseverance and passion.
Commitment is driven by a passion to help people solve seemingly intractable problems, because you have to love it, or you won’t sacrifice for it. I had a belief I could fix problems that everyone knew existed but thought were unsolvable because of payer complexity. I knew by experience even before I started AccuReg that I could make a difference solving systemic problems in healthcare. That drove me. But it’s interesting how much more broadly that vision is now than when I started. Now, the tools my team and I developed can accomplish fundamental change in healthcare delivery that improve the way hospitals do business and improve the patient financial experience simultaneously. I never imagined we could go so far.
Ok super. Let’s now shift to the main part of our discussion about the tech tools that you are helping to create that can make a positive impact on our wellness. To begin, which particular problems are you aiming to solve?
Studies show patient engagement is directly correlated to improved health outcomes and the reason is simple — highly engaged patients tend to make better informed decisions about their healthcare options. Patients are demanding more control and a safer, simplified healthcare experience. They want ownership of their patient journey and providing them with increased understanding and knowledge gives them the tools to make smart decisions about their own health. When patients aren’t provided the appropriate tools to help them easily access and receive services or understand their financial obligation, it causes tremendous stress and negatively impacts their overall wellness. In fact, many patients have greater anxiety about the financial and administrative aspects of healthcare than they do about the care itself.
So, why aren’t patients receiving the experience they want and demand? A significant amount of the responsibility falls on the shoulders of hospitals and health systems, but often, due to lack of technology, healthcare providers struggle to provide the patient engagement, consumerism and price transparency needed to dramatically improve how patients navigate their healthcare journey. COVID-19 added another layer of issues as patients now want safer visits and greater access to digital tools that reduce person-to-person contact.
Lack of patient engagement doesn’t just affect the patient; it is also problematic for our hospitals. When patients aren’t financially engaged and aren’t provided accurate information on the front-end, it can lead to denied claims and loss of revenue for hospitals.
Our team knew the solution to these industry-wide problems started with the hospitals, they simply needed the technology to combine the front-end of their revenue cycle with digital patient intake and engagement tools to create a seamless, intuitive experience for patients and their staff.
How do you think your technology can address this?
AccuReg EngageCare®, the name of our technology platform, lets patients digitally engage with their care similarly to how they use Amazon, Expedia or pay bills using their mobile phone, all while driving higher patient volume and net revenue for providers. It allows hospitals and clinics to provide patients with easy-to-use digital solutions that offer increased visibility into the cost of care, ownership of their healthcare journey and the tools to make smart decisions about their own health, which positively impacts their overall wellness. An exciting part of involving them in self-registration is the care provider gets more accurate information because of the automated analysis and intelligence of our rules engine at the beginning of the patient journey instead of having to fix errors after the fact.
EngageCare allows patients to shop and compare services on a hospital’s website and self-generate accurate out-of-pocket cost estimates. It truly makes the experience as easy as shopping on Amazon or booking travel on Expedia and reduces the financial anxiety that can be overwhelming for patients.
What’s interesting to me is how we’ve been able to get patients involved in taking control of their care. With EngageCare, patients can use their own device (phone, tablet or PC) to access a highly intuitive digital experience that includes online pre-registration, automated appointment reminders, digital check-in, virtual waiting rooms, bi-directional texts and an easy way to make payments with a single click. Patient communication is improved because hospitals can use text messages to communicate timely pre-service information such as fasting reminders, provide directions to the site of care, acknowledge patient arrival and send a QR code that serves as a pass, exactly the same as a digital boarding pass, to quickly enter the facility and go directly to their service location, which makes crowded waiting rooms a thing of the past — I think we’re all ready for that to go away.
EngageCare is really providing a “next generation” healthcare experience by bringing the same digital consumer experience to healthcare that we’ve all been accustomed to now for more than a decade.
Can you tell us the backstory about what inspired you to originally feel passionate about this cause?
At the beginning of my career, when I was a social worker, I spent a lot of time with the business office trying to help patients who were worried they couldn’t pay their bill. They listened to me and seven or eight times out of 10 I could get some sort of financial assistance to the patient to make it more affordable. That’s when in my heart I realized I could make a difference, but only one patient at a time. I liked being a change agent but wanted to do it on a bigger scale because this was a systemic problem. So that’s when I went to business school and got my MBA in health administration.
How do you think this might change the world?
We understand that when most people think of world-changing ideas, their thoughts don’t immediately gravitate to how their healthcare services are arranged and paid for. But think of the number of people whose lives are impacted by improving efficiency and reducing the frustration and administrative expense of healthcare.
