ICD-10
Turning Regulatory Compliance into Strategic Advantage
Produced by the
Deloitte Center
for Health Solutions
ICD-10
A Collaborative Framework for
Disease Diagnosis and Treatment
Since 1900, regulators of the U.S. health care system have endeavored to give care providers a
systematic way to classify diseases so that care processes could be standardized and appropriate
payments made. Like many of the world’s developed health care systems, the United States follows
the World Health Organization’s (WHO) International Statistical Classification of Diseases and
Related Health Problems (ICD) code. The ICD is used internationally to classify morbidity
and mortality data for vital health statistics tracking and in the U.S. for health insurance claim
reimbursement. The ICD has gone through numerous iterations since its inception.
In 2011, per the mandate of Senate Bill 628, the United States will move from the ICD-9 system to ICD-10, a
much more complex scheme of classifying diseases that reflects recent advances in disease detection and treatment
via biomedical informatics, genetic research and international data-sharing.
The health of populations supersedes country borders, so it is logical that knowledge about these diseases, their
causes and cures, should be an international pursuit void of political boundaries and bias. ICD-10 is, in many
ways, a highway for international collaboration – a common language already spoken by ten countries.
It is essential that information systems used by U.S. health plans, physicians and hospitals, ambulatory providers
and allied health professionals also become ICD-10 compliant. This process, however, is not an inconsequential
task; it will require careful planning and effective implementation. This paper from the Deloitte Center for
Health Solutions (the “Center”), part of Deloitte & Touche USA LLP, describes the impact of the proposed move
to ICD-10 on U.S. health plans and providers and discusses the need to prepare for this change now to turn
regulatory compliance into strategic advantage.
Health care is a powerful global force. The collaboration of leading health systems to share knowledge and
encourage innovation in the diagnosis and treatment of disease provides a solid framework for medical
diplomacy. The implementation of ICD-10 is, therefore, more than an exercise in compliance; it is a key step
in the continued maturation of the global health care system.
Paul H. Keckley, PhD
Executive Director
Deloitte Center for Health Solutions
ICD-10
U.S. Health Care: Evolution or Revolution?
Dramatic market changes, spiraling costs and increasing
regulatory challenges are making the evolution of the U.S. health
care industry feel more like a revolution. Over the past three
decades, stakeholders have wrestled with managed care, HIPAA,
the rise of consumerism, and the introduction of comprehensive,
integrated clinical and practice management technology
solutions. Today, industry visibility is at an all-time high among
both the public and private sectors. Coverage for the uninsured,
quality and price transparency, and the high cost of insurance
premiums (and health care costs in general) are platform issues
for virtually every politician and policy maker, including the 2008
Presidential candidates. The stage is set for a transformation
of the U.S. health care system – a revolution that will require
massive investment in new technologies and care processes.
IT Investments Essential to Keep Pace
As early as the 1930s, U.S. employers recognized that
the costs of delivering health care were becoming too
burdensome for individuals to shoulder alone. Health plans,
or payors, emerged as the mechanism that could bear these
costs. Originally, health plans were established as not-forprofit entities designed to spread the costs of health care
delivery across a broad employer group that guaranteed
“health care for life” for all loyal employees. Over time,
however, a payor shift to for-profit organizations and the
advent of managed care in the 1990s as the primary method
for delivering health insurance dramatically altered the
health care landscape – particularly the way that physicians
and hospitals interact with patients and health insurance
companies. Providers’ ability to consistently and accurately
communicate transactional data and clinical information
about each health care encounter, or claim, to the appropriate
payor has become critical to managing the provider-payor
relationship, generating a steady stream of reimbursement
revenue, and sustaining patient loyalty. The importance
of producing accurate and timely claims data has, in turn,
created a complex and costly technology infrastructure that is
now integral to most providers’ operations.
On the next page, Figure 1 illustrates the waves of information
technology (IT) investment that have been required to keep
pace with changes in the U.S. health care industry. It also looks
ahead to a new IT investment challenge: the mandated 2011
move to ICD-10.
