How do you
prepare today for
the health care
of tomorrow?
New horizons
The executive briefings collection
September 2016 edition
B rief x | T itl e
To our clients
and other
friends
W el c ome to New horizons! I n res pons e to y ou r f eedbac k , w e are pl eas ed to introdu c e
a new executive briefing format to make reading and discussing health trends quicker
and eas ier. I n th is edition, w e f oc u s on s ev eral is s u es th at h av e th e potential , eac h in its
unique way, to disrupt how health care is reimagined and delivered. I hope you enjoy this
new , digital - f riendl y c ol l ec tion of h eal th s ec tor ins igh ts .
Jacques Mulder
EY Global Health
Sector Leader
“ W e engage w ith th e
w ic k ed probl ems in
h eal th bec au s e w e
rec ogniz e th at h eal th
is an as s et and th at w e
h av e a res pons ibil ity to
h el p peopl e ev ery w h ere
l iv e h eal th ier and
more produ c tiv e
l iv es . T h is is a pu rs u it
inex tric abl y l ink ed w ith
E Y ’ s pu rpos e: to bu il d a
better w ork ing w orl d. ”
H eal th , more th an any oth er s ec tor, h as a h u man f ac e. W e s ee it w h en w e l ook in th e
mirror and at th e peopl e in ou r ow n l iv es . A t E Y , th is bel ief motiv ates u s to ex amine c l os el y
th e driv ers th at are res h aping h ow th e w orl d th ink s abou t — and approac h es — h eal th :
1. Spending: U ns u s tainabl e l ev el s of s pending on h eal th c are, al ongs ide th e s h if t to
v al u e- bas ed c are and popu l ation h eal th management, driv e th e s earc h f or th e mos t
ef f ec tiv e and af f ordabl e s ol u tions .
2. Technology: E merging tec h nol ogies empow er h eal th c ons u mers and s h if t th e l oc u s
of c ontrol in th eir direc tion. T h is is al ready dis ru pting th e del iv ery of c are and w il l l ead to
a c ompl ete reimagining of h eal th and h eal th c are.
3. Mindset: W orl dw ide, attitu des tow ard h eal th are c h anging: peopl e are v iew ing ac c es s
to c are as a righ t, w h il e gov ernments rec ogniz e th at th e ov eral l w el l nes s of a popu l ation
is an economic asset that requires well-planned investment.
T h e topic s w e dis c u s s in N ew h oriz ons , inc l u ding data anal y tic s , c y bers ec u rity , patient
c entric ity and th e s earc h f or s u s tainabl e s ol u tions f or c h ronic dis eas es , addres s th es e
challenges and are responses to these drivers. I hope you find the articles thought
prov ok ing and u s ef u l in th ink ing abou t h ow y ou r organiz ation c an meet th e c h al l enges
ov er th e h oriz on.
New horizons is part of EY’s contribution to redefining health as a holistic pursuit — an allencompassing, daily and lifelong engagement with wellness, not just of concern when an
illness arises. It reflects our passion and relentless focus on the work we do with members
ac ros s th e h eal th ec os y s tem as w e l iv e E Y ’ s pu rpos e to bu il d a better w ork ing w orl d by
mak ing a h eal th y w ork ing w orl d.
I look forward to joining you in discussions on these and other topics. In the meantime,
pl eas e v is it H eal th R eimagined f or ou r l ates t ins igh ts .
page 2
New horizons: the executive briefings collection | September 2016 edition
1 | page 4
Focusing on wellness: giving the
world a shot at controlling diabetes
2 | page 8
M&A trends in health:
change is inevitable
3 | page 12
Putting people at the
center of health analytics
4 | page 16
Participatory health: a world of alternatives
for consumers and health players
5 | page 20
The black market
for medical data
6 | page 24
Getting true value
from big data
page 3
New horizons: the executive briefings collection | September 2016 edition
B rief x | T itl e
1.
Focusing on wellness:
giving the world a shot at
controlling diabetes
W orl dw ide, th e grow ing probl em of ex panding w ais tl ines is ex pl oding h eal th
c are c os ts . W es tern diet, popu l ations s h if ting to u rban env ironments and
lack of exercise are decreasing quality of life, straining resources, and
c ontribu ting to ris ing body w eigh ts and inc idenc e of diabetes .
Obesity and impaired glucose tolerance (a form of prediabetes) are two of the five
metabol ic ris k f ac tors th at inc reas e th e l ik el ih ood of dev el oping a nu mber of c h ronic
dis eas es . T h ree of th es e l if es ty l e- rel ated c au s es of death , h eart dis eas e, diabetes and
s trok e, ac c ou nt f or 28% of death s gl obal l y ev ery y ear. 1. 1
L ik e ou r w ais tl ines , diabetes is s preading. I n 2012, 86 mil l ion peopl e in th e U nited
States aged 20 y ears or ol der h ad prediabetes , u p 9% f rom 2010. 1. 2 F or w ork ing age
adu l ts , th e prev al enc e of gl obal diabetes w il l inc reas e 37% by 2040. 1. 3 A mong s eniors ,
who already account for a majority of health care spending, prevalence will increase by
a w h opping 113% . 1. 4 A n es timated 12% of gl obal h eal th ex penditu re is c u rrentl y s pent
on diabetes . W orl dw ide, G D P l os s es du e to diabetes , inc l u ding th e direc t and indirec t
c os ts , are es timated to be U S$ 1. 7 tril l ion betw een 2011 and 2030. 1. 5
I nterv ention — pref erabl y earl y and, w h en it inv ol v es treatment, c ompreh ens iv e — is
es s ential to redu c e th e ris k of dev el oping diabetes and prev ent c ompl ic ations . T h e
f ac tors th at modif y ris k — f amil y h is tory , eth nic ity , h is tory of ges tational diabetes and
h igh birth w eigh t, 1. 6, 1. 7 — mu s t be tak en into ac c ou nt. T reatment may inc l u de regu l ar
monitoring, medic ation, l if es ty l e interv entions , ex erc is e and s mok ing c es s ation.
Treatment requires medical personnel to provide education, develop realistic “around
th e pil l ” treatment pl ans and regu l arl y engage w ith h eal th c ons u mers .
page 4
New horizons: the executive briefings collection | September 2016 edition
1. | F oc u s ing on w el l nes s : giv ing th e w orl d a s h ot at c ontrol l ing diabetes
Insight
Technology will enable smarter
cities and smarter choices ...
