Tag: healthcare

HealthEdge Acquires Complementary Product Vendor The Burgess Group | Blog

On July 21, 2020, HealthEdge announced its acquisition of The Burgess Group, which we recently recognized as a Major Contender on our Healthcare Payer Payment Integrity Solutions PEAK Matrix™ Assessment 2020.

Healthcare Payer Payment Integrity Solutions PEAK Matrix™
HealthEdge provides an integrated financial, administrative, and clinical software platform (the HealthRules suite), while The Burgess Group is a specialist in the payment integrity software space.

Here’s our take on this deal.

The strategic intent behind the deal

The healthcare payer industry is plagued with notoriously old infrastructure. While healthcare payers are working to increase data transparency, offer member-centric solutions, and adopt a value-based care model, they’re obstructed by high reliance on dated, disconnected, and non-interoperable systems. Cost management is another endemic issue impacting the payer industry. One of the key reasons for this financial distress is the high share of expenditure on administrative costs in the US healthcare system, driven by redundant processing and limited automation. To address these roadblocks, payers are increasingly leveraging a core-admin platform approach.

The interesting fact here is that medical costs account for 80-85 percent of the total payer cost, while only 15-20 percent are admin and IT costs. Payers leave a lot of value on the table when they manage these costs separately. Payment integrity is one of the principal tools to manage medical costs and, hence, is a key functionality that payers value in core-admin platforms. By adding The Burgess Group’s offerings to its own expertise, HealthEdge’s goal is to create an integrated claims processing, payment integrity, and adjudication platform that addresses both administrative and medical expenses.

Another point worth noting is that Blackstone completed the acquisition of a majority stake in HealthEdge in April 2020, giving HealthEdge the financial muscle it required to make the right investments to expand its product offerings and compete with the other big players such as Cognizant (TriZetto), HM Health Solutions, Mphasis, and NASCO.

Unpacking the companies’ synergies

The acquisition offers several synergies.

HealthEdge Acquires Complementary Product Vendor The Burgess Group synergies

Things to watch out for

Ram Jagannath, global head of healthcare at Blackstone Growth and chairman of HealthEdge, has stated that the acquisition of Burgess is a great strategic fit for HealthEdge to enter the large, high-growth payment integrity market, helping address the estimated $1 trillion in wasteful spending in the US healthcare system.

We are positive about this deal, particularly for what it means to the market and current market demand. However, it remains to be seen how HealthEdge leverages this investment, while also mitigating the major concerns that enterprises cite around using platforms, including integration, interoperability, scalability, and user experience.

Platforms that can address medical costs while encouraging data-driven process efficiency are generating growing interest in the market. If HealthEdge can partner with payers to create tightly knit contracts with strong risk mitigation and guaranteed savings clauses, this comprehensive platform can unlock tremendous value for payers. We’ll be tracking this one closely.

Reach out to me at [email protected] with your thoughts on this acquisition or the market in general.

How the COVID-19 Pandemic is Impacting Pharma Sales Interactions with Healthcare Providers | Blog

With the world facing an unprecedented health crisis, one group shouldering the brunt of the challenge is our healthcare workers, who are battling the threat from the front lines. Under the circumstances, their interactions with pharma sales representatives have naturally taken a back seat, with many healthcare providers closing down access. This reality is accelerating pharma firms’ shift toward a virtual sales organization, and not only for the short term.

The amount of time, access, and influence hospitals have been willing to grant pharma sales reps has been dropping for quite some time now, and face-to-face engagements have declined significantly over the years. According to a survey from DRG’s 2019 annual ePharma Physician Report, 54 percent of physician respondents said they saw pharma reps in person in 2019, down from 67 percent in 2018.

DRG ePharma Physician Report 2019 – % of physician respondents on pharma rep interactions11 1

Source: ePharmaPhysician® US 2019

Today, given the COVID-19 pandemic, healthcare providers, including hospitals and clinics, are increasingly refusing in-person visits from pharma sales reps, and pharma companies such as Biogen and Global Blood Therapeutics have themselves suspended face-to-face meetings. In turn, virtual interactions between reps and healthcare providers are increasing, with BMS, GSK, Pfizer, and Sanofi – to name a few – scaling up the use of remote technology to ensure continued engagement with healthcare professionals. We expect this progress to continue even after the pandemic’s threat has abated.

However, not all pharma firms are well equipped for this shift; there’s a wide degree of variance when it comes to the maturity of their virtual healthcare provider engagement capabilities. Not surprisingly, the many digital solutions that exist in the current market can help them. Several software vendors and IT services providers have developed innovative CRM solutions, such as around personalized engagement, interactive detailing, and live video through intuitive mobile apps and web portals, in order to effectively engage healthcare providers virtually.

In response to the crisis, many vendors have recently begun to enhance product functionality. For instance, Veeva recently introduced new capabilities for remote drug sampling in Veeva CRM Engage Meeting. The company also announced several alliances for digital field engagement.

Yet, going forward, getting virtual sales right could be a major deciding factor for whether or not pharma firms are able to convert extensive R&D efforts and patent wins into commercially successful therapies.