ICD-10
Figure 1: IT Spending Trends to Support the Evolution of U.S. Health Care
Stages of Industry Evolution
Payor Trends Inreasing
Baseline IT Capital
Investment
Can standalone health entities and smaller regional players find the capital to evolve to this level?
4
3
ICD–10 &
Health Advocacy
Subtantial capital investment & modernization efforts launched
ConsumerCentric Model
Rollup of small health plans and providers
Corresponding
Provider Trends
ICD–10 &
Consolidation to
Uniform Systems
Platform
2
Initial Consolidation
1
Managed
Care
HIPAA &
Y2K
Patient-Centric
Capabilities
Y2K &
Emergence
of the EMR
Best-of-Breed
Automation
1990s
Time Frame
1998 – 2003
2004 – 2010
2008 – 2015
ICD-10, combined with other trends, will drive another spending wave,
which will lead to consolidation pressure with both providers and payors
Copyright © 2007 Deloitte Development LLC. All rights reserved.
As illustrated above, managed care initiated a major wave of IT
investment for payors, with many considering consolidation to
scale their operating and technology models. Simultaneously,
providers were installing and attempting to integrate myriad
package applications across their front and back offices and
ancillary service areas. Compliance with the 1996 Health
Information Portability and Accountability Act (HIPAA) and
measures to address Year 2000 (Y2K) concerns initiated
the second wave of IT investment, forcing health plans to
standardize their interactions with outside constituents and
remediate their large legacy applications to accommodate a
4-digit-year field. While providers were dealing with similar
concerns, this period also saw an aggressive move toward
implementation of electronic medical records (EMRs), which
had finally matured to a point where viable solutions existed
which had both state-of-the-art functionality and a reasonable
price tag. These first two waves of investment were major
contributors to the massive complexity and associated
operating costs of today’s IT systems.
ICD-10
Enter the ICD-10 Challenge
As if existing IT investments weren’t a large enough strain on
provider and payor budgets, the U.S. health care industry is
facing a new challenge: ICD-10 implementation. The ICD-10 bill
(Senate Bill 628) is predicted to become a requirement for all
U.S. health entities as early as 2011.1 Industry analysts such as
the Robert E. Nolan Company characterize ICD-10 as exceeding
Y2K with respect to cost and impact.2
U.S. ICD-10 adoption has the potential to revolutionize the
nation’s health care system and produce another huge wave of
IT spending. This paper describes the impact of the proposed
move from ICD-9 to ICD-10 on payors and providers and the
need to prepare for this change.
What is ICD-10?
When a physician evaluates a patient, the physician collects
subjective and objective data (the “history and physical”)
to diagnose the patient’s condition and develop a plan for
treatment. The most widely used diagnostic taxonomy in health
care is the World Health Organization’s International Statistical
Classification of Diseases and Related Health Problems (ICD).3
The ICD is a coding of diseases and signs, symptoms, abnormal
findings, complaints, social circumstances and external causes of
injury or diseases4 that is used internationally to classify morbidity
and mortality data for vital health statistics tracking and in the
U.S. for health insurance claim reimbursement.
Emerging health care consumerism came hard on the heels of
wave two, and it affected (and continues to affect) payor and
provider alike. Health care costs and purchasing responsibility
are shifting from employers to employees. At the same time,
physicians and hospitals must address consumer demands
for a streamlined and more transparent health care delivery
model. Whether this means delivery of a single bill for all
services rendered, easier access to facilities and services across
an Integrated Delivery Network (IDN), or personal access to
their health information over the Internet, providers have
been challenged to deliver more patient-centric solutions.
Health plans, in turn, are being charged with developing new
insurance products that appeal to changing consumer needs.
All health entities are wrestling with the associated IT costs to
address this market shift.