P eopl e- env ironment interac tions are
bidirec tional and dy namic ; to tak e
adv antage of th is rel ations h ip, c ommu nities
are being des igned to s u pport l if el ong
w el l nes s . G l obal l y , peopl e w ith diabetes are
general l y c l u s tered in u rban areas . B etter
artificial intelligence, cheap, ubiquitous
s ens ors , and c l ou d or f og c ompu ting c reate
new pos s ibil ities f or c reating env ironments
th at s u pport h eal th y beh av iors .
page 5
Figure 1.1:
Diabetes-related health spending, 2015 vs. 2040 1. 11
Prevalence: age-adjusted comparative prevalence (20–79 years), percentage
T o addres s th is h u man c ris is and bring c os ts
to s u s tainabl e l ev el s , c ros s - domain s ol u tions
th at enabl e new model s of w el l nes s and
care are needed. Innovation in just one
area, w h eth er it be tec h nol ogy , anal y tic s ,
pay ment model s , gov ernment regu l ation
or c are del iv ery model s , is not enou gh .
C ooperativ e ef f orts are needed to dev el op
s c al abl e tec h nol ogies and mak e th em w idel y
av ail abl e, al ign s tak eh ol der inc entiv es
f or data s h aring, bu il d env ironments th at
s u pport h eal th y l if es ty l es , and res h ape th e
w ay c ons u mers th ink abou t th eir h eal th .
This requires a firm understanding of local
h eal th mark ets , th e div ers e s ec tors and new
entrants c ontribu ting to and dis ru pting it,
and a tru l y gl obal pers pec tiv e.
Middle East and North Africa
North America
and Caribbean
South and Central America
10
Western Pacific
Southeast Asia
8
Europe
6
4
Africa
2
2015
2040
0
50
100
150
200
250
300
Health spending due to diabetes (20–79 years), US$b
New horizons: the executive briefings collection | September 2016 edition
350
400
1. | F oc u s ing on w el l nes s : giv ing th e w orl d a s h ot at c ontrol l ing diabetes
I n th e near f u tu re, al gorith ms th at c ombine
data f rom c ity w ide pol l u tion s ens ors ,
w eath er c onditions and medic al rec ords c an
f orec as t th e bes t times f or ou tdoor ac tiv ities
and au tomatic al l y s c h edu l e appointments
and errands du ring th at time. T h is c ou l d
prev ent s ev ere as th ma attac k s in c h il dren
and k eep adu l ts w ith C O P D ac tiv e and
engaged w ith th eir c are prov iders .
A s c ities grow s marter, s w itc h ing betw een
( and pay ing f or) driv erl es s c ars , mas s trans it
and manu al trans port ( w al k ing, bik e s h ares )
may bec ome s eaml es s . C ombing data
f rom el ec tronic h eal th rec ords and s ens orenabl ed ac tiv ity trac k ers , h eal th pay ers may
s oon u s e data- driv en, w el l - timed inc entiv es
to nu dge h eal th y beh av iors , s u c h as w al k ing
a f ew bl oc k s to a bu s s top or bik ing. Su c h
s mal l c h anges , made ac ros s a l if etime, c an
mean th e dif f erenc e betw een ac tiv e, h eal th y
aging and a middle to late life filled with
c h ronic dis eas es .
Insight
… but only if it rapidly moves
beyond early adopters
R apid adoption of tec h nol ogies ac ros s
s oc ioec onomic grou ps is c ru c ial f or
improv ing c h ronic dis eas e ou tc omes ( e. g. ,
diabetes and obes ity ) , c u rbing c os ts and
addres s ing ex is ting h eal th dis parities .
page 6
F or th e l as t dec ade, diabetes prev al enc e h as
been ris ing mos t rapidl y in l ow and middl e
inc ome c ou ntries . 1. 8 P eopl e are l eav ing ru ral
areas for urban office jobs, exacerbating
th e grow ing prev al enc e of diabetes in pl ac es
s u c h as I ndia, Sou th eas t A s ia and parts of
A f ric a. O bs erv ational s tu dies indic ate th at
s itting f or l ong periods of time c an dou bl e
ris k of ty pe 2 diabetes and c ardiov as c u l ar
dis eas e. 1. 9 D es igning w ork s pac es and
w ork day s arou nd opportu nities f or ph y s ic al
mov ement c an improv e w ork ers ’ h eal th ,
c onc entration and perf ormanc e.
T h e f u tu re of h eal th is env is ioned to be
c ons u mer- c entric , arou nd th e c l oc k and
w el l nes s f oc u s ed ( s ee H eal th R eimagined) .
B u t ev en in a rel ativ el y w eal th y c ou ntry
l ik e th e U nited States , 73% of peopl e
don’ t ow n an ac tiv ity trac k ing dev ic e of
any k ind. 1. 10 T h e k ey to c irc u mv enting th e
nex t digital div ide, and addres s ing h eal th
dis parities , is to mak e rapid adoption
pos s ibl e f or ev en ec onomic al l y c h al l enged
popu l ations . B ringing tel emedic ine and
inex pens iv e s ens ors to c ou ntries w ith l ow
diagnosis rates would improve quality of
l if e and redu c e ov eral l c os ts th rou gh earl y
treatment. R apidl y dis s eminating af f ordabl e
tec h nol ogies c ou l d enabl e l ow and middl e
inc ome c ou ntries to addres s th e ex pl os ion
of metabol ic dis eas e driv ers , improv e
diagnos is rates , c ontain c os ts and k eep th eir
w ork f orc e h eal th y w ith ou t s l ow ing grow th .
Insight
Sweeten the deal for sharing
M is al igned inc entiv es f or pay ers , prov iders
and c ons u mers h inder th e management of
dis eas es l ik e obes ity and diabetes . P ay ers
in c ou ntries w ith priv ate ins u ranc e are
rel u c tant to f u nd programs w h os e dow nthe-road benefits may be realized by a
c ompetitor: mos t peopl e do not h av e th e
s ame ins u rer f or th eir entire l if e ( es pec ial l y
when they change jobs). Even in countries
w ith a c entral pay er, immediate- term
c os t pres s u res c an c row d ou t f u nding
f or ef f ec tiv e beh av ioral interv entions .
P rov iders h av e traditional l y been
rew arded f or s erv ic es or, more rec entl y ,
dis eas e ou tc omes , rath er th an ov eral l
h eal th . C ons u mers may need additional
inc entiv es to prov ide th e k ind of data th at
enabl es indiv idu al iz ed, h ol is tic c are pl ans .
T h is is partic u l arl y tru e of ol der adu l ts ,
w h o are more l ik el y to report h av ing
priv ac y c onc erns .
C entral , permis s ion- bas ed databas es of u s er
and prov ider- generated h eal th inf ormation
c an giv e al gorith ms th e data needed to
bec ome better predic tors and enabl ers
of h eal th w h il e prev enting th e erec tion of
s il os th at impede progres s . O pen ac c es s
to h eal th data, in th e f orm of abs trac ted
rec ords , w il l l et pay ers generate th e data
to support the most efficacious practices.
