Social impact

The money exists. It's in the wrong place.

Accrua's social impact starts there: returning to hospitals the capital they have already produced, and returning to society the care capacity that capital represents.

The context

In 2024, payers made a profit. Hospitals paid the bill.

Brazilian health plan operators made R$ 11.1 billion in profit, almost four times more than the year before. In the same year, they failed to pay hospitals for services already provided. Patients already treated. Surgeries already performed. Beds already occupied.

R$ 11.1Bin payer profits in 2024, almost 4× the previous year

R$ 5.8Bnot paid to hospitals for services already provided

~16%of everything hospitals billed was held up in denials

< 2%of the denials analyzed were justified, according to the hospital association

The result is a system in which the link that cares for the patient is the link that bleeds the most. Fewer beds. Older equipment. Smaller teams.

4 in 10private hospitals cut investment in 2024 because of denials

~2 bedsper thousand inhabitants in Brazil, when the WHO recommends 3 to 5

There is no shortage of money in Brazilian private healthcare. There is a shortage of money in the right place.

Who bills for healthcare in Brazil

Think about who sits in a hospital's billing office.

She is the one who turns care into a bill. Who checks every item, every code, every supply before sending it to the payer. Who gets the denial back and decides whether it's worth fighting. Whether the hospital gets paid for what it has already done depends on each of her decisions.

R$ 2,450is the average monthly salary of billing staff in Brazil

50%of people in this role leave their job every year

It's a career with no ladder: little training, little recognition, a lot of pressure and a volume of repetitive work no human being should carry alone.

And when one of them finally gets good, when she learns to read a contract, anticipate a denial and dispute with solid arguments, a healthtech or a consulting firm takes her away with a better salary. The hospital loses the person, loses the knowledge and goes back to zero.

That is the second place where healthcare bleeds. Not in the operating room. At the billing desk.

Accrua was built to take care of both:Capital that becomes beds Work that becomes a career

Capital that becomes beds

Revenue the hospital has already produced, back in the right place.

Accrua recovers revenue that would be lost to improper denials and accelerates cash that would arrive too late. This money isn't new. It isn't credit, a subsidy or a donation. It is what the hospital was already entitled to receive and wasn't receiving.

Hospital pays its suppliers46 days

Hospital gets paid by the payer73 to 79 days

And when it returns to the right place, it becomes what Brazilian healthcare needs most.

R$ 325kequips a new ICU bed for society

R$ 1 millionkeeps an ICU bed running for a full year

And there is one place where this capital yields more than anywhere else: a bed opened inside a hospital that already exists, with the operating room, ICU, brand and accreditation already paid for. It is the fastest-return investment a hospital can make.

New hospital

Between R$ 60 and R$ 120 million in investment and 7 to 10 years to pay back.

Beds on existing infrastructure

The fastest-return format. The country's largest hospital network concentrates 75% to 80% of its expansion on it.

That is why recurring cash matters so much. A hospital that receives what is its own, every month, on time, can fund its own expansion with its own operating cash, without expensive debt, without selling equity, without waiting.

In a country below the WHO bed benchmark, this isn't financial efficiency. It is the capacity to care.

Work that becomes a career

We chose to be the employer this profession never had.

Accrua doesn't sell billing software to the hospital. Accrua takes over billing and auditing. And that means the people in this role are our team.

01
We train
Our own revenue cycle training program, open to people coming from outside the industry or from low-skilled roles. The knowledge stays with the person, inside or outside Accrua.
02
We pay better
We pay for performance, above the market benchmark of R$ 2,450. Whoever recovers a bed's worth of money for the hospital deserves to be paid accordingly.
03
We retain
In a role where half the people leave every year, our commitment is to keep voluntary turnover below the industry benchmark.
04
We measure who joins
Gender, race and socioeconomic background are part of what we report. This career is one of the most accessible doors to skilled work in Brazil, and we want it open to those who need it most.

The industry treats billing staff as a cost. We treat them as the people who keep the hospital open.

AI and people

If AI does the work, what are people for?

It's a fair question, and the answer lies in what AI does and what it doesn't.

TIARA absorbs

The volume

Thousands of bills checked item by item against the contract, inconsistencies fixed before submission, denial risk anticipated, every decision recorded in an auditable way. The repetitive, invisible work no one should do by hand.

People take on

The highest-value work

The difficult dispute, the negotiation with the payer, the complex audit, the case that doesn't fit any rule.

AI doesn't replace billing staff. It turns them into specialists.

That is what makes it possible to pay better and retain more at the same time.

Our impact in numbers

What we have already returned to Brazilian healthcare.

12Mreturned to hospitalsWrongful denials recovered plus working capital released. Money that only came back because Accrua exists.

37ICU beds fundedEvery R$ 325k funds a new bed. The equivalent of 12 beds kept running for a year.

168skilled jobsBilling staff and auditors trained and paid above average, in a role where half leave every year.

17days of cash returnedAverage reduction in the gap between what the hospital does and what it gets paid.

How we measure, and what we don't promise

That is why we only count what we can measure.

What we measure

What is under our control: capital recovered, days of cash returned, people trained, salaries paid, who stayed. Every hospital starts with a baseline measured before Accrua, and every number we publish is the difference against it.

What we don't promise

What the hospital does with the cash it recovers is its decision. We say the capital returned funds a bed, because it's true. We don't say we opened the bed, because the hospital is the one who opens it.

We prefer a smaller, honest number to a big number that doesn't survive a single question.

That is how we want to be held accountable.

Hospital by hospital

We won't fix Brazilian private healthcare all at once. No one will.

Every hospital that receives what is its own is a hospital that doesn't close.
Every R$ 325k that returns to the right cash account is an ICU bed society can fund.
Every billing professional who becomes a specialist is a career that is no longer disposable.

Hospital by hospital, person by person, Accrua gives society back the capacity to care for a country that runs on fewer beds than it needs.

That is the social return of fixing an inefficiency the system treated as normal.