Currently, the ICD code is in its tenth edition, ICD-10, which
was developed in 1992. As of 2007, the United States is the
only country in the industrialized world still using older ICD-9
codes for administration and health care delivery (Figure 2,
next page). The ICD-9 system was developed in the 1970s
and contained structure/space limitations that constrained its
ability to accommodate advances in medical knowledge and
technology.5 ICD-10 codes address these issues and also help
in morbidity and mortality reporting.
Because the United States continues to use version ICD-9, it has
difficulty comparing its health service utilization to other countries.
Also, ICD-9’s age makes its content no longer clinically accurate
with current medical science, and U.S.-adopted national/state
ICD-10 mortality data cannot be compared to ICD-9. Numerous
sources are concerned that the U.S. will continue to lag ICD-10
implementation, despite the Critical Access to Health Information
Technology Act of 2007’s (Senate Bill 628) mandate for ICD-10
implementation by October 1, 2011.
1 Senate Bill 628, February 15, 2007, page 10
2 “Replacing ICD-9-CM with ICD-10-CM and ICD-10-PCS: Challenges, Estimated Costs, and Potential Benefits,” Robert E. Nolan Company, October 2003, page 6
3 http://en.wikipedia.org/wiki/List_of_ICD-10_codes
4 Ibid
5 “The Cost and Benefits of Moving to the ICD-10 Code Sets,” Rand Corporation, March 2004
ICD-10
Figure 2: Worldwide ICD-10 Adoption
Germany
United Kingdom
Canada
• Adopted in 1998
• ICD–10–AM for morbidity
• Implementation took 3 years
• Adopted in 1995
• Began adopting in 2001
• Over 5-year
implementation
• ICD–10–CA for morbidity
• Coding is used for
statistical purposes
rather than for billing
Russia
• Adopted in 1999
China
• Adopted in 2002
Australia
Brazil
France
• Adopted in 1998
• Adopted in 1996
South Africa
• Adopted in 1998
• Implementation took 2 years
• 2 years from decision
to change to actual
implementation was
insufficient lead time
to build the classification
and educate users
• Adopted in 1996
Countries who have adopted ICD – 10
SOURCE: http://www.who.int/classifications/icd/en/
ICD-10 Could Eclipse Y2K
in Scope and Complexity
U.S. adoption of ICD-10 will undoubtedly require a massive
overhaul of the nation’s medical coding system because the
current ICD-9 codes are deeply imbedded as part of the
coding, reporting and reimbursement analysis performed
today. Indeed, in our opinion, ICD-10 implementation has
the potential to overtake Y2K in terms of impact and cost. It
will require a massive wave of system reviews, new medical
coding or extensive updates to existing software, and changes
to many system interfaces. Because of the complex structure
of ICD-10 codes, implementing and testing the changes
in EMRs, billing systems, reporting packages, decision and
analytical systems will require more effort than simply testing
data fields – it will involve installing new code sets, training
coders, re-mapping interfaces and recreating reports/extracts
used by all constituents who access diagnosis codes. In
short, ICD-10 implementation has the potential to be so
invasive that it could touch nearly all operational systems and
procedures of the core payor administration process and the
provider revenue cycle.
Clearly, U.S. health care organizations have much to consider
before deciding how to address ICD-10 compliance. The Deloitte
Center for Health Solutions encourages those payors and
providers who are seeking long-term viability to consider ICD-10’s
impact to their overall strategic plan before choosing an adoption
strategy. While ICD-10 might at first appear to be solely a tactical
remediation effort, we view ICD-10 as a potential platform for
future strategic innovation.
ICD-10
Where Does U.S. ICD-10
Implementation Stand Today?