New horizons: the executive briefings collection | September 2016 edition
Wander while
you work
A t s ome c ompanies U nitedH eal th c are
ins u res , empl oy ees are being paid to
engage in h eal th y beh av iors . A f ree
ac tiv ity monitor and a mobil e ph one
app h el p th em meet dail y ac tiv ity
goal s by tak ing regu l ar ex erc is e break s
th rou gh ou t th e day . T h is proac tiv e
approach to fitness is designed to
k eep h eal th y peopl e ac tiv e, av oiding
th e l ong- term c os ts of l if es ty l e- rel ated
c h ronic dis eas es .
1. | F oc u s ing on w el l nes s : giv ing th e w orl d a s h ot at c ontrol l ing diabetes
B u il ding inc entiv es arou nd good ou tc omes ,
s ometh ing al l agree is a w orth y goal , w il l
c ontain c os ts and enc ou rage a 24/ 7 h eal th y
minds et f or al l s tak eh ol ders .
K ey to reac h ing th is goal is ens u ring data
integrity , a probl em th at is c ompou nded
when data are abstracted and de-identified
( s ee G etting tru e v al u e f rom big data) .
Insight
Healthy bodies need healthier fuel
F or mu c h of th e w orl d, th e av ail abil ity of
h eal th y f ood is tied to ec onomic s tatu s :
th e more money a pers on h as , th e greater
th e ac c es s to h eal th y options . W es tern
diets, overflowing with caloric possibilities,
are h eav il y meat and s atu rated f atbas ed, inc reas ing th e ris k f or earl y death ,
P ark ins on’ s and A l z h eimer’ s dis eas e. 1. 12
F res h f ru its and v egetabl es , th e bas e on
w h ic h mos t gov ernmental f ood py ramids
are bu il t, rec eiv e c ons iderabl y l es s monetary
s u pport ( i. e. , s u bs idies ) th an c rops u s ed
as animal f eed or ingredients f or h eav il y
proc es s ed f ood. 1. 13 T h e narrow w indow of
ripenes s f or s u c h f oods al s o mak es th em
difficult to transport and store cheaply.
T h ere are enormou s opportu nities to bring
tec h nol ogy and big data approac h es to
gl obal f ood produ c tion and s u ppl y c h ain,
to s h ape pol ic ies th at enc ou rage s ens ibl e
eating h abits , to addres s res ou rc e- intens iv e
page 7
f ood produ c tion and to inc reas e ac c es s to
h eal th y f ood w orl dw ide. E ating beh av iors
c an be nu dged w ith data- inf ormed c h anges
to th e ty pes of f ood av ail abl e, by c reating
s mal l barriers to ac c es s and c h anging h ow
portions are pres ented. M eat protein,
w h ic h is res ou rc e intens iv e to produ c e,
u ntenabl e to f arm in s ome areas and
eth ic al l y f rau gh t f or s ome, is today being
s u c c es s f u l l y grow n in th e l ab. 1. 14
3- D printing tec h nol ogies c an c reate
pal atabl e, h eal th y meal s f rom raw material s
th at are eas y to trans port and s tore. 1. 15
Increasing access to quality, palatable foods
h el ps s h if t peopl e aw ay f rom a l if etime of
dietary mis tak es w h os e end res u l t is of ten
gl u c os e intol eranc e or diabetes .
Chips instead of an apple?
There is a tax for that …
M ex ic o h as impl emented a tax on c al oriedens e, nones s ential f oods and s u gary
drink s th at h as redu c ed c ons u mption in
l ow and mediu m inc ome h ou s eh ol ds . T h e
ex pec tation is th at redu c ed c ons u mption
H eal th is more th an dis eas e- f oc u s ed h eal th
c are: it is a patient- c entric , on- demand,
arou nd- th e- c l oc k endeav or. W el l nes s ,
prev ention and c are h av e to be s c al abl e
bu t al s o tail ored to th e partic u l ar mark et:
c u l tu ral is s u es , eth nic ity and regional
dif f erenc es in res ou rc es w il l al l determine
w h eth er a partic u l ar model is s u c c es s f u l .
W h at is c ertain is th at th e s ooner new
s ol u tions are empl oy ed, th e greater th e
impac t — on peopl e, c os ts and th e
w orl d’ s w el l - being.
New horizons: the executive briefings collection | September 2016 edition
of th es e “ empty c al ories ” w il l redu c e
w eigh t gain and diabetes inc idenc e. Su c h
tax es h av e not met w ith s u c c es s in al l
cases; this highlights the need to find the
mos t appropriate s tic k ( and c arrot) .
B rief x | T itl e
2.
M&A trends in health:
change is inevitable
A s eis mic , onc e- in- a- l if etime mark et s h if t in h eal th del iv ery and pay ment
models requires every organization in the industry to rethink its business
model , s tru c tu re and mode of operation. R eimbu rs ement bas ed on
ou tc omes , as oppos ed to f ee f or s erv ic e, is pu s h ing prov iders to broaden
th eir s c ope of c are ac ros s a f ragmented s y s tem. T h e grow ing abil ity to
diagnos e, monitor and treat c h ronic dis eas es — l eading to more ef f ec tiv e
treatments and s h orter rec ov ery times — of f ers an opportu nity to max imiz e
ou tc omes w h il e el iminating inef f ec tiv e or w as tef u l modes of treatment.
The bar is set much, much higher for tracking outcomes, which requires
s oph is tic ated tool s , peopl e and inf ras tru c tu re. T h e l ands c ape is c ompl ex and
c ompetitiv e, th e c h al l enges are dau nting, and traditional model s of del iv ery
are inadequate for today’s standard of care, documentation and billing.
W h at is th e ans w er f or many h eal th organiz ations ? O ne option to redu c e enterpris e
risk may be to join forces with another organization through an acquisition, merger,
al l ianc e or partners h ip. H eal th c ompanies are inc reas ingl y l ook ing at M & A , al l ianc es
and joint ventures to expand their geographic footprint and to have more input into
th e c ontinu u m of c are — al l to gain th e s c ope and s c al e of s erv ic es and inf ras tru c tu re
c apabil ities needed to c ompete or ev en s u rv iv e.
page 8
New horizons: the executive briefings collection | September 2016 edition
2 | M & A trends in h eal th : c h ange is inev itabl e
Current and expected activity
A majority of health executives remain
pos itiv e abou t th e ec onomy ov eral l ,
w ith 79% s eeing it as eith er s tabl e or
improv ing, ac c ording to EY 14th annual
it l onfi ence ro eter. H eal th
ex ec u tiv es al s o remain pos itiv e abou t deal
f u ndamental s , w ith al mos t tw o- th irds
seeing a positive trend for acquisition
opportu nities . T h is is du e, in l arge part,
to th e f ragmented natu re of th e h eal th
indu s try , w h ic h inc reas es ris k as
prov iders are del iv ering onl y a f rac tion of
th e c are, y et reimbu rs ement is tied to th e
ov eral l ou tc ome.
