HEALTHCARE INSIGHTS Top Trends Driving the US Healthcare Industry Volume # 1 the Changing Pulse of the US Healthcare Industry 04

HEALTHCARE INSIGHTS Top trends driving the US healthcare industry Volume # 1 The changing pulse of the US healthcare industry 04

Trend #1 Medicare and Medicaid Expansion 07

Technological imperatives 10

Trend #2 ACO and new payment models 16

Technological imperatives 19

Trend #3 Regulatory compliance and fraud 24 and abuse prevention

Technological imperatives 26

External Document © 2018 Infosys Limited With the introduction of new healthcare acts and reforms, the healthcare industry in the US has undergone significant transformations brought on by challenges and solutions driven by new technology. This year, the industry can look forward to more innovation and advancements driven by new and existing trends, powered by technology.

However, all of these trends and technologies are made relevant by yet another powerful and critical driving force – the consumer, who demands, adopts, and expects nothing but the best, from the healthcare industry.

The healthcare industry in the US is healthcare. In surveys conducted forced to settle for consultations facing numerous challenges. Ageing by the Economist Intelligence Unit with healthcare providers in populations, chronic diseases, and PricewaterhouseCoopers their locality. and new players in the market are 64% of respondents from the US They are being provided with indicated that they were open to among the top issues. Of these, new alternate modes of consultation. seeking medical attention through entrants – including the young and If they want to discuss their health new and non-traditional ways. To existing technology companies, issues and get opinions from meet these changing expectations, and most importantly, retailers providers in other parts of the the healthcare industry, which is – are creating the most impact. country, or even the world, they increasingly becoming consumer- As consumers get comfortable can get it in a few clicks. Patients driven, is transforming the way with the one-click services are being empowered to seek it operates. provided by other industries, the expert medical advice – even if healthcare technology companies Today, healthcare delivery has taken healthcare providers are miles away and retailers are changing the on a new meaning in the US. For and unable to give face-to-face way consumers experience instance, no longer are patients consultations – via e-visits.

External Document © 2018 Infosys Limited Patients too are responding and accommodate consumer care friendly payment methods to positively to the new trends in anywhere. healthcare data analytics for healthcare. Research shows that the more effective treatment plans It is not just healthcare delivery US$9.59 trillion global healthcare – everything is undergoing a that is transforming. Almost every seismic shift. market is receptive to these aspect of healthcare is changing. innovations that can supplement From insurance coverage to The common undercurrent or replace traditional person- consumerization of healthcare, from passing through these changes is to-person clinical interaction healthcare provider- and patient- technological disruption.

It is not just healthcare delivery the market are fuelling this change The healthcare industry has come with the technology-based tools a long way in how it has leveraged that’s transforming. they bring to the market. For technology to provide better and Almost every aspect instance, technology companies’ more cost-effective care for patients mobile-based apps have made who have expensive treatment of healthcare is it easier for healthcare providers requirements and understand the changing. to share crucial information with population and its healthcare needs. patients. Similarly, social media Traditional healthcare companies platforms have bridged the huge are partnering with those who have gap that had long separated patient, a strong knowledge of healthcare Technology has now reached the healthcare providers, and insurance and deep expertise in technology core of healthcare and is changing companies - it has helped create a to help offer services and develop the way it evolves. New players in vital connect. new products better aligned with patient needs.

Medicare and Medicaid Expansion

Besides a shift in power, the reform has brought a change in the way primary care is delivered.

ACO and new payment models

Achieving the triple goal that the ACO has set out can be quite challenging, when approached independently or in siloes. Regulatory compliance and fraud and abuse prevention

Compliance is essential to not just pass audits, but also to stay relatively safe against growing threats. Retailization and digital transformation

Public exchanges are getting integrated in a stealthy but sure manner into the insurance industry.

Population health and care analytics

The aim of population health management is to enhance outcomes of a group’s health by monitoring and tracking its members. Legacy modernization, cloud, automation, and outsourcing

To keep up with ever-evolving needs of the healthcare industry, organizations must undertake legacy modernization.