As of late 2007, the Centers for Medicare and Medicaid Services
(CMS) had begun its assessment of ICD-10’s impact to its internal
systems and to the overall U.S. health care system, but had not yet
published its requirements for ICD-10 (also known as the “Final
Rule”).6 Similarly, the Bush administration is expected to request
nearly $40 million in funds to begin overhauling CMS systems
in 2009.7 Because the Senate’s ICD-10 bill has not yet been
passed into law, an accompanying air of uncertainty presents a
significant challenge for health care stakeholders. However, using
CMS compliance mandates for earlier legislation such as HIPAA,
Medicare Part D, and National Provider Identifiers (NPI) as a guide,
the industry should assume that, at a minimum, CMS will require
that health care entities perform electronic transactions (EDI)
using ICD-10 code nomenclature. This will require a conversion
from today’s standard 4010 version of HIPAA messages to the
expanded 5010 version, which is required to handle the new
ICD-10 coding formats.8 Taking things a step farther, it is likely
that CMS will develop a new Medicare fee schedule which, in
turn, will require payors and providers to remediate their systems
to bill and submit claims against this new schedule. These changes
alone could create a ripple effect that impacts nearly all core
provider revenue cycle and payor claims adjudication processes
and systems, as illustrated in Figures 3 and 4.
Figure 3: Potential ICD-10 Impact on Payor Claims Process
Health Care Claim Life Cycle
Renegotiate fee schedule
& special arrangements
provisions for ICD–10
Remit Payment
to Provider
Claim posted
to repository
Revise auth for
procedure criteria
and develop new
fee schedules
START:
Patient
Encounter
Provider training – understand
and change diagnosis patterns
based on ICD–10
Physician
diagnoses
patient
Staff receive
diagnosis/
procedure code
Claim successfully
adjudicated
Price Claim
Electronic claim
forms forwarded
to clearing house
or health plans
Check Auth
Select
Provider
Determine
Benefit
Levels
Adjust Med Mgmt
benefits
Begin claim
adjudication
process
Check
Eligibility
Map benefits logic
to ICD–10 codes
Legend: ICD–10 Impact
Training
Payor Process
Process & Systems
Provider Process
Copyright © 2007 Deloitte Development LLC. All rights reserved.
6 http://www.ahima.org/press/CMScontract.asp
7 http://insidehealthpolicy.com/secure/health_docnum.asp?f=health_2001.ask&docnum=CMS-10-24-6&DOCID=CMS-10-24-6
8 Ibid
Remediate
practice mgmt
system
Update
electronic
systems to
transmit claims
Update
electronic
systems to
accept claims
ICD-10
Figure 4: Potential ICD-10 Impact to the Provider Revenue Cycle
Charge/Coding Integrity
PreRegistration
Scheduling
Function
Process
Patient Access Services
Financial
Counseling
Patient Access Department
Registration
Charge
Capture
And Entry
Nursing
& Site
Coding
Assignment
Med Records
& Site
Patient Financial Services
Pricing
Finance
Claims
Processing
Account
Resolution
Payment
Posting
Patient Accounting Department
Information Systems
Regulatory Compliance
Legend: ICD–10 Impact
Medium Impact to Process/Systems
Large Impact tp Process/Systems
Medium Training Requirement
Large Training Requirement
Copyright © 2007 Deloitte Development LLC. All rights reserved.
ICD-10
Three Strategic Responses to Consider
If history serves as a guide, we expect that health care
organizations will fall into three potential camps when
preparing for and adopting the ICD-10 standards:
pragmatists, collaborators, and innovators (Figure 5).
Figure 5: ICD-10 Adoption Maturity Model
Pragmatists
Achieve “Basic Compliance”
~ 60% of Health Entities
Negative ROI
Collaborators
Achieve “Successful Compliance”
~ 20 – 25% of Health Entities
Break – Even
Innovators
Achieve “Strategic Value”
~ 15 – 20% of Health Entities
Value
Realization
Competitive
Advantage
Strategic Value
Benefit
CMSMandated
Changes
• Basic Coding
• EDI Transactions
• Government Reporting
Cost
• Core Administrative
& Revenue Cycle
Processes
• Remediation of
Internal Reporting
Integration Level
Copyright © 2007 Deloitte Development LLC. All rights reserved.
