Among the essential building blocks of a community, healthcare is part of what makes up the foundation. But what happens when critical resources and talent in the healthcare system are forced to handle administrative burdens—like insurance claims—that takes their time away from the critical care patients need?
Countless healthcare professionals have experienced this problem firsthand, and now we’ll introduce you to two of them who were inspired to build the solution.
Meet Gretchen Heinen and Wael Khouli, healthcare professionals turned entrepreneurs, who are the leaders of Authsnap.
The Cost of Denied Claims
Across the United States, healthcare institutions of all sizes and the medical professionals that work for them face a problem. It comes in the form of denied healthcare insurance claims, the effects of which ripple out from the healthcare institution itself, to the medical professionals providing care, and all the way to the patients they care for.
Insurance claims for care and prior authorizations are a common part of the experience for hospital visits in the United States. Unfortunately, denial of insurance claims for healthcare services are also an all too common occurrence.
The denial of a claim can happen for a whole host of reasons, spanning lack of documentation, the medical necessity of care, clerical errors, and more. While some denials are sound, there are others—a lot of others—that, given they were simply denied as a result of an error or another reason, could be overturned with an appeal.
The result is an extreme strain on resources for handling denied claims, and significant losses in coverage for procedures that should have been covered in the first place. Gretchen, who serves as the company’s Chief Executive Officer, explained the magnitude of the problem across the country:
“20% of all claims get denied. It equals about $262 billion worth of denied claims. That’s not even the cost to take care of the claims. That’s the actual size,” she said. “That’s hundreds of millions of patients every year who are dying or getting delayed in their care, all because, let’s say, a box didn’t get checked on an insurance form.”
As a practicing physician, Wael, who serves as Chief Medical Officer, also understands the burden denied insurance claims puts on medical professionals.
“It’s estimated that the time spent by staff, per physician, in a week on denials of prior authorization is about 13 hours a week,” Wael shares. “That is time they could be spending with the patients.”
It adds a significant amount to the workload of physicians who are often already stretched thin—especially in rural healthcare systems. It is critical time spent in front of paperwork and away from patients.
“I witnessed that myself also firsthand with the amount of time that you’re spending on administrative tasks, especially denials on prior authorization,” Wael says. “That is time that you could be spending with the patients.”
And for patients? As Wael emphasized, the impact of denied claims can seep into the care they have access to as medical professionals and healthcare systems continue to become stretched thin as a result of being inundated with denied claims. The problem can become so severe that healthcare providers are forced to shut their doors, leaving patients without access to care entirely.
Building the Missing Link - How Authsnap Fills the Gap
From observing the strain on resources—particularly time—medical professionals face from denied insurance claims, to the effects on healthcare systems and patients, Gretchen and Wael realized a solution was necessary to fix the problem that is denied insurance claims.
Their experience in the medical field and countless conversations with those in many corners of the healthcare system helped them identify the basis of their solution.
Authsnap seeks to give physicians back the critical time they spend on appeals, so they can spend time doing what matters most—taking care of patients.
Gretchen describes how: “We shorten the time that it takes to submit that appeal. We use technology. We use human-in-the loop AI. We use our clinical expertise. And we custom built software so that we can run a patient’s chart into the system, and it will spit out an appeal letter within about five minutes or less, from start to finish.”
Authsnap is built with technology that can read a patient’s chart, understand the necessary points needed to make the appeal, and structure the case by means of an appeal letter. The critical time and effort for the physician transfers from writing the appeal from scratch, to simply reviewing and modifying the appeal so that it is ready to send.
“There’s a lot that has to go into writing an appeal letter so that it will be successful, and we’ve eliminated that time it takes to do that,” Gretchen elaborated.
The time recaptured by medical professionals as a result of reducing their time writing claim appeals is transformative for their own work, as well as patients by recentering their focus on providing care. “We’re enabling physicians to focus on taking care of their patient’s condition rather than being worried about responding to denials and chasing them,” Wael explained.
By recapturing money lost by denied insurance claims, the impact of Authsnap can be what makes the difference in a healthcare provider’s ability to keep their doors open. Rural communities are where this problem looms largest, yet where the largest potential for positive change also exists.
Forming The Team
Along the journey of building Authsnap, Gretchen and Wael have been a dynamic team, playing crucial roles in driving the company forward with their varied experience. But this isn’t the first time the pair has worked together. In looking for a counterpart to create Authsnap, Gretchen held a firm belief that Wael would be the right fit, and up to the task.