Empowering people with better control over healthcare

TREND #1 MEDICARE AND MEDICAID EXPANSION

External Document © 2018 Infosys Limited One of the key objectives of the To make the program more those who were previously not Patient Protection and Affordable accessible for those who are below covered under a private health Care Act (PPACA) is to reduce the the eligibility criteria, the ACA has insurance plan by their employer, number of Americans who are given states permission to expand a new program was launched. currently uninsured. In an effort the program to cover this section Also, the ACA established new to meet this objective, the PPACA of people, too. This was achieved rules mandating insurers to extend offered incentives to those who by creating uniform eligibility healthcare coverage to everyone signed up for health coverage under standards across the country. For who applies. the Medicaid healthcare program.

The PPACA and revenue, and a decrease in spend, healthcare organizations unpaid care. In stark contrast, the and insurers are adopting new care offered incentives to states that have not expanded their models that move patients to care those who signed up insurance program, are witnessing settings that are less expensive, for health coverage the opposite effects. and offer a more holistic approach under the Medicaid At a time when the industry is to healthcare, rather than send healthcare program. under pressure to reduce healthcare them to emergency rooms or spend, the US has identified a very inpatient care. small percentage of the country’s With Medicare and Medicaid patients, whose healthcare expenses Expansion, the Affordable Care Act make up a significant portion of (ACA) has given back consumers the country’s healthcare spend. These efforts have made a control over their healthcare Compounding this issue are the dual significant difference in a number and has brought significant eligible, those who are eligible for of areas. For instance, the states transformations in the industry. both Medicare and Medicaid. and districts where healthcare Besides a shift in power, the reform organizations have carried out The money that the country spends has brought new entrants to Medicare and Medicaid Expansions, on these patients continues to the economy, an increase in the have seen an increase in volume rise. To counter the effects of this retailization of health insurance,

External Document © 2018 Infosys Limited and a change in the way primary be uninsured by 20163. And, by 2022, expenses in the coming years. care is delivered. To keep pace with the states would have paid close to Fortunately there are a host of these shifts, industry leaders should US$23 billion in payment towards new technologies and business be flexible and forward-thinking. Medicaid3. Their expenses will models that can help them speed up the process. This is especially necessary in states continue to mount by about US$167 that have not yet opted for Medicaid billion in enhanced payments 3 Expansion – in the coming years, towards Medicaid , to counter the they will experience a greater push reductions that they face from the to move towards expansion. By federal government. Ever since the 2020, hospitals that serve in these With insurance coverage at the heart ACA was signed states will see a decline in federal of the matter, hospitals interested in support, to the tune of US$39 billion. offering Americans the provision to in 2010, more According to a research by the gain healthcare coverage, will soon than 90 new Robert Wood Johnson Foundation have to go down the Expansion and Urban Institute, if the 24 states path. The sooner this transition is companies have that have not yet opted for Medicaid made, the faster a larger section of been created4. Expansion continue without change, the population can access better 6.7 million of their population will healthcare while avoiding huge

Primary care physicians, surgeons, and other specialists in Expansion states saw a higher percentage of Medicaid patients during the first three months of 2014 than were seen in non-Expansion states5.

Most will get coverage in the rst few years of ACA Expans6ion 45 40 35 30 25 20 15 10 5 0 2014 2015 2016 2017 2018 2019 2020

Exchanges Medicaid Uninsured

Some of the challenges the – are generated under Medicare Reduce care-delivery cost healthcare industry faces, and Medicaid across the country. One of the biggest challenges technologies that enable healthcare How can this information the healthcare industry faces is in organizations to overcome them be leveraged to benefit the reducing the cost of care delivery. and deliver benefits to providers, healthcare industry? With the help of big data generated payers, and patients, by leveraging under the Medicare and Medicaid Medicare and Medicaid Expansion: Solution Expansion, organizations will get Big data in healthcare is the insights that will enable them Big data and analytics extremely valuable. Analyzed and to understand where money is interpreted the right way, it will being spent. With this information, Challenge offer insights that can help take they can adopt the right tools and the healthcare industry to the solutions that would be better Every day, vast amounts of data – on suited to tackle problem areas. billing, payments, treatments, etc. next level.

External Document © 2018 Infosys Limited Treatment effectiveness and types of treatments most effective information generated in the physician dues for specific illnesses and identify past year and released by the US healthcare providers who are government recently, shows that Besides gaining insights on not getting their dues. Big data specialists get paid more on a expenses and cost reduction can show how different kinds of per-visit basis, while family practise opportunities, organizations can providers are getting paid per visit physicians get paid better on a also use big data to understand vs. on a daily basis. For instance, daily basis.