10
• Advanced Analytics
• Payment Monitoring
• Transformed HCM, Contracting,
& Business Acquisition
• Advanced Training, Outcomes
Mgmt, & Physician Score Cards
ICD-10
Pragmatists
We expect that nearly 60 percent of all health care entities will
achieve basic ICD-10 compliance – the bare minimum required
by law. This means they will be investing only in infrastructure to
fulfill core CMS mandates: claims adjudication, referral processing
and related communication of health transactions for payors; and
basic coding and core revenue cycle processing using the ICD-10
code set for providers. We expect that organizations which choose
this approach will look to leverage “wrap-around” solutions such
as EDI crosswalks and similar technologies that attempt to shield
core processes and systems from the invasive nature of the ICD-10
mandate. However, lessons learned from HIPAA and NPI have
shown that organizations often underestimate the complexity of
these solutions, which ultimately bear very large costs but yield
very little strategic value.
Because of their lack of investment in advanced capabilities,
payors that choose this path will not be able to:
•Improved claims adjudication and provider reimbursement
rates, in spite of having better-quality data due to improve
medical-coding accuracy and granularity;
•Make efficient use of granular drug data to improve patient
care and safety by observing usage trends and analysis of
harmful side effects;
•Make efficient use of data granularity for diagnosis, procedure
and case mix groups (CMGs) to profile a patient’s condition, or
track length of stay related to improving utilization management.
Similarly, providers choosing basic ICD-10 compliance will not be
able to:
•Realize cost savings through effective infrastructure planning
(Cost savings can be realized by accurately predicting resource
utilization, appropriate site of service, and improve care
delivery team communication.);
•Use higher specificity of coded clinical data in payor contracting
to obtain accurate and appropriate reimbursement, improved
outcome management and monitor key indicators of revenue
cycle effectiveness (re-admission rates, medical necessity
screenings, etc. );
•Minimize adverse impact to revenue cycle performance
without advanced training and preparations for ICD-10
Health Information Management (HIM) coder training and
delivery team documentation requirements.
We expect that health care entities that choose this path
will likely have negative ROI on their ICD-10 remediation
investments and will not gain operational and strategic
advantage in the marketplace.
11
ICD-10
Collaborators
We anticipate 20 to 25 percent of all health care entities to
strive to exceed basic compliance and to drive ICD-10 into all
core administrative and clinical functions. This more strategic
approach, termed successful compliance, means preparing for
compliant transaction sets and extending ICD-10 utilization to
claim processing, care tracking and reporting for payors, as well
as advanced analytics and payment monitoring for providers.
Due to the extensive cost of a complete system overhaul,
we expect numerous organizations to seek partnerships and
collaborative opportunities to achieve successful compliance.
For example, we expect some mid-sized health plans to
collaborate with other plans to share the ICD-10 upgrade cost.
The trend of collaboration is already prevalent among regional
payors, especially as it relates to providing technology services.
We expect this trend to spike as awareness of the coming costs
of ICD-10 clash with the need to further reduce administrative
costs and improve service. Similarly, while providers may look to
their package vendors to provide much of the ICD-10 solution,
those who look to maintain market position will take a more
aggressive approach outside of their core operation.
Collaboration around ICD-10 implementation can benefit a
health care entity as a way to share costs and as a mechanism
to add value through data aggregation and analytics. Access
to the more granular data available via the ICD-10 code set
creates an opportunity to develop deeper and richer analyses
for both providers and payors. The ability to aggregate data
across multiple organizations would be a likely outgrowth of a
collaborative model.