I n f ac t, h eal th trans f ormation is driv ing a
rec ord l ev el of M & A ac tiv ity and al l ianc es ,
and th e grow th is ex pec ted to c ontinu e.
A bov e and bey ond th e pending mega- mergers
among ins u rers , th e
it l onfi ence
ro eter al s o f ou nd th at h eal th ex ec u tiv es
antic ipate th e trend of inc reas ed M & A ac tiv ity
to remain w el l abov e h is toric al h eal th s ec tor
Figure 2.1:
Global Capital Confidence Barometer: key health findings 2. 1
av erages . O v eral l , 56% of res pondents
indic ated th at th ey ex pec t to ac tiv el y pu rs u e
acquisitions in the next 12 months.2. 2 T h is
repres ents th e s ec ond h igh es t perc entage
s inc e l ate 2010. A l mos t tw o- th irds of h eal th
res pondents indic ated th at th ey h av e th ree or
more deal s in th eir pipel ine.
F u rth er, a v ariety of deal s tru c tu res
are being ex pl ored. W h ere a merger or
acquisition may not be the right fit, health
c ompanies are inc reas ingl y l ook ing at
alliances and joint ventures to expand
th eir geograph ic f ootprint and h av e more
inpu t into th e c ontinu u m of c are. I n f ac t,
w ith 50% of res pondents pl anning to
enter into al l ianc es w ith oth er c ompanies
or c ompetitors , h eal th organiz ations are
v as tl y ou tpac ing th eir gl obal c ou nterparts
( 40% ) in oth er indu s tries in th is area. 2. 3
G iv en th e trans f ormativ e natu re of today ’ s
h eal th s ec tor, l eaders s ee al l ianc es as an
opportu nity to manage ris k , improv e th e
quality of care and lower costs.
Start with the end,
and follow three key steps
The first steps for any organization are to
a) determine its des ired s trategic ou tc ome
or mark et pos itioning, b) identif y th e gaps
or ris k areas w ith in c u rrent of f erings or
capabilities, and c) look to the financial
and operational metric s to h el p gu ide
w h ic h s tru c tu res are optimal . “ K now ing
th es e th ree th ings w il l c l arif y th e goal ,
prov ide f oc u s on th e k ey is s u es driv ing a
s tru c tu ral c h ange and h el p u nc ov er th e
pos s ibl e path w ay s f orw ard, ” s ay s
G regg Sl ager, E Y G l obal H eal th T rans ac tion
A dv is ory Serv ic es L eader. “ H ow ev er,
figuring out the best approach is like a
pl ay ing a th ree- dimens ional c h es s game.
Y ou need to ex amine al l th e v ariabl es
s imu l taneou s l y , inc l u ding pos s ibl e
organiz ations to al ign w ith , th e s trategic
nex t s tep, and th e bes t organiz ational and
financial structure for all parties.”
F or ins tanc e, if a ph y s ic ian grou p w ants to
s tay f oc u s ed on patient c are rath er th an
trac k ing or tec h nol ogy , its s trategy migh t
be to find a larger physician group with a
more robust infrastructure to either acquire
or partner w ith . A n orth opedic prac tic e
might acquire or develop an alliance with a
ph y s ic al th erapy grou p as a w ay to ens u re
it h as more c ontrol ov er ou tc omes of
s u rgeries , s u c h as k nee or h ip repl ac ements .
Comparison is between health executives and other global respondents.
page 9
Insight
New horizons: the executive briefings collection | September 2016 edition
2 | M & A trends in h eal th : c h ange is inev itabl e
Insight
Key motivators for change
“ W ith th e s teady mov e tow ard v al u e- bas ed
c are, th ere c ontinu es to be c onv ergenc e
among h eal th c are s ec tors and f u rth er
dev el opment of a c ontinu u m of c are w ith in
h eal th c are c ompanies , ” s aid G regory P ark ,
Senior M anaging D irec tor, U S H eal th c are
I nv es tment B ank ing, E rns t & Y ou ng C apital
A dv is ors , L L C . “ P arties th at h av e h is toric al l y
been s eparate, s u c h as managed c are
and prov iders — or s u bs ec tors w ith in th e
prov ider u niv ers e — are c oming togeth er in
dif f erent w ay s . ”
W h il e th ere are many s trategies and
motiv ations , a f ew th emes emerge th at
point tow ard s trategic reas ons beh ind M & A
activity. Bolstered by cheap financing and
s pu rred by th e opportu nities th at big data
migh t of f er, th es e inc l u de:
1. The evolution toward value-based
reimbursement from volume-based
payments — forcing a focus on the full
spectrum of care.
O rganiz ations s eek to better manage ris k
if th ey are paid bas ed on patient ou tc omes ,
y et prov ide onl y part of th e c ontinu u m of
c are. F u rth er, th es e reimbu rs ement model s
require more results tracking, and health
organiz ations need to ef f ec tiv el y adopt and
empl oy digital tec h nol ogy and anal y tic s .
2. The move toward consumer-directed
health care — adding an incentive for
technology and wearables.
T o ride th e ris ing tide of c ons u meris m,
organiz ations mu s t inc entiv iz e c u s tomers
to u s e new tec h nol ogies and s erv ic es and
s h are th e res u l ting data.
3. The traditional consolidation drivers of
increasing market presence and reducing
costs — to reduce the cost of care and
increase efficiency.
C os t pres s u res are intens e, and organiz ations
mu s t c ontinu al l y improv e operational
efficiency and effectiveness while also
redu c ing ov eral l and per c apita c os ts .
4. The shift from inpatient to outpatient
care — to reduce the cost of care and
increase efficiency.
H os pital s are c h al l enged to c arry on th e
traditional mode of inpatient c are. A s
reimbu rs ements drop f or inpatient s erv ic es ,
many are s pu rred to f oc u s on oth er
av enu es f or grow th , partic u l arl y ou tpatient
s erv ic es . O u tpatient c are is of ten del iv ered
at l ow er c os t s ites , and ou tpatient v ol u mes
h av e ac c el erated at a f as ter pac e th an
inpatient admissions over the past five
y ears . T h is s c enario is adv antageou s to
l arger h eal th s erv ic es prov iders w ith more
dev el oped ou tpatient netw ork s , es pec ial l y
w h en c ompared w ith s ingl e f ac il ities or
s mal l er h os pital s . T h e c os t f ac tor is driv ing
es tabl is h ed h os pital operators to s eek
M & A opportu nities ou ts ide of th e s c ope of
th e traditional ac u te c are h os pital , s u c h
as bu y ing s mal l er c ommu nity h os pital s to
dev el op regional netw ork s or s etting u p
ac u te c are ou tpatient s u rgic al s ites .
5. Scale up or consolidate — to better
spread the cost of overhead and to
offer a wider range of services along the
care spectrum.