This level of big data mining has Fraud control (CMS) started a Virtual Research Data Center. This will provide researchers The Department of Justice (DoJ), helped authorities in anytime access to encrypted files that the Federal Bureau of Investigation would otherwise have to be shipped the USA to prosecute (FBI), and the Department of fraudsters and save Health and Human Services (HHS), to them on request. The data center billions of dollars. have been using real-time big data will contain all the information that to understand factors costing the it collates from different sources. Medicare program money. The DoJ Researchers can analyze and interpret has already identified fraudsters the data from their systems. This Population health in the healthcare industry, initiative will help reduce costs, responsible for draining resources. increase access, decrease time For both healthcare providers This level of big data mining has of research, and increase overall and payers, knowing what ails helped authorities in the US to efficiency of the process. the country, is critical. To get this prosecute fraudsters and save information, they can leverage big Since 2008, hospital outpatient billions of dollars. data and get a better understanding departments (HOPDs) and of the illnesses affecting specific age As part of the Big Data and ambulatory surgical centers (ASCs) groups. This can then be used to Development Initiative by the have been taking on the role of create awareness and urge people to government, the Centers for treating a large section of the take preventive measures, if possible, Medicare and Medicaid Services country’s population. A research especially if they are in a risk group. conducted by the Centers for

External Document © 2018 Infosys Limited Medicare and Medicaid Challenge Solution Services indicates that by 2008, How can ASCs and HOPDs The best way to do this is to harness 3.3 million Medicare eligible effectively meet the needs of these the power of data by analyzing it. citizens were being treated by ever-increasing number of patients A few areas that ASCs could direct just 5,175 ASCs7. with limited resources, while their analytic focus on, would decreasing costs and increasing include the following: revenue?

Data can help identify trends and up a lot of most organizations’ medication and equipment. changes in staffing, spend. Using analytics, Analyzing the organization’s a critical area which healthcare providers can metrics, based on aspects like identify organizational structure physician performance and takes up a lot of weaknesses, alter staffing utilization of ancillary tests, will help most organizations’ schedules for better efficiency, them stay more accurately prepared. spend. and reduce spend on areas like overtime Prevention of fraud and resource drainage Accurate forecasting One of the biggest roadblocks Optimizing labor cost If an organization is able to healthcare organizations face when These healthcare organizations predict supplies and medication it comes to precisely allocating should leverage metrics to get requirements, their stock can be funds is fraud. Data analytics can a better understanding of their more closely aligned with patient reveal departments into which staffing capacity. Data can help needs. If not, the organizations money is being funnelled and identify trends and changes in may have more of what is not highlight potential problem areas – staffing, a critical area which takes essential, and less of crucial which act as hot spots for fraud.

External Document © 2018 Infosys Limited Telehealth and mobile patient health outcomes, they are remote patient-monitoring on the lookout for smarter processes can help organizations With healthcare organizations and tools. Mobile technology can decrease instances of hospital facing increasing pressure to reduce be the answer to these problems. readmissions and extend care hospital readmissions and improve Telehealth, mobile apps, SMS, and beyond the hospital.

Telehealth, mobile interaction between a patient and bundled payments, wherein, instead apps, SMS, and remote physician who is not located in the of a hospital focusing on gaining patient monitoring same area. When a patient needs reimbursements, it works to get a can help organizations follow-up consultations, he does share of the savings. decrease instances of not have to visit the hospital and get Mobile app developers should focus readmitted to get the healthcare hospital readmissions on creating paid solutions closely attention she needs. It also helps and extend care aligned with patient needs, to help organizations avoid penalties for beyond the hospital. them reduce hospital visits and readmissions. readmissions. Once app developers Mobile too can help reduce are able to convince patients about hospital readmissions – however, the benefits they gain with the not by taking the traditional app, the uptake of these apps will Medicare supports consultations reimbursement route that most increase. If successful, hospitals provided via a two-way healthcare organizations like to will reduce readmissions, and get telecommunication system take, as mobile is currently not a percentage of the savings, the enabling real-time video and audio covered by Medicare. They will offer solution will generate.