We expect to see many benefits from ICD-10 collaboration across
the health care information value chain. Examples include:
•Improved claims adjudication and reimbursement rates
between provider and health plans due to more accurate
payments for new procedures, and fewer miscoded and
rejected claims due to greater specificity in ICD-10 codes;
•Improved patient safety and care from sharing ICD-10
granular data on drug side effects and usage among health
plans, providers and life sciences companies;
•Improved utilization management through the efficient use
of ICD-10 diagnosis and procedure codes by payors and
providers and the exchange of patients’ profile information,
variations in treatments across the care process, and hospital
resource management;
12
•Improved clinical documentation and coding accuracy to
enhance assessing and monitoring of patient safety and
quality indicators, and compliance with third-party payor
coding and billing rules and regulations.
As a strategy, we anticipate that successful compliance will
maintain an organization’s market position and competitive
advantage. However, it will not improve market position nor
will it generate a positive return on investment. We encourage
health care entities, at a minimum, to adopt this strategy to
position themselves for future strategic growth.
Innovators
While we expect that a majority of health care organizations will
adopt programs that just meet or moderately exceed the ICD-10
mandates, we also anticipate that a small, elite percentage of
10 to 15 percent will use ICD-10 compliance as a way to further
their market agendas, business models and clinical capabilities.
By making use of the new code set, these innovators will seek
to derive strategic value from the remediation effort. As was the
case with previous compliance efforts around HIPAA and NPI, we
believe that these innovators will approach ICD-10 compliance
as a strategic initiative and, as a result, could increase patient
satisfaction and quality of care, while moving their business and
clinical model into new markets.
ICD-10 offers potential benefits not seen in earlier regulatory
compliance initiatives. Although the considerable investment
required may dissuade many organizations from tackling
such a complex remediation effort, those that do will have an
opportunity to develop new business partnerships, create new
care procedures, and change their business models to grow
overall revenue streams. Health care organizations looking
for these new business opportunities can employ ICD-10
as a catalyst to anchor a more competitive market position.
Potential opportunities for these market innovators include:
•Merger & Acquisition (M&A) Opportunities – We expect that
ICD-10 compliance could trigger a trend similar to the wave of
consolidations experienced in the 1980s during the growth of
managed care. Some organizations may simply “opt out” of
ICD-10 remediation due to the massive investment required.
A portion of these could become merger candidates for those
organizations who are aggressively moving forward.
•Shared Service Opportunities – Some health care entities will be
looking for outsourced solutions for their ICD-10 technology
remediation, while wanting to retain their core business and
clinical processes. As with the M&A opportunities, organizations
who are moving forward aggressively with ICD-10 will have the
opportunity to offer their services to these entities.
ICD-10
•Information and Data Opportunities – Health care entities that
are early adopters of ICD-10 will be in a position to partner
with their peers and constituents to improve data capture,
cleansing and analytics. This could lead to the development of
advanced analytical capabilities such as physician score cards,
insightful drug and pharmaceutical research, and improved
disease and medical management support programs, all of
which create a competitive advantage.
Conclusion
•Personal Health Records Opportunities – Using ICD-10 codes,
innovative health care entities will have access to information
at a level of detail never before available, making regional
and personal health records (PHRs) more achievable for
the provider and member communities. Organizations that
align themselves appropriately can provide a service that will
differentiate them in the marketplace.
Step 1: Identify your organization’s position along
the ICD-10 remediation spectrum – Every health care
organization should proactively decide how it will deal with
ICD-10. Do you want to be a pragmatist, a collaborator,
or an innovator? Each of these positions carries trade-offs
with respect to cost, solution quality and market position.
This decision requires a thoughtful review of your corporate
strategy and whether ICD-10 can be leveraged to support
other corporate goals.
•Clinical Documentation Excellence Program – Developing
and implementing a Clinical Documentation Excellence (CDE)
program is a critical component of organizational preparedness
to respond to future regulatory changes. Hospitals need to
understand the financial impact that ICD-10 will have on their
bottom line and begin the operational readiness assessments,
gap analyses and process improvement plans to facilitate
accurate and appropriate reimbursement.
•Opportunities to Leverage Non-Traditional Staffing Models
– Providers have experienced stress from the national
shortage of professional certified coders for many years.