D riv en in part by h eal th ref orm, c os t
pres s u res on h eal th prov iders enc ou rage
an inc reas e in s c al e, and th e reporting
• Larger hospital and managed care
operators acquiring smaller hospitals,
tak ing adv antage of th e s c al e and s c ope
to f u rth er redu c e th eir c os t per patient.
US healthcare services deals per quarter
Figure 2.2:
US health care services deals per quarter 2. 4
60,000
180
55,212
162
50,000
160
159
47,499
140
139
40,000
121
121
129
120
117
113
111
100
94
30,000
80
20,000
16,779
15,387
60
40
10,000
6,370
2,723
US$m 0
Q1-14
Q2-14
3,819
Q3-14
6,177
Q4-14
Q1-15
Q2-15
Disclosed deal value $m
Page 1
page 10
requirements demand a more complex
and robu s t tec h nol ogy inf ras tru c tu re.
H ere, l arger pl ay ers w il l h av e an adv antage,
w ith more ov erh ead dol l ars to f u nd I T
and c l inic al s y s tems , improv e pu rc h as ing
c ontrac ts , negotiate better deal s w ith
l arge c ommerc ial ins u rers and enh anc e
organiz ational c apabil ities . E f f ec ts w e s ee in
th e mark et inc l u de:
New horizons: the executive briefings collection | September 2016 edition
Q3-15
Volume
5,405
4,867
Q4-15
Q1-16
20
Q2-16
0
2 | M & A trends in h eal th : c h ange is inev itabl e
T h e s ame is tru e f or managed c are
operators ( M C O s ) , w h ic h c ontinu e to
pursue strategic acquisitions as actively
as regu l atory approv al al l ow s . L as t y ear
produ c ed th e propos ed megamergers
of A etna- H u mana and A nth em- C igna
( pending gov ernment approv al ) , and
l arge regional M C O s , s u c h as K ais er
P ermanente and oth er M C O s , are bu l k ing
up through acquisitions.
• Regional consolidation of hospital
operators, to ac h iev e s c al e and s c ope
to driv e dow n th e c os t per patient.
O ne ex ampl e is D etroit- bas ed H enry
Ford Health System’s acquisition of
A l l egianc e H eal th , a dominant prov ider in
J ac k s on, M ic h igan.
• “Super physician” practice groups,
c ombining to f orm beh emoth prac tic es to
ac h iev e s c al e and mark et c onc entration.
An example is the recent merger of equals
betw een E nv is ion H eal th c are and A ms u rg,
c reating a l arge ph y s ic ian grou p.
6. A focus on technology, tools and digital
devices — to track required outcomes and
leverage analytics to increase operational
and patient effectiveness.
H eal th c are- rel ated inf ormation tec h nol ogy
c ontinu es to grow , in part bu oy ed by
government policies and requirements.
A l th ou gh l agging oth er indu s tries , h eal th
organiz ations are inc reas ingl y adopting I T
page 11
s ol u tions to h el p s impl if y and s treaml ine
th eir operations , and tec h nol ogy is of ten
a big f ac tor in M & A ac tiv ity and dec is ionmak ing. H os pital s , h eal th organiz ations ,
indiv idu al s or s mal l prac tic es u nabl e ( or
unwilling) to provide the required capital
ou tl ay f or el ec tronic h eal th rec ord ( E H R )
s y s tems are s eek ing to bridge th e gap,
eith er th rou gh partners h ips , mergers or
acquiring technology companies outright.
T h os e w ith robu s t E H R s are l ook ing to boos t
th eir s c al e as a w ay to max imiz e v al u e f rom
th os e inv es tments . A nd al l are f oc u s ed on
technology as a tool to help find efficiencies
in operational proc es s es , enh anc e c l inic al
dec is ion s u pport s y s tems f or prov iders and
bol s ter patient engagement ( by enc ou raging
patients to ac c es s and u s e portal s , f or
ex ampl e) . H os pital s are al s o s tarting to l ink
th eir E H R data direc tl y to adminis trativ e
and bil l ings f u nc tions , not onl y to s treaml ine
and au tomate th e rev enu e c y c l e bu t al s o to
gath er data f or anal y s is of operational and
care flows and ready their organizations for
v al u e- bas ed reimbu rs ement.
7. Move toward investment in less risky
segments of health — to count on better,
more stable reimbursement.
H eal th organiz ations , es pec ial l y th os e
privately owned or funded by private equity
inv es tors , are div ers if y ing th eir s erv ic es and
acquiring providers in niche segments in
an ef f ort to s mooth or manage ov eral l ris k .
Niche organizations sought for acquisition
or al l ianc es are attrac tiv e bec au s e of th e
l ow er reimbu rs ement ris k and inc l u de:
tel eradiol ogy , maternal - f etal and pediatric
ph y s ic ian s erv ic es ) and independent
medic al ex aminers .
• Physiotherapy – P h y s ic ians w ith
orth opedic prac tic es and oth ers are
l ook ing to pu rc h as e or partner w ith th es e
organiz ations to improv e th e ou tc omes of
orth opedic and oth er proc edu res and/ or
redu c e th e inc idenc e of s u rgeries .
• Niche segments – T h es e inc l u de dental
c are, dermatol ogy and v eterinary s erv ic es ,
al l of w h ic h are of f th e radar f or mos t
traditional h eal th organiz ations .
• Behavioral care – T h is l arge, of ten
ov erl ook ed mark et is f ac ing grow ing
s u pport, as both th e regu l atory and
l egis l ativ e s ides s eek to prov ide better
mental h eal th c ov erage f or adu l t M edic aid
beneficiaries. These moves bode favorably
f or beh av ioral c are prov iders .
What to watch for next
• Home health and hospice – D emograph ic s ,
patient pref erenc e and meaningf u l c os t
adv antages s u gges t more grow th in
th e h ome h eal th and h os pic e arena, as
th e perc entage of A meric ans 65+ is
ex pec ted to grow f rom 13% to 20% of
th e popu l ation by 2030. 2. 5 I ndu s try
anal y s ts al s o point ou t th at th os e f oc u s ing
on quality are likely to benefit as the
C enters f or M edic are & M edic aid Serv ic es
c ontinu es to mov e tow ard ou tc ome- bas ed
reimbu rs ement.
• Ancillary health care services – T h is
inc l u des rev enu e c y c l e management
bu s ines s es , independent s pec ial ty
prov iders ( s u c h as neonatal , anes th es ia,
New horizons: the executive briefings collection | September 2016 edition
Insight
U S deal ac tiv ity in th e s ec tor is s til l s trong,
and P ark ex pec ts 2016 to be a “ top 5” y ear
f or M & A in h eal th . “ W e are in th e mids t of a
tec tonic s h if t in patient c are, del iv ery and
pay ments , and f rom a big- pic tu re pers pec tiv e,
th e deal boom is f ar f rom ov er, ” P ark s aid.