Challenge Information sharing There is a pressing need for Videos are short and easy-to- Videos also educate viewers on Medicare and Medicaid programs understand. They present details how they can share this information to reach the masses in an effective on most of the critical aspects of with friends and family through and impactful way. How can this Medicare, like how to enroll for it, other social media platforms, too. be achieved? when and how to use it, and how They encourage people to continue the program is beneficial for them. the conversation with friends and family on blogs, via Pinterest, Solution Through the YouTube channel, Medicare Made Clear, people can Skype, and LinkedIn. This is an In an effort to reach the population, learn about enrollment in the effective way of increasing reach drivers of the Medicare program program and know more about the and getting attention of people. have created a channel on YouTube benefits they can receive through that serves as a platform where online resources. payers, providers, and most importantly, patients, can get information they need.

External Document © 2018 Infosys Limited Besides this dedicated channel, the videos take a look at why Connecting with and keeping track there are more videos about Medicaid Expansion is essential of customers Medicare and Medicaid Expansion for healthcare organizations, and that other organizations have provide statistics on benefits other Medicaid agencies for states can shared on YouTube. Both patients organizations and states have hire analytics service providers to and physicians can benefit a experienced post-expansion. gather important information; for lot from these videos. Some of instance, people’s opinion on the programs, on social media.

Through the YouTube channel, Medicare Made This will help program drivers for the better. The way healthcare understand general perception Clear, people can learn industry uses social media is quite of the population about the similar to how private companies about enrollment in the programs. It will also provide do. They are connecting with program and know more crucial insights into which users are customers, monitoring public data, about the benefits they having problems with their health and interpreting it with analytics can receive through online coverage. tools to get insights that can help resources. Based on this information, deliver better care. customer service can be changed

AHIP’s Coalition for Medicare Choices (CMC) – more than 1.8 million seniors and counting – are writing letters and emails, making phone calls, attending events, and engaging on social media to urge policymakers to protect Medicare Advantage as lawmakers consider policies that could impact their coverage8.

Paving the way to more rewarding experiences

TREND #2 ACO AND NEW PAYMENT MODELS

External Document © 2018 Infosys Limited Currently, leaders across one of the five key traditional when approached independently organizations are trying to payment models based on a or in siloes. This is especially true, create one payment model healthcare provider’s performance. for the US, where healthcare that incentivizes physicians and The five models are: one-sided costs are rising and quality motivates them to achieve the shared savings, two-sided shared of care varies drastically. The three-pronged aim the ACO savings, episode payments, partial challenge is compounded further has set: enhancing care quality, capitation, and global payments. for organizations in which the improving patient outcomes, and fee-for-service model is deeply Achieving the three-pronged reducing costs. Accountable Care ingrained. The impact is felt most goal can be quite challenging Organizations (ACO) generally follow by healthcare payers.

Besides bringing increased savings, Recent reports by HHS indicate benefits that the model brings that a payment model – Pioneer are likely to convince the HHS to the model has Accountable Care Organization integrate the model into other continued to (PACO) that was developed as part programs under Medicare. of the Affordable Care Act (ACA), has ensure that The CMS developed another brought significant savings of more patients get high program, the Advance Payment than US$384 million over two years. ACO Model, through which quality care This means that over the course of organizations participating in the the year, about US$300 has been Shared Savings Program receive generated per beneficiary each year. payments in advance, which will be Adding more credibility to this retrieved from the shared savings They have to make the transition payment model is a finding by they generate. It was created to to a model where the healthcare CMS that shows that this is the motivate more organizations provider is reimbursed on the basis first patient care model to meet to participate and offer better of quality of service provided, not expansion criteria of Medicare patient care, by offering advance the quantity. If adopted the right beneficiaries. Besides bringing payments.Medicare Shared way with the right technology, increased savings, the model has Savings Program was created to payment models under the ACO can continued to ensure that patients encourage greater cooperation bring financial benefits to payers. get high quality care. The dual and coordination

External Document © 2018 Infosys Limited among healthcare providers, to offer better coordination of healthcare based on prepaid shared savings. better healthcare to beneficiaries of services, and more investment It takes forward learnings that Medicare Fee-for-Service and bring in new healthcare processes the CMS has with the Advance down costs. Through this program, and infrastructure that improve Payment Model to provide new ACOs can enhance healthcare physician efficiency. ACOs joining this year or in 2016, value by promoting greater Another payment model by the ACO the motivation to move into areas accountability among providers, is the Investment Model, which is that are under-served.