Coding changes such as CMS’ Medical Severity Diagnosis
Related Groups (MS-DRGs) are exacerbating this shortage by
reducing inpatient coding productivity. Most providers are
augmenting coding staff to mitigate increased receivables
during the learning curve. Providers that opt to pursue nontraditional staffing models for professional coders, such as
home-coding programs, will be better positioned to respond
to the continued coding shortages – including ICD-10 – and
not be limited by geography.
While the potential benefits of being an ICD-10 innovator are
great, it is clear that achieving them will require significant capital
and personnel investments. Those organizations that are genuinely
interested in leveraging ICD-10 for competitive advantage should
align their ICD-10 remediation strategy, approach and roadmap
with other key long-term corporate initiatives. A program of this
magnitude runs the risk of wavering support and sponsorship if it
encounters implementation difficulties; however, securing up-front
executive alignment can help to mitigate these challenges.
While the ICD-10 regulation is not yet finalized, HIPAA and Y2K
proved that health care regulatory remediation programs can
take years of planning to achieve successful implementation.
The window of opportunity for ICD-10 is closing very quickly
on a number of fronts. Therefore, we suggest that all health
care entities immediately undertake the following steps:
Step 2: Begin assessing impacts – Despite the current
lack of specific CMS guidelines, your organization can and
should make a high-level impact assessment to determine the
potential size and scope of basic remediation. Determining
how much the current ICD-9 code set is ingrained in your
organization’s operations and technology infrastructure will be
a key indication of how invasive the transformation could be.
Similarly, if your organization wants to be an innovator, it is
important to begin identifying and planning for the significant
changes that will be required to support new business models
and the associated technical and organizational adaptations.
Step 3 (optional): Identify collaborators – If your
organization deems itself a collaborator or innovator, it is
prudent to understand how collaboration might be achieved,
and to identify potential targets in the marketplace. Because
partnering arrangements between organizations often require
lengthy negotiation and legal proceedings, it is important to
begin this process early to meet important goals and milestones.
The road to ICD-10 compliance will be neither easy nor quick.
However, with foresight and planning, health care providers
and payors can transform a regulatory necessity into a
competitive advantage.
13
ICD-10
Authors
Contributors
We’d like to recognize the individuals who
contributed their insights and support to this project.
This paper is a result of a team effort that spanned our
Life Sciences & Health Care and Public Sector industry
practices. Casey Graves, Senior Manager, Deloitte
Consulting LLP, and Heather McPherson, Senior Manager,
Deloitte Consulting LLP provided content input. Erin
Poetter, National Marketing, Deloitte Services LP, helped
with publication and marketing activities.
David Biel
Principal
Deloitte Consulting LLP
[email protected]
Paul H. Keckley, PhD
Executive Director
Deloitte Center for Health Solutions
[email protected]
Lou Anne Barnhouse, RHIA
Principal
Deloitte & Touche LLP
[email protected]
Derek Hamilton
Senior Manager
Deloitte Consulting LLP
[email protected]
Howard R. Underwood, MD, FSA
Senior Manager
Deloitte Consulting LLP
Senior Fellow & MDP
Deloitte Center for Health Solutions
[email protected]
14
Contact Information
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its projects and events, please visit www.deloitte.com/us/
healthsolutions.
Deloitte Center for Health Solutions
555 12th Street N.W.
Washington, DC 20004
Phone 202-220-2177
Fax 202-220-2178
Toll free 888-233-6169
Email [email protected]
Web http://www.deloitte.com/us/healthsolutions
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About the Center
The Deloitte Center for Health Solutions (the “Center”), located in Washington, D.C., is part of Deloitte & Touche USA LLP
and was formed to further research on and develop solutions to some of our nation’s most pressing health care and public
health-related challenges. Tommy G. Thompson, former Secretary of health and Human Services and former Governor of
Wisconsin, is a senior advisor and Independent Chairman of the Center.
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