Health care costs can be prohibitive, not only for the average citizen but for employers and insurance providers, too. Rising Medical Solutions, a Chicago, Illinois-based company, works with insurance providers to help keep health care costs down without sacrificing the quality that patients receive. Their specialities include medical bill review, hospital bill review, care management and provider negotiation, among others.
Sramana Mitra: Hi, Jason. To begin, give us some background about the company. What do you do, what kind of outsourcing. What is the business? Tell us why and how you started the company.
Jason Beans: Our tag line is “We keep health care healthy.” Another one we use is “Protecting the financial health of health care.” This company is designed to be in the middle of doctors, patients and payers and to make the transactions more efficient and effective. We help people find the right treatment for the right price. We use technology and our infrastructure to start to create more of a free market in health care.
SM: What format does that take? On a more granular basis, what does it do?
JB: Let me give you a very granular history of the company. We started in 1999. I was doing a consulting firm before that, a very small one. It hadn’t hit your one million at $1 million, yet. People would hire us to analyze their technology partners or their managed care partners. Some of the things our clients were looking to do, we couldn’t find in the market, so in 1999, we formed a service company. Our first clients, for auto insurance, wanted us to build out technology that allowed them to know what to pay on claims where there really was no cost containment, and there was a lot of fraud and abuse.
SM: The consulting company that you were doing, from which all this came about, was also in the insurance sector?
JB: Yes, very similar. I’ve been doing this since college. In college, I was working for a company that had nurses who went out to injured people and helped them get back to work or get the right treatment. It’s called case management. I was just working in their home office in various roles throughout college. I learned a lot about this industry. I left – I was a finance major – and went to the treasury department at GTE, GTE Spacenet, actually, down in DC. I just did not like working for a big company. At the same time, I had had some medical bills that my insurance wasn’t covering, so I was fighting with my insurance company. So, this group that I used to work with started a division that was going to help do medical bill review, process medical bills. I didn’t know anything about it, but I quit to go join them. It was kind of a startup division within a larger company. So, I’ve been doing this for a very long time.
When they went public and then private, I left and started this consulting firm called B&D Operations that was based in Boston. We did stuff like help states write their worker’s comp pay schedules or how to reimburse doctors or help insurance companies pick managed care partners, etc, etc. It was still in the insurance space, but more consulting on what I used to do. From that, we met someone who wanted us to build this out. That’s where Rising came to be, and we switched our name and became a service entity and not a consulting firm.
SM: What does Rising do?
JB: The primary thing we do is what we call medical bill review. It’s a form of managed care where we will build out the PPO networks for small insurance companies or self-insured employers. We’ll build out the technology, the Web portals, so that their people can manage medical bills. We’ll build out their rules sets so that if there’re are certain things that should be covered that are not covered, we build that out so that we apply it automatically. We have doctors and nurses who then look at the treatment patterns and will help figure out what types of treatment [should be administered].
We focus on two areas. What should be done, and what should it cost? And then we apply our knowledge and technology to make that process as efficient as possible. Most of our clients are self-insured employers or small insurance companies and mid-sized insurance companies, usually not the gigantic ones, because they have this in-house. They’ll spend the money to build it themselves.