ACOs will be offered savings prepayments at the beginning and Pioneer ACO Model and Medicare on an ongoing basis. Shared Savings Program. The in prepayments CMS, which largely oversees The CMS recently introduced a new different payment models and at the beginning payment initiative for ACOs – Next- their effectiveness, shares savings Generation ACO Model. This is best and on an generated from a program with suited for organizations with prior ongoing basis. the ACO that adopts it. The criteria experience in coordinating care for for this is: the ACOs should keep different patient populations. This their spend below a specific level new model is more aligned with – a benchmark – over the course CMS’ focus on looking into payment of three years. This is one of the It also provides for current ACOs models encouraging healthcare key factors that drives ACOs to participating in the Medicare Shared providers to take on bigger financial adopt new payment models – Savings program to shift to systems risks while rewarding them well for which may bring in better savings with increased financial risks. These positive healthcare outcomes. The than older models. ACOs will be offered savings in new model is an alternative to the

Physicians say that their payment models are changing. 51% of clinicians said that in five years, 3/4th of their total revenue will come through channels other than fee-for-service9 24% of clinicians stated that their practice was likely to partner or merge with a hospital, resulting in full employment by the hospital9

Here are some of the challenges the healthcare industry faces, and the technologies that enable healthcare organizations to overcome them and deliver benefits to providers, payers, and patients in the area of ACO payments.

Big data Solution it brings, the few that have adopted it are seeing good returns Challenge One of the technology-based trends that has caught the attention of How can big data be used to help the healthcare organizations is big Recommending the ideal model the healthcare industry leverage data. While not many have the tools, Healthcare agencies like CMS information about the ACO resources, or skills necessary to gather information about different payment models? make the most of it and the benefits payment models used

External Document © 2018 Infosys Limited by ACOs, money spent and saved, who can then retain existing providers for effectively delivering and benchmarks for each ACO. models (if they are beneficial) or good patient outcomes. The This information is then accessed, adopt new ones. programs will leverage big analyzed, monitored, and interpreted data to create a better match to get a better understanding of Developing outcome-based between healthcare providers and which models work best. reimbursement models companies based on how positive CMS and other organizations can healthcare outcomes of the former Organizations can create payment share this information with ACOs, have been. models that reward healthcare

This information is then accessed, healthcare providers will be In the coming years, organizations analyzed, monitored, rewarded by the companies. will have to invest more in and interpreted to get technology that will support better Reducing patient readmissions big data analysis, as penalties and a better understanding payment reductions for hospitals are of which models work In 2012, the ACA started the increasing every year. Compounding best. Hospital Readmissions Reductions this issue are healthcare challenges Program, to bring down incidences that plague the country. For of patient readmissions that can instance, hospitals face a 3% penalty be avoided. To align better with on reimbursement they receive This will allow companies to pay less this program, organizations are regularly for excessive patient on group insurance for employees, adopting big data tools that will readmissions within thirty days for even for those who have preexisting enable them to aggregate data predominant health issues10. conditions, as healthcare providers capable of providing insights to who have been matched with them help them avoid unnecessary show greater potential for delivering readmissions. positive health outcomes. For the quality of care they offer employees,

Big data

Challenge and kind of healthcare they deliver, Having learnt from inefficiencies of Large amounts of patient data is organizations will be able to save this data, healthcare organizations generated each day. Physicians will a specific amount of money. This are now integrating data analytics not have time to look through all of money then gets split among the into the system to not only bring it, understand what is essential, and organization’s members. greater coherence to payer and leverage it to offer better healthcare provider data, but also bring in This is in contrast to the capitation- to patients. How can this data be efficiency into physician workflows. based Health Maintenance Model used by ACOs? Analytics will help organizations that prevailed prior to the ACO sift through mountains of data model, according to which a generated and bring meaning to Solution healthcare provider is given a fixed all that information. This means revenue based on preventing Over the past few years, the concept that physicians do not have to look illnesses and related costs. However, of accountable healthcare has through reams of data – just what is this model failed, as healthcare made a significant impact on the identified as essential. industry. According to the ACO providers did not have data they Model, the government allocates needed to measure performance. specific funds for organizations to Data that was available was care for their pool of patients. Based retrospective, and was neither on the number of patients they see accurate nor timely.