A l th ou gh c ompanies are adopting al l f orms
of new s tru c tu res and partners h ips , P ark
ex pec ts more c ons ol idation on a l oc al bas is ,
enhancing an already significant middle
mark et. “ E x pec t a c ontinu ing rel oc ation f rom
W al l Street to M ain Street in h eal th M & A , as
c ompanies c ombat s h rink ing reimbu rs ement,
c u t c os ts and, u l timatel y , pas s th os e
savings down to the consumer.” Park’s final
obs erv ation is to ex pec t more portf ol io
pru ning, “ D raf ting beh ind th e l if e s c ienc es
s ec tor, w e ex pec t c ontinu ed div es titu res f rom
h is toric al l y M & A - oriented c ompanies , as
s erv ic e, del iv ery and reimbu rs ement model s
continue to be refined.”
B rief x | T itl e
3.
Putting people at the
center of health analytics
Today’s artificial intelligence (AI) technologies are, well, not that intelligent
on th eir ow n. A l th ou gh A I tool s are progres s ing at an inc redibl e rate, th e
real pow er emerges w h en th e data anal y tic s au gment h u man dec is ionmaking rather than replace it. The analytics alone are just not smart enough
to deriv e tru e ins igh t. I dentif y ing h eal th trends means pairing A I and
anal y tic s w ith s u perv is ed, h u man l earning.
Imagine a future world where the analytics look at a patient’s specific gender, age,
l if es ty l e, medic al h is tory , f amil y bac k grou nd and geograph y and indic ate a h igh ris k of
diabetes . T o prev ent th e f u l l ons et of th e dis eas e, th e patient u s es a w earabl e app to
regu l arl y monitor bl ood gl u c os e l ev el s . W h en it ris es , th e dev ic e s ends th e ph y s ic ian a
tex t, th e ph y s ic ian mak es a dec is ion arou nd th e medic ation needed, and th e patient is
alerted to take a specific amount of oral medicine to reduce the amount of sugar made
by th e l iv er. D iabetes av erted.
W h at does it tak e to get to th is real ity ? W e are partw ay th ere, w ith th e c apabil ities of
tec h nol ogy , w earabl e apps and data grow ing ex ponential l y eac h y ear. B u t th e k ey is
th e c ru c ial interac tion and “ dial ogu e” betw een th e data, tec h nol ogy and peopl e. T h is
reality requires an active level of human judgment and decision-making, informed by
th e anal y tic s .
Perhaps the best example of the gap that needs to be filled is represented by Google
Flu Trends. When it first appeared, its ability to spot flu outbreaks weeks ahead of
traditional methods, by analyzing search engine queries about symptoms, was hailed
as a breakthrough. But for the 2013 flu season, the tool’s predictions were widely off
th e mark . W h y ?
page 12
New horizons: the executive briefings collection | September 2016 edition
3. | P u tting P eopl e at th e C enter of H eal th A nal y tic s
T h e v ol u me of th e w orl d’ s h eal th
data is projected to balloon to
2.3 zettabytes ( 2. 3 tril l ion bil l ion
gigaby tes ) by 2020 — grow ing
48% per y ear and ou tpac ing th e
grow th of big data ov eral l .
True data disruption requires
human interpretation
W e are f ac ing an ex pl os ion of data, c oming
f rom ev ery c orner of th e h eal th indu s try
ac ros s th e gl obe, f rom a diz z y ing array
of s ou rc es — au dio, v ideo, geos patial ,
tel emetric and s ens or data, el ec tronic
h eal th rec ords , pay er c l aims data and
real - time inf ormation generated by mobil e
h eal th tec h nol ogies . C ompu ting pow er
is now av ail abl e at dramatic al l y redu c ed
c os ts , adding enormou s new c apabil ities to
the equation and making analytics more
financially feasible.
page 13
H ow does th is add u p to tru e dis ru ption?
A s w ith th e G oogl e F l u T rends ex ampl e, th e
s h eer u nprec edented v ol u me and af f ordabl e
ac c es s ibil ity of data are not in its el f a
dis ru ptiv e f orc e. W h at is dis ru ptiv e — and
ev en rev ol u tionary — is th e abil ity to pu t th e
data togeth er, c reating l ink ages among and
betw een l arge data s ets and data ty pes to
tru l y u nc ov er patterns , trends and ins igh ts
h eretof ore u ns een.
T h e righ t c ombination of s mart al gorith ms
and peopl e c ou l d h el p redu c e or ev en
el iminate c h ronic dis eas es . I t c ou l d h el p
redu c e c as es of pos t- operativ e inf ec tion to
a v anis h ing point. A nd it c ou l d point w ith
confidence toward medicines and treatments
that dramatically increase the efficacy
among specific populations of people.
T h e k ey ? A c c ording to C h ris M az z ei, E Y
Global Chief Analytics Officer, it is strategy,
l eaders h ip and peopl e. “ T h is dis ru ption
f rom adv anc es in tec h nol ogy and adv anc ed
anal y tic s of f ers a prof ou nd opportu nity
f or th e h eal th indu s try , ” s ay s M az z ei.
“ I f organiz ations tru l y pu t data and anal y tic s at
th e c enter of th eir operations , th e c ol l ec tiv e
pow er of th e data c ou l d u tterl y trans f orm
h eal th c are — and s av e l iv es . B u t getting th ere
will not be easy. It is usually more difficult to
trans f orm a l arge, matu re organiz ation th an it
is to bu il d s ometh ing c ompl etel y new . ”
The starting point
L et’ s s tart w ith w h ere th e h eal th indu s try
is now c ompared w ith oth er indu s tries . T h e
c h art bel ow s h ow s h eal th c are c l os e to th e
middl e, w ith room to grow in terms of both
anal y tic s produ c tion and c ons u mption.
C ombined w ith th e al mos t inc ompreh ens ibl e
projections for growth in health data to 2.3
z ettaby tes ( 2. 3 tril l ion bil l ion gigaby tes )
by 2020, w ork ing f as t — and w ork ing now
— to find the right combination of human
dec is ion- mak ing w ith s mart al gorith ms is
both an opportu nity and a mandate.
Figure 3.1:
The data and analytics impact axis 3. 1
15
points
Strategy and leadership
Scores represented by
bubble size and color
Consumer products and retail 58.4
14
11
Analytics production (maximum 25)
T h e al gorith m didn’ t dis tingu is h betw een
s omeone w h o h ad th e s y mptoms and
s omeone w h o w as merel y as k ing abou t th e
s y mptoms . W ith s u c h a v as t amou nt of data,
th e v ol u me of f al s e data bec ame s o great as
to render the findings almost meaningless.
