Itiliti

Itiliti Health operates as a health data access and decision automation company, targeting the administrative inefficiencies within the U.S. healthcare system. The company was co-founded in 2019 by Michael Lunzer (CEO) and Kurt Hulander (COO), and is headquartered in Eden Prairie, Minnesota. Lunzer's journey to creating Itiliti began during his time as an Entrepreneur-in-Residence at Blue Cross and Blue Shield of Minnesota (BCBSMN) in 2018, where he identified the significant friction and costs associated with the prior authorization process. This experience, combined with his previous entrepreneurial successes in founding and exiting two other technology companies—a vendor management system for the staffing industry and Warm Health, a virtual care manager platform—provided him with the direct expertise to tackle this complex healthcare challenge. Hulander also brings relevant experience from his time at BCBSMN.

The firm's core business revolves around streamlining and automating the prior authorization (PA) process for its primary clients: health insurance plans (payers). By digitizing a payer's specific medical policies, Itiliti enables real-time collaboration between payers and healthcare providers, aiming to eliminate wasteful administrative expenses and improve patient care outcomes. Revenue is generated by providing these technology solutions to health plans, which in turn saves money for both the insurers and the providers by reducing unnecessary manual work, phone calls, and faxes. The company has successfully raised $5.46 million in seed funding over three rounds to scale its operations.

Itiliti Health's main product is a suite of tools designed to bring transparency and automation to prior authorizations. The flagship product, PA Checkpoint™, integrates with a payer's existing provider portal, allowing healthcare staff to determine in seconds if a prior authorization is required for a specific procedure or service. This is achieved by creating a searchable database of the payer's medical policies, a process that has already seen the digitization of over 650 policies for a major Blue Cross Blue Shield plan. A second product, PA Complete™, leverages artificial intelligence and natural language processing to compare medical policies against a patient's record to determine if they meet the clinical criteria for authorization. These solutions are designed to be modular, allowing payers to implement a comprehensive system or tailor it to specific needs, while also helping them comply with evolving CMS mandates for interoperability.

Keywords: prior authorization automation, healthcare administration, payer solutions, provider collaboration, medical policy digitization, health data interoperability, utilization management, revenue cycle management, healthcare IT, decision support, care management, administrative cost reduction, PA Checkpoint, Michael Lunzer, health plan efficiency, medical billing, CMS compliance, healthcare workflow, insurance technology, claims processing, benefits management, automated adjudication