External Document © 2018 Infosys Limited Cloud Challenge functions like health information information (ePHI) aggregated exchange and credentialing more from companies and healthcare Big-data-based insights generated effectively. It also helps with providers, to ensure compliance by analytics tools should be easily case management and quality with the requirements Health accessible to physicians. How can performance registries. These Insurance Portability and organizations make this happen? capabilities come together as Accountability Act (HIPAA) has viable alternatives to bring down set out. Organizations can opt for Solution dependency on hosting systems for HIPAA-compliant cloud services, ACOs to meet specific requirements. which will offer necessary flexibility Healthcare organizations employ without compromising on security cloud-based services to make ACO To run payment-related programs, or wasting resources. payment alignment more seamless. healthcare organizations have to With cloud, ACOs can carry out secure electronic protected health

External Document © 2018 Infosys Limited Mobile Solution Challenge Payment model implementation How can a healthcare provider, To help in implementation of Act – mobile apps have been payer, or group ensure they are certain payment models – like developed for both healthcare implementing a payment model the Open Payments that was started providers and payers. With such right way, especially with the many as part of a move to increase apps, users can collaborate to rules and regulations evolving and transparency in the industry record, track, share, and store becoming complex with time? with adoption of the Sunshine important information.

The payments can be role in affecting health outcomes being developed to make the captured and recorded is patients’ intake of prescribed payment process more seamless in the system through medicines. and comprehensive. Healthcare the app, which can also providers use these apps to safely By using mobile apps to remind collect payments from patients. send receipts to patients patients to take their medicines on Payment collection is enabled at acknowledging their time, healthcare providers increase any interaction point – from an payment. the chances of better healthcare emergency room to a home office outcomes. This could in turn bring – with mobile apps. Payments can better reimbursements for them be captured and recorded in the through the new payment models. system through the app, which Better alignment with fee for quality can also send receipts to patients of service model acknowledging their payment. The Development of a seamless Mobile technology can also be used information can also be synced with payment pathway in other ways to align healthcare other devices that the organization providers better with their fee for Besides apps leveraging to uses for healthcare needs. the quality of service provided. align with payment model How? A factor that plays a big implementations, they are also

Ensuring effective and authorized use of valuable resources

TREND #3 REGULATORY COMPLIANCE AND FRAUD AND ABUSE PREVENTION

External Document © 2018 Infosys Limited There is a rise in the integration of have to be complied with. Those factors too – like unnecessary new rules and regulations at local, that do not comply, will be subject patient readmissions – health national, and international levels. to penalties and enforcement organizations are feeling the Organizations of all sizes are being actions. At a time when they are pressure to align more closely with affected by these regulations, which facing penalty threats for other regulatory requirements.

Nearly 29 million patient records that These figures indicate that there subsequently large amounts of data have violated HIPAA is a pressing need for regulations are generated. Most organizations to protect patients, payers, and want to leverage this data to codes have been providers against security threats that increase returns and decrease risks. affected, based leave critical information shared by However, achieving both outcomes on a 2013 Redspin and among these players exposed. independently can be quite 12 Besides security threats, there are challenging and time-consuming Breach report . other issues that mandate the need for organizations. for strong regulations – Fraud, Waste, They can leverage technological and Abuse (FWA). A direct implication Regulatory compliance is essential innovations developed to comply of FWA is an increase in healthcare to not just pass audits, but also stay better with the regulations and costs, which is borne by the safe against growing healthcare- gain benefits that they bring. While patient, payer, or provider. Other information-related threats complying with rules can help implications of FWA are resource stemming from technological organizations avoid penalties and and time wastage. integration in nearly all aspects damage to their reputation, it also of the industry. In 2009, over 800 To prevent this, healthcare provides opportunities to fortify patient data breaches occurred organizations must align closely and make their structure stronger. within five months of a new state with the latest regulations. This Organizations that take proactive law11. Nearly 29 million patient can be quite an expensive deal for steps like employee training, records that have violated HIPAA most healthcare organizations. The benchmarking, technology codes have been affected, based on healthcare system in the US sees adoption, and best practices, will a 2013 Redspin Breach Report12. millions of patients every year and be at an advantage.

External Document © 2018 Infosys Limited A study by the Institute of Medicine estimates healthcare fraud at a massive US$75 billion a year. Increasing litigation and financial reimbursement models that pay per procedure have increased wasteful expenditure13.

The top five security challenges in 2014 were identity management and access control (35%), prevention of data leakage (30%), cloud computing (30%), encryption during transit and storage (27%), and regulatory requirements (23%). The same year, security incidents soared to 60% and costs related to this rose to an unprecedented 282%14.