12
13
14
15
Technology
61.8
13
Pharma 51.7
Financial services 53.4
12
Manufacturing 54.8
Energy 50.8
Health care 52.8
Government 49.2
11
26
27
28
29
Analytics consumption (maximum 50)
New horizons: the executive briefings collection | September 2016 edition
30
31
32
33
3. | P u tting P eopl e at th e C enter of H eal th A nal y tic s
Case study: Intermountain Healthcare
Insight
Insight
The road ahead begins
with your destination
Three steps toward
powerful data insights
Before you begin any journey, it’s important
to k now w h ere y ou ’ re going. T h e end
pu rpos e of data and anal y tic s is to adv anc e
th e h eal th ou tc omes and ex perienc es f or
patients and to prov ide organiz ations w ith
new ins igh ts to mak e better operational
decisions. Analytics requires having good
data, bu t th e v al u e onl y c omes w ith th e
behavioral alignment required to “consume”
th e res u l ts — mov ing f rom c ol l ec tion to
ins igh ts to ac tion. T h es e ins igh ts c ou l d
h el p w ith :
• Organizational decision-making to
better u nders tand th e patients , ou tc omes ,
del iv ery mec h anis ms , s erv ic es of f ered
and operational s tru c tu res , and s erv ic e
pos itioning and operations
• Individual decision-making, enabl ing and
empow ering empl oy ees at al l l ev el s and
l oc ations th rou gh ou t th e organiz ation to
improv e th e res u l ts f or th e organiz ation
and f or patient ou tc omes and ex perienc es
• Decisions on the collective, w h ic h in th e
h eal th arena means prof ou nd ins igh ts into
treating c h ronic dis eas e and th e potential
f or prec is ion, c u s tomiz ed medic ine
page 14
I ns igh ts are mos t v al u abl e w h en th ey are
th e res u l t of data th at is ac c u rate and
c aref u l l y c u rated, generated by h u mans u perv is ed al gorith ms and part of a c l ear
process that defines how analyses are
u s ed to inf orm dec is ions . M any h eal th
organiz ations are s tru ggl ing to trans f orm
into anal y tic s - driv en enterpris es and deriv e
v al u e f rom th eir data anal y tic s . H ow do
organiz ations mov e f rom c u rrent to f u tu re
state as quickly as possible? It requires a
f oc u s on th ree th ings :
1. A strategy: W ith ou t a s trategic approac h
prov iding h igh - l ev el gu idanc e, anal y tic s
ef f orts are ru dderl es s . “ W e s ee many
organiz ations th at h av e s pu n u p
initiativ es and are s pending a l ot of
money , y et don’ t nec es s aril y h av e a
c l ear point of v iew on h ow v al u e w il l be
del iv ered, ” s ay s M az z ei.
2. A good structure: “ I n th e earl ier s tages
of anal y tic s , organiz ations tend to
h av e dis parate, s il oed ef f orts dotted al l
ov er th e pl ac e, w ith ou t mu c h c ontrol ,
and w ith potential du pl ic ation and
inefficiency,” says John Hopes, EY Global
B u s ines s M odel l ing L eader. “ O ne part
of th e organiz ation may produ c e great
I ntermou ntain H eal th c are h as been u s ing anal y tic s f or dec ades , improv ing operations ,
driv ing better h eal th c are ou tc omes and mak ing a dif f erenc e in patients ’ l iv es . T oday ,
Intermountain empowers doctors to make data-informed choices that benefit patients and
improv e bu s ines s res u l ts . T h e k ey s to s u c c es s ?
1. Keep data at the heart of the
organization: M os t of its c l inic al
programs h av e th eir ow n data teams ,
ens u ring th at I ntermou ntain’ s data and
anal y tic s ex perts s tay v ery c l os e to
bu s ines s probl ems , as k ing and ans w ering
better questions to drive results.
2. Create “learning loops” to streamline
operations: T h es e prov ide immediate
f eedbac k res u l ts to th e data team. I n
c ardiol ogy , f or ins tanc e, ev ery time
doc tors treat a h eart attac k , data on th e
operation is s h ared w ith th e treatment
team as part of a rapid improv ement
proc es s . B y dev el oping c ons is tent,
repeatabl e proc es s es , th is f eedbac k
h el ped redu c e th e median treatment
time f rom 90 to 57 minu tes .
3. Use data to ask smarter, better
questions: I ntermou ntain c reated an
env ironment w h ere any empl oy ee c an as k
f or anal y tic s s u pport. G etting ev ery one
on board for data success required:
New horizons: the executive briefings collection | September 2016 edition
• Hands-on training in a dataorientated culture: A t I ntermou ntain,
th is meant improv ing doc tors ’
k now l edge of data and anal y tic s
proc es s es and enc ou raging s taf f to ac t
on th e f indings .
• Letting data speak for itself:
I ntermou ntain does not f orc e th os e
w h o dis agree w ith anal y tic al f indings
to f al l into l ine. B y l etting th e data
s peak f or its el f , th e organiz ation
is ins tead abl e to bu il d l oy al ty to
anal y tic s proc es s es and inc reas e
adoption of more ef f ic ient approac h es .
• Adding incentives to drive positive
behaviors: I ntermou ntain’ s approac h
ac k now l edges th e importanc e of
al igning inc entiv es w ith des ired
beh av iors . I t is l au nc h ing a new
ins u ranc e produ c t th at w il l mak e
physicians and Intermountain jointly
res pons ibl e f or h eal th c are ef f ic ienc y .
D oc tors w h o adopt more ef f ic ient
meth ods w il l earn more inc ome, and
I ntermou ntain th ink s th is inc entiv e
w il l h el p th em f oc u s on data- driv en
dec is ion- mak ing.
3. | P u tting P eopl e at th e C enter of H eal th A nal y tic s
ins igh ts , bu t th ey w il l not be l ev eraged
el s ew h ere. ”
3. People: “ D ata and anal y tic s are as mu c h
an art as th ey are a s c ienc e. A s u c c es s f u l
data and anal y tic s env ironment does n’ t
depend on tec h nol ogy al one to del iv er
th e righ t ins igh ts at th e righ t time, ” s ay s
Mazzei. “It requires a human capital
s trategy , w ith l eaders h ip c oming f rom
th e top, and w ith empl oy ees at al l l ev el s
bu y ing into th e ef f ort. ”
Insight
The people are the center
D ata and anal y tic s c ou l d mov e h eal th
organiz ations in entirel y new , innov ativ e
direc tions , c h ange operational
inf ras tru c tu res , h av e a prof ou nd impac t
on c h ronic dis eas e and patient ou tc omes ,
and c h ange th e w ay organiz ations th ink
abou t h eal th and patient c are, opening
new opportu nities and prov iding new and
pow erf u l ins igh ts . H ow ev er, th es e ins igh ts
w il l onl y bec ome a real ity if peopl e are at th e
center of the equation, curating the data,
managing the algorithms and finding ways to
trans l ate th e ins igh ts into prac tic al u s e.