Here are our suggestions on how pharma firms can successfully pivot to a virtual sales :

Picture1

  • Realign budgets Drive C-suite endorsement of initiatives whose goal is improving virtual engagement with healthcare practitioners. Money saved on aspects such as travel and organizing marketing conferences/gatherings should be diverted to investments in IT and content creation.
  • Engage technology partners to have the right solutions in place Assess the landscape of solutions from Independent Software Vendors (ISVs) and IT services providers. Look for verticalized CRM solutions meant particularly for healthcare provider engagement. Prioritize quickly implementable and scalable solutions that give the assurance of little downtime and offer omni-channel (email, web, mobile, etc.) and personalized engagement.
  • Create compelling content Rethink marketing strategies. Content delivered virtually needs to be all the more engaging, detailed, and easy to consume. Such content could include live videos, webinars, intuitive brochures, and web/mobile portals. Generating personalized content can improve conversion rates. Finally, content needs to be such that healthcare providers can consume it in their own time and follow up on as needed, minimizing the need for live interactions.
  • Train representatives to effectively engage and deliver information in virtual settings Facilitate a cultural shift in sales operations from being in-person to virtual through dedicated training programs. Representatives need to utilize the time saved on travel to draft strategies for more engaging interactions. They also need to be trained on using specific technology tools for provider engagement.

While healthcare workers are bound to be overburdened and under tremendous stress in these times, this is also a tough time for pharma sales representatives. Assertive sales behavior might come across as being insensitive, but at the same time, healthcare practitioners need to be kept aware of new therapies for ailments apart from COVID-19. Shifting to a virtual model represents a huge change. Engaging with empathy and showing flexibility in working around physician schedules will be paramount in the near term, as pharma enterprises come to grips with what could potentially be a new, or next, normal.

 

Taking a Value Chain-led View to Secure Healthcare Enterprises | Blog

Between 2018 and 2019, the US healthcare industry experienced a five-fold increase in patient data breaches, with hacking accounting for more than 88 percent of them. More than half of the targeted entities were healthcare providers, primarily due to inadequate investments in cybersecurity and the negligence of unsuspecting employees.

Patient data is sacrosanct for the healthcare industry given its highly sensitive nature. In fact, patient Electronic Health Records (EHRs) are priced 10 times higher than credit card information on the dark web. Given that healthcare data is a lucrative target for cyber attackers, healthcare CXOs need a guided approach to secure their patients and enterprises against cybersecurity threats.

A value chain-led view of cybersecurity

Healthcare enterprises are becoming increasingly vulnerable to attacks as patient-centric care takes center stage and care delivery models such as mHealth and remote monitoring become commonplace. So, they must identify their crown jewels – patient data, care delivery applications, and medical devices, among others – across the value chain and allocate their cybersecurity investments accordingly. To do so, they need to contextualize threat intelligence, understand attackers’ behavior and intent, and make appropriate investments in cybersecurity to increase preparedness and reduce response time in the event of a breach.

Stress-testing the value chain-led view

To hack-proof their estates, healthcare enterprises need to adopt a value chain-led view to identify and alleviate cybersecurity concerns across four areas:

  • Patient engagement: Patient care starts as soon as a patient is made aware of a health condition. To prevent any patient data leaks, healthcare applications must be HIPAA-compliant, designed with patient privacy at the center, and have strong identity and access management controls.
  • Care/case management: The primary activities in care/case management are appointment scheduling, remote consultations, and mHealth application use, for which physicians need access to sensitive EHR data. It’s important to incorporate patient identity verification and data security layers for EHR access, as well as to build in network and endpoint security protocols to protect EHRs and devices connected to them.
  • Diagnostics, treatment, and monitoring: As medical devices increasingly connect to the provider network, malware attacks aimed at halting care operations threaten to disrupt hospital functioning. Healthcare enterprises can strengthen their endpoints by adopting malware protection, endpoint detection and response solutions, and device management software. Additionally, providers need to prevent unauthorized access to their systems.
  • Financials and network management: Providers should also invest in data and network security to make sure all patients’, payers’, and banks’ financial transactions are safe and secure.

Here’s an example of how a healthcare provider can prioritize its IT security investments in accordance with its business priorities by taking a value-chain view.

digital healthcare provider enterprise

Setting the wheels in motion

Once healthcare enterprises have identified what to do to bolster security across the value chain, they need to think about how to do it. We recommend a three-phased approach:

  • Prioritize: Enterprises need to prioritize their investments and chart out a strategic and technical implementation roadmap. Having a cyber architecture in place, along with a future security plan, will aid implementation.
  • Evangelize: Once implementation begins, providers should address internal risks and change management by combining a consultative approach with a sharp focus on managed services. They should ensure that all business units across the value chain are involved for a harmonized security view.
  • Protect at scale: They should also invest in talent, short-term detection, and long-term threat investigation capabilities across the value chain, as well as solutions contextualized for threat management.

A real-life example of the value chain-led approach in action

US-based Trinity Health adopted an enterprise-wide data security strategy in the aftermath of the WannaCry ransomware attack in 2017. It implemented an asset management plan to govern its connected devices and networks to improve its response to adverse events. It also instituted an event response team to isolate, contain, and deploy patches when threats were identified. Realizing that its employees could also be vulnerable targets, Trinity Health initiated exercises to help them recognize and respond to cybersecurity threats. And that’s not all; it also leveraged the National Institute of Standards and Technology (NIST) Cybersecurity Framework to redesign its procurement process, technology and security assessments, and supplier evaluation responsibilities to recover in case of actual emergencies.

In an industry committed to digital transformation and increasingly embracing patient-centric care, healthcare providers must devise a well-thought-out cybersecurity strategy to protect their crown jewels across the value chain. This is the only way they’ll retain patients’ trust, drive brand value, and ensure better outcomes for all stakeholders involved.

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