Technological imperatives Here are some of the challenges the healthcare industry faces, technologies that enable healthcare organizations to overcome them and deliver benefits to providers, payers, and patients, in the area of regulatory compliance and FWA:

Social media Challenge information with a wide network protected, on social media, to and maintain dialogues. The connect and discuss about the What is an innovative method healthcare industry too can follow latest in rules and regulations. of sharing information about in their footsteps. Employees can get updates regulatory compliance across a about ethics, address concerns, healthcare organization? Communicate with healthcare or answer questions about this. Such internal channels providers about compliance Solution on social media will not only and ethics connect people, but also Organizations in several other Healthcare organizations can provide the opportunity to start industries across the globe start internal channels, which are conversations with each other. are adopting social media for communicating important

In 2013, 41% Organizations said they communicate about compliance and In 2014, 51% ethics topics through internal social media channels15.

In 2013, 45% Organizations said they review public social media and In 2014, 40% other sources as part of pre-hiring due diligence15.

Challenge the cloud should ensure that the l Data should be located / stored provider is HIPAA-compliant. If the in the United States of America, Cloud plays an important role in provider has essential procedures not in foreign countries where today’s healthcare industry, which and policies in place to stay information may be analyzed by generates large amounts of data. compliant, organizations can other governments. Organizations need the cloud to worry less about security of data store, retrieve, and share healthcare either in transit or at rest. What are l Disaster recovery plan in the and patient information. But how the criteria that healthcare leaders event of a calamity (natural or can they ensure that the cloud is should look for in cloud providers man-made) secure? they are using, before initiating a l Operational procedures that cloud strategy? monitor data round-the-clock Solution A few requirements that HIPAA- for security threats Organizations covered under compliant cloud providers l Data should be encrypted in HIPAA and considering moving to should meet: transit and at rest

External Document © 2018 Infosys Limited HIPAA-compliant cloud providers also create incident presented, especially in case of service providers typically response processes that help them audits. They also have strong have policies in place to meet take care of security breaches credentials that prove their different challenges and tackle without much delay. Procedures expertise and are willing to various situations, like change they follow are documented enter into a Business management. The service thoroughly and are ready to be Associate Agreement.

The service providers also create Business Intelligence is that it helps organizations reduce healthcare costs and enable incident response Emergence of the Affordable Care compliance and adherence more Act brings twofold mandates that processes that help effectively. It brings big benefits for organizations have to align with them take care of patients, too – encourages them – ACA, and existing requirements to make healthier lifestyle choices, security breaches that are part of the organization’s stay educated about treatment systems. To achieve this, they have without much delay. plans, take ownership of their to streamline all requirements into health, and more. Below are other one framework – a task that can be benefits of integrating gamification best performed only by business intelligence tools. The right tools in healthcare: Most cloud service providers who can positively impact their are aligned with HIPAA compliance bottom line and experience Educating physicians offer two factor authentication that patients have. systems, where both healthcare According to a recent research, providers and the service providers physicians who used specific Gamification have joint access to the stored health-related video games to information. They also encrypt Besides EHRs, analytics, and big learn were able to deliver better data (including patient, billing, data, gamification has become an patient care than most others and payment information) with important element for stakeholders who used traditional methods of latest techniques to ensure that in organizations. One of the reasons education. A game that the former information is reasonably protected. gamification has gained importance used consisted of online trivia

External Document © 2018 Infosys Limited which provided physicians their use these video games to practice also tells them best practices that scores and ranking in terms of other anytime. It gives them a better edge can get them to their goals faster. players. Such games can reduce to handle surgical instruments like One such instance of gamification time physicians spend on learning laparoscopic devices, more precisely. helping patients is Packy and and fast-track them to delivering Marlon, a game that was developed better results. Influencing patient adherence to help children manage juvenile diabetes. It has been successful in With the help of patient-focused Enhancing surgical precision reducing the need for urgent care games, people can set health goals and emergency visits to healthcare Video games targeted at surgeons for weight loss or gain. These games facilities due to diabetes-related can help them increase their chart the path that patients take to conditions, by 70%16. precision and aim. Surgeons can reach their goals more effectively. It

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15http://www.pwc.com/en_US/us/risk-management/state-of-compliance-survey/social- media-impact.jhtml

16http://www.hcs.harvard.edu/hghr/print/student/gamification-rules/

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