Archive

Archive for the ‘Deloitte’ Category

Health care fraud and abuse enforcement: Relationship scrutiny

July 17, 2015 Comments off

Health care fraud and abuse enforcement: Relationship scrutiny
Source: Deloitte

Where is fraud and abuse enforcement headed in health care? One emerging area of interest is relationship scrutiny. Relationships can be complex in the business of health care: tracking and analyzing them is an important part of minimizing the fraud and abuse that may result from questionable relationships and improper influence.

Many organizations depend on analytics to understand their own performance. Insights and patterns within the data are often used to inform strategy and decision making. Researchers can apply analytics to identify external trends and factors that may impact businesses. To that end, Deloitte researchers used analytics techniques to examine the text of tens of thousands of federal regulations and identify emerging trends in health care fraud and abuse enforcement. The results are telling: Federal health care regulators are emphasizing relationship scrutiny in their fraud and abuse enforcement efforts. Also, discussion of health care fraud and abuse topics – including relationship scrutiny – is recurring, as evidenced by the cyclical rise and fall in frequency and relevance of keyword groups related to “enforcement,” “value-based care,” and “fraud and abuse.” The bottom line: discussion of these topics is present; relationship scrutiny is likely here to stay.

Health care fraud and abuse enforcement: Relationship scrutiny

July 5, 2015 Comments off

Health care fraud and abuse enforcement: Relationship scrutiny
Source: Deloitte

Where is fraud and abuse enforcement headed in health care? One emerging area of interest is relationship scrutiny. Relationships can be complex in the business of health care: tracking and analyzing them is an important part of minimizing the fraud and abuse that may result from questionable relationships and improper influence.

Many organizations depend on analytics to understand their own performance. Insights and patterns within the data are often used to inform strategy and decision making. Researchers can apply analytics to identify external trends and factors that may impact businesses. To that end, Deloitte researchers used analytics techniques to examine the text of tens of thousands of federal regulations and identify emerging trends in health care fraud and abuse enforcement. The results are telling: Federal health care regulators are emphasizing relationship scrutiny in their fraud and abuse enforcement efforts. Also, discussion of health care fraud and abuse topics – including relationship scrutiny – is recurring, as evidenced by the cyclical rise and fall in frequency and relevance of keyword groups related to “enforcement,” “value-based care,” and “fraud and abuse.” The bottom line: discussion of these topics is present; relationship scrutiny is likely here to stay.

Minimizing the risk of health care fraud and abuse doesn’t have to be an impossible task. New insights can come from the application of analytics to an organization’s data sets. These insights, in turn, can be used to build a fraud and abuse risk-mitigation program.

This paper examines health care fraud and abuse enforcement drivers and laws, the cyclical trend of relationship scrutiny within the regulatory discussion, and how health care organizations can build a responsive, analytics-based program to address potential fraud and abuse. An effective program will likely enable organizations to identify risks in real time, adjust to mitigate them, communicate their importance, and learn from the regulatory and legislative landscape.

The 10 percent problem: Future health insurance marketplace premium increases likely to reach double digits

June 25, 2015 Comments off

The 10 percent problem: Future health insurance marketplace premium increases likely to reach double digits
Source: Deloitte

Health plans setting their premiums for the public health insurance marketplaces have faced one of the most challenging pricing scenarios in recent history. A new set of rating rules, a competitive environment, and ambiguity around enrollee populations collided to create unprecedented uncertainty.

While the Affordable Care Act (ACA) established three programs – risk adjustment, risk corridors, and reinsurance – to address some of this uncertainty, two of the programs will expire after 2016. How might these expirations and other policy levers influence health plans’ strategies for setting their marketplace premiums?
This report presents a forward-looking view for health plans participating in the marketplaces, with modeling by Deloitte Consulting LLP’s health actuarial practice estimating the effect of the risk corridors and reinsurance program expirations on health plan premiums. Among key observations:

  • Premium increases of 10 percent or more could be likely over the next three years as health plans prepare for the end of the risk corridors and reinsurance programs and try to reach or maintain profitability in 2017.
  • Certain policy levers are influencing health plans’ options for premium increases and their decisions around insurance marketplace participation. Among these are pressures to not exceed the 10 percent rate increase threshold, to offer broader networks, and to discontinue other strategies to keep prices down.
  • Health plans should consider a multi-year strategy for setting their marketplace premiums and test its execution by modeling different scenarios.