Healthcare represents about one-fifth of US economic output in any given year and literally everyone could be impacted by improving it because everyone is either a patient or a friend or loved one of a patient. How much time is spent trying to figure out what you will owe for a procedure or sitting in the waiting room? How much health is sacrificed when patients decide to forego care because they don’t know how they’ll pay for it, can’t get a ride to the appointment or are concerned about safety and fear getting sicker by going to the hospital?
Our platform addresses all of this. And that’s only one aspect of the benefits. Healthcare is all-too-often inefficient and serves the patient poorly. Healthcare is one of the last industries in the United States that has not adopted the modern digital technologies that have revolutionized retail, travel, banking, entertainment — the list goes on. What we do brings that advancement to healthcare and everyone associated with our company from the executive team to sales to the trainers to the developers who continue to improve our platform are all committed to this mission.
No. As I mentioned, most industries have already benefited from using the types of technology we provide. The drawback right now is that there are too many disconnected technologies that make this more costly than it should be for providers and a suboptimal user experience for the patient. But this is true win-win. Contracts spell out exactly what’s required for hospitals and clinics to receive appropriate reimbursement, and hospitals and patients should expect insurance companies to be accountable to them. Our products ensure providers can continue their mission to provide the highest quality healthcare and provide accurate information to the patient about what they will owe so they can make informed decisions about their care before service is rendered. And patients should have the safe, intuitive experience they expect. That’s what our solution provides.
Here is the main question for our discussion. Based on your experience and success, can you please share “Five things you need to know to successfully create technology that can make a positive social impact”? (Please share a story or an example, for each.)
First, you need a deep understanding of the problem and firsthand experience with it. You have to be the person down in the mud cleaning it up and trudging through it to get a deep understanding of the problem or you won’t solve it. You must be able to define that problem really well and achieve clarity around what it is.
Second, you must have curiosity and a sense of experiment, to try many things that might work. Another way of saying that is you have to fail a lot before you succeed. How many times did Edison fail before he invented a light bulb that worked?
Third, you need commitment. That may sound trite, but you must consistently think about the problem over and over again, coming at it from different angles, until you find a possible solution you can try. I had to teach myself a lot of tech tools I didn’t know and creating these products was tedious, but I saw what was possible, so it was worth the sacrifice. Today I think that’s how tech entrepreneurs have to learn — they have to be self-taught to a large extent. In my case, that meant coding my own software and understanding very granular healthcare data. What do the letters and numbers mean? Can you find patterns?
Fourth: Get help and don’t micromanage. You can’t do it all on your own and you can only go so far with the skill set you have. I hired people smarter than me. I could never have grown the business without people like Ian Whelan, our CFO & COO, David Peterson, our Chief Strategy and Marketing Officer, Blair Baker, our CIO and Chief Product Officer and Scott Dalgety, our VP of Client Services, and so many others. These are incredibly smart people that have higher IQs than me. I realized early on I was never going to be the brightest bulb in the room, but I could outwork everyone. I have the best leadership team ever. I think they’ll agree that some of our success is because I don’t try to control it all and I don’t micromanage.
Fifth: Confidence and faith in a solution you’ve built from the ground up to solve a real-world problem. This industry is infamous for overpromising and underdelivering, so one quote on the wall at our headquarters is “current clients come first.” I had faith that what I was doing was working and I had to convince other people to give me the chance to prove it. Almost without realizing I was doing it, the way my business grew, I naturally leveraged the customer to help me sell to the next customer. That doesn’t mean we’re not always looking for new prospects to build the business, but I’ve found in the way I’ve built this business that most of our growth has come from recommendations from current clients who are delighted by how we’ve helped them improve the lives of their employees and patients and collect the money they’re owed from insurers. Many of the hospitals we work for are nonprofit, so being paid correctly ensures they can continue their mission to improve patient health.
If you could tell other young people one thing about why they should consider making a positive impact on our environment or society, like you, what would you tell them?
Believe in yourself and your ability to accomplish great things. Secondly, I would tell them to pay attention, take your time and look for the moment when you can envision a solution to a problem everyone else is seeing as unfixable. People will beat a track to your door.
Is there a person in the world, or in the US with whom you would like to have a private breakfast or lunch, and why? He or she might just see this, especially if we tag them. :-)
For me it would be Elon Musk. I am driving a Tesla right now in bumper-to-bumper traffic as I’m talking to you and I’m very comfortably in Autopilot mode. He is off-the-charts brilliant not only as an engineer but also as an entrepreneur and visionary.
How can our readers further follow your work online?
For our customers, success goes beyond measurable ROI. We promise to reduce patient wait time and frustration from not knowing what they will owe, and we promise increased net revenue for our customers. All of those elements are extremely important, and our customers wouldn’t use us if we couldn’t deliver on them. But philosophically, what we do is about making healthcare safer, more efficient and more transparent for the patient.
Thank you so much for joining us. This was very inspirational, and we wish you continued success in your important work.