“I sent Wael a LinkedIn message, after not having talked to him for several years. He responded right away, and I was like, ‘Hey, what are you doing right now for work? And would you be interested in doing something with me to help solve this problem?’” Gretchen recalled. “We got on the phone and quickly realized that the problem is the exact same as it was ten years ago.”
Ten years ago was when the pair worked together at a health system in the Twin Cities area, where Wael was the director of care management and Gretchen helped coordinate care for patients. Their direct experience working with patients with different needs for care, along with regular touchpoints with the healthcare insurance system made them deeply aware of the gaps in the system and how it affects patients, providers, and the healthcare systems overall.
When Gretchen sent Wael that LinkedIn message a decade ago, they had the makings of a great team to harness their expertise and skills to develop their solution to the massive challenge of denied insurance claims.
“I own speed and I keep the team going at a pace that we, hopefully, can sustain,” Gretchen said. “Wael brings a really, really rich knowledge of clinical expertise that we need in order for the product to work correctly.” It is exactly the combination that Authsnap needs to grow and make a genuine impact.
Authsnap’s team stretches beyond its two leaders; the company is also supported by a talented team of individuals including healthcare professionals, software engineers, and advisors who diligently work to make Authsnap’s vision a reality.
Two healthcare professionals building a software company doesn’t happen by accident or in isolation. It also takes a strong network of support to accelerate growth and identify and pursue opportunities. For Authsnap, that support network was located right here in Marquette.
Launching Toward Success
Any startup founder can tell you that the learning curve of growing your own business is steep, no matter what industry experience you bring. Gretchen and Wael understood this well, and it’s why they found Innovate Marquette SmartZone and the broader Marquette entrepreneurial ecosystem to be the right fit to support Authsnap’s growth.
As Authsnap navigates the ever-complex landscape of the startup world, Innovate Marquette’s support has been impactful and steadfast. From strategic connections to fractional leaders to drive the company forward, to extensive coaching that helped the company secure funding through fundraising and pitch competitions, Innovate Marquette has been the wind in the sails of Authsnap to guide the company forward.
“I came from being a nurse who primarily talked with patients at the bedside and doctors in my shift, to a CEO of a C-corporation,” Gretchen shared. “There was a giant learning curve that had to happen there. Without having coaching, I think it would have been really difficult for me to grow into those skills.”
It wasn’t by chance that Authsnap found Innovate Marquette–or Marquette. Wael originally came to the area to work in the hospital system, as part of a visa exchange to work in a rural, underserved area. As life took him and his family to the Twin Cities area, Marquette never left his family’s mind, and they eventually found their way back to the community.
As the team discovered where there were business-building gaps in their own experience, Wael discovered that the solution was right in his own community.
“We needed skills that we didn’t really have. You can’t be the ones who come with the idea, have the skills in your own business and your own profession, and also who have all the skills that you need to grow a startup,” Wael shared. “That’s why Innovate Marquette was extremely helpful for us to give us those skills and the keys for the next stage.”
Having lived in metropolitan areas, Wael found that Marquette was the perfect blend of opportunity and tight-knit community. Building a business has only solidified that. “There’s a disproportionate depth of both business, tech, diversity, knowledge, a lot of knowledge for a town of 25,000 people,” he said.
With their software developed, a growing team, funding through pitch competitions secured, and healthcare systems already bringing Authsnap online into their system, Authsnap has the momentum to make a substantial impact in how our healthcare systems operate. Their pilot program is currently active and already producing sound evidence towards this.
Gretchen told us about the program:
“We have a pilot program where for 90 days, we can go into a health system and help them for free. They have to qualify for this,” she explained. “They can take the revenue that we return and they can put it back into their operating budget so they can hire more doctors, they can hire more nurses, they can fix up the building. This is something that’s important to us—to give back to the community.”
The impact is apparent. They’ve found that healthcare systems are able to see results in just 3 to four weeks of appealing denied claims.
By identifying the nexus of where providers, healthcare systems, and patients were facing challenges, Authsnap has developed a solution that truly makes an impact across the board. As Gretchen described, the bottom line is this: “We want to make sure that the patients get the care they need, and that hospital doors stay open.”
Authsnap’s story is a prime example of how passion, problem-solving, and collaborative partnerships can all work together to spur positive change on ever-complex challenges that permeate foundational services in our communities. With a steadfast commitment to supporting our healthcare systems, providers, and the patients they care for, Authsnap is championing our communities and the structures they rely on, one healthcare system at a time.
To learn more about Authsnap, click here
To watch the video, click here