The Social Progress Index: A holistic measure of progress

May 28, 2015 Comments off

The Social Progress Index: A holistic measure of progress
Source: Deloitte

On 9 April, the 2015 Social Progress Index launched – it measures the social and environmental outcomes for 133 countries, covering 94% of the world’s population.

As a complement to economic measures such as GDP, the Social Progress Index provides a more holistic measure of country performance and helps to drive real and sustainable growth that is important for business and vital for building a prosperous society.

How did your country do?

Expanding coverage: How primary care physicians are accommodating the newly insured

May 21, 2015 Comments off

Expanding coverage: How primary care physicians are accommodating the newly insured
Source: Deloitte

Are there enough physicians in the US to accommodate the millions of newly insured patients? If not, how will the health care system manage its growing (and aging) patient population?

The Deloitte Center for Health Solutions 2014 Survey of US Physicians shows that 44 percent of physicians are treating more newly insured patients – an important finding for health care stakeholders and decision makers. More primary care physicians (PCPs) (56 percent) experienced an increase in the number of newly insured patients than did surgical specialists (40 percent), non-surgical specialists (38 percent), and other physicians (33 percent). Survey respondents report that this is causing longer appointment wait times and driving PCPs to work longer hours. To cope, some PCPs are adding new physicians and hiring clinical staff to help with care coordination.

Expanding coverage: How primary care physicians are accommodating the newly insured

May 14, 2015 Comments off

Expanding coverage: How primary care physicians are accommodating the newly insured
Source: Deloitte

Are there enough physicians in the US to accommodate the millions of newly insured patients? If not, how will the health care system manage its growing (and aging) patient population?

The Deloitte Center for Health Solutions 2014 Survey of US Physicians shows that 44 percent of physicians are treating more newly insured patients – an important finding for health care stakeholders and decision makers. More primary care physicians (PCPs) (56 percent) experienced an increase in the number of newly insured patients than did surgical specialists (40 percent), non-surgical specialists (38 percent), and other physicians (33 percent). Survey respondents report that this is causing longer appointment wait times and driving PCPs to work longer hours. To cope, some PCPs are adding new physicians and hiring clinical staff to help with care coordination.

How does this compare with the Massachusetts experience with coverage expansion? What impacts will expansion of health care coverage to the newly insured have at national and state levels? What effect will it have on the role of the US safety net system and hospital emergency departments? How will growth in the insured population affect mid-level providers and retail health and urgent care clinics?

Physicians are already experiencing increased demand from a larger patient population. Adapting to that demand is one of the next challenges, not only for physicians, but for many health care stakeholders and decision makers. States and other policy makers may want to consider policy solutions to alleviate physician pressure, including increasing Medicaid primary care service reimbursement rates, sponsoring patient-centered medical homes (PCMH), advancing scope-of-practice standards, and reducing barriers to technology adoption. While physicians will continue to play a critical role in the US health care system, they will likely need to adapt to ever-growing patient numbers and demands. And, they should adapt quickly and prepare to weather the storm. Physician practices should consider redesigning care delivery models, developing new relationships, using data and analytics, and improving patient engagement.

Compensation Committee Guide

May 7, 2015 Comments off

Compensation Committee Guide
Source: Deloitte

Given the continuing focus by shareholders and directors on the role of compensation committees and corporations’ compensation programs, this guide provides information on:

  • Composition and meetings;
  • Charters;
  • Roles and responsibilities; and
  • Legal standards and regulations that govern compensation committees and their members.
  • Detailed guidance is also provided around many other topics to promote compensation committee effectiveness.

Posted with permission from Wachtell, Lipton, Rosen & Katz. Copyright 2015.

Follow

Get every new post delivered to your Inbox.

Join 1,052 other followers