🔒Lorinsky’s data analytics keep medical providers, insurers afloat

Jared Lorinsky had some good mentors for the work he does now in healthcare information technology ensuring payment accuracy between health insurance companies and medical services providers, and helping both sides with business analytics and intelligence.

The senior vice president of business development for The Burgess Group LLC in West Hartford got his start in the industry with the former HSS Inc. in Hamden, whose principals worked on Yale University studies related to diagnosis-related groups, or DRGs, which determine payments hospitals receive for various procedures. DRGs were developed at Yale and later refined there in the 1980s in studies addressing how to group services into geographically and clinically similar groups and determine prospective payments for those services.

“This whole concept of how the government reimburses providers started here,” said Lorinsky, 33. “I learned this business working with some people who actually worked on the original studies of how to reimburse hospitals across the country,” and went on to start Connecticut companies like HSS.

He landed at HSS in 2005 while getting his MBA at Quinnipiac University and working as a consultant on drug-data studies for Pfizer in Groton. When an MBA colleague who worked at HSS posted a job, he jumped at the opportunity to work and study in Hamden while remaining in the healthcare industry.

HSS was acquired in 2005 by Ingenix Inc., a subsidiary of UnitedHealth Group that later became OptumInsight Inc., where Lorinsky worked as product director for prospective payment solutions until joining Alexandria, Va.-based Burgess in 2011. He worked remotely for Burgess before opening its West Hartford office in a modern, second-floor space in Blue Back Square in 2013.

Revenue has grown 60-plus percent and the staff has doubled to about 20 since then, and another 10 to 20 employees could be added next year, Lorinsky said.

Burgess focuses on what Lorinsky calls payment integrity. For example, it helps insurance companies make accurate payments to hospitals for treating patients.

“There's a great deal of complexity in it,” Lorinsky said. “Most people don't realize government changes regulations almost every day and changes the rates things are paid. So our clients essentially outsource the effort to us because it's very resource intensive.”

Beyond ensuring payment accuracy, Burgess helps hospital systems and health insurance companies with their analytics, assessing performance and quality, he said.

That includes helping doctors assess if they are taking in the revenue they expected to run their practice.

The analytics help insurers and providers make financially sound decisions in an evolving healthcare landscape, he said.

Burgess has staff whose job it is to monitor those changes, including to medical codes and Medicare and Medicaid regulations.

“There's so much pressure to get everything right, but half the battle is, honestly, interpreting the rules,” he said. “I think that's why we're successful, we have a nice process in place that gives our clients comfort that we can meet that demand and we give them the information that they need so that they can make smart business decisions.”

Lorinsky, who spends about a third of his time traveling among insurers and medical providers, has a girlfriend, Jennifer, whom he met at HSS and works at UnitedHealthcare. They have a daughter, 2, and son on the way in March.

Among his hobbies outside the office, he plays bass guitar and more recently took up jujitsu, which offers a mental escape and challenging form of exercise.

“It'll make you think twice about how good a shape you're in,” he said.

Read more

CCSU aims to lift business-school profile