E Y ’ s M az z ei bel iev es organiz ations need
to pu t more f oc u s on u nders tanding th e
c u rrent s tate of th eir retu rn on anal y tic s
page 15
Leading practices in all industries
inv es tment: w h at is w ork ing and
w h at th e barriers are to improv ing.
“ I t’ s th e c ombination of peopl e,
proc es s and tec h nol ogy th at
c onv erge to c reate v al u e, ” h e s ay s .
“ A nd, of ten, th e bottl enec k is not
data, tec h nol ogy or ev en adv anc ed
analytics skill sets. It’s a question
of , onc e w e h av e th e ins igh ts f rom
th e anal y tic s , w h at are w e doing
w ith th os e ins igh ts ? T h at l as t mil e
is often the most difficult.”
R eal iz ing bu s ines s v al u e in data
and anal y tic s depends on getting
th e h u man el ement righ t. Strategy
is onl y as good as its ex ec u tion,
and s u c c es s f u l ex ec u tion of
ins igh ts f rom anal y tic s h appens
indiv idu al by indiv idu al . U l timatel y ,
data and anal y tic s w il l driv e mos t
h eal th c are dec is ion- mak ing
and au gment — bu t not repl ac e
— human judgment. EY’s Mazzei
s ay s , “ A t th e end of th e day , mos t
analytics uses still require a human
being to do s ometh ing dif f erent,
s u c h as c h ange a bu s ines s proc es s
or dec is ion th ey w ou l d h av e
oth erw is e made. ”
A f ew c ommon th emes emerge among th e bes t in al l indu s tries , w h ic h c ou l d be l ev eraged in h eal th :
• Consider analytics central to business
strategy: E x ec u tiv es in th e top 10% of
enterpris es report th at th ey are al ready
s eeing tangibl e bu s ines s res u l ts f rom th eir
anal y tic s ef f orts and a notic eabl e s h if t in th eir
abil ity to meet c ompetitiv e c h al l enges .
• Designate leaders to guide the initiatives:
T h e v is ion to energiz e and s u s tain data and
anal y tic s ac tiv ities needs to c ome f rom th e
top l ev el s of th e organiz ation. O rganiz ations
are al s o identif y ing and embedding data and
anal y tic s l eaders th rou gh ou t th e enterpris e.
• Have (or get busy building) advanced
data management capabilities — the tools
and the people: A better- oil ed anal y tic s
tec h nol ogy inf ras tru c tu re means h av ing a
w el l - es tabl is h ed portf ol io of anal y tic s tool s
and technology services and well-defined
c ompetenc ies . I t is peopl e w h o are at th e c ore
of ev ery initiativ e, s u ppl y ing th e s k il l s ets to
gath er and anal y z e data and c reate anal y tic s bas ed bu s ines s ins igh ts .
• Align the entire organization around
analytics: T h e v al u e of anal y tic s c omes f rom
the behavioral alignment required to move
f rom ins igh ts to ac tion to v al u e. T h is of ten
requires a profound change management
ef f ort to adv anc e an anal y tic s v is ion and
New horizons: the executive briefings collection | September 2016 edition
dev el op an anal y tic s - driv en c u l tu re. W h il e
th ere is not one perf ec t model , it is adv is abl e
to h av e a c entral team, w ith anal y tic s
del iv ery res ou rc es c l os e to th e bu s ines s u nits
and f u nc tions .
• Get talent from the outside and inside:
L eading prac tic es s u gges t a c ombination of
h iring anal y tic s and data ex perts and grow ing
and training tal ent internal l y . T w o c ritic al
el ements of th is are to ens u re th at th e new
s tru c tu re is rew arding f or th e organiz ation
and empl oy ees and it c reates empl oy ee
au tonomy . E mpow ering empl oy ees to pu rs u e
anal y tic al th ink ing, u s e anal y tic s tool s as th ey
s ee appropriate and h av e th e l eew ay to ac t
on the insights gained through their findings
is th e “ l as t mil e” tow ard real iz ing tru e v al u e
of data and anal y tic s .
• Act on analytics insights at all times:
T h e k ey is to s tart w ith th e end u s er in mind.
T h e bu s ines s probl em or opportu nity needs
to be identified, and appropriate analytics
s ol u tions need to be dev el oped to h el p u s ers
mak e dec is ions . A nal y tic s bec omes a natu ral
ex tens ion of ongoing ac tiv ity embedded into
jobs, providing employees latitude to act on
anal y tic s opportu nities and ins igh ts .
B rief x | T itl e
4.
Participatory health:
a world of alternatives for
consumers and health players
Despite feeling ok, you have learned that you have a significant risk of
dev el oping a c h ronic dis eas e. P erh aps one th at af f ec ted y ou r moth er or f ath er.
T oday , th is means a bu nc h of pamph l ets f rom y ou r doc tor and onl ine s earc h es
that frequently reveal conflicting, or questionable, information. But as health care
is trans f ormed — by c os t pres s u res , c h anging demograph ic s and tec h nol ogic al
adv anc ement — traditional del iv ery model s are being u pended.
T omorrow , ins tead of a trip to th e doc tor f or a c ons u l tation ( if y ou are l u c k y ) ,
s tandardiz ed inf ormation mos t rel ev ant to th os e new l y diagnos ed w ith y ou r c ondition
is sent right to your smart device. An app guides you through a questionnaire and
provides the data to the artificial intelligence (AI) handling your case. Once completed,
y ou al l ow th e A I ac c es s to y ou r s ec u re medic al rec ord and s ens or data f rom y ou r
w atc h , c l oth ing, h ome, and l oc al , pu bl ic env ironmental s ens ors . T h e A I dev el ops a
c u s tomiz ed l if es ty l e management pl an, pu tting y ou in c ontrol of y ou r h eal th . I t al s o
c onnec ts y ou to a w orl dw ide c ommu nity of peopl e w ith y ou r c ondition. P erh aps y ou
allow the AI to adjust your calendar or shopping habits. Maybe you take virtual walks
w ith s omeone on anoth er c ontinent, or s h are artic l es or produ c t rec ommendations
w ith th os e w h o h av e been managing th is ris k f or s ome time. W h at is c ertain is th at th e
h eal th c are s y s tem of tomorrow w il l be on- demand, c onnec ted and data driv en.
T ec h nol ogy , inc reas ing h eal th c ons u meris m and s oc ial media 2. 0 are c h anging th e
w ay w e th ink abou t w el l nes s and c are.
W el c ome to h eal th , reimagined.
page 16
New horizons: the executive briefings collection | September 2016 edition
4. | P artic ipatory h eal th : a w orl d of al ternativ es f or c ons u mers and h eal th pl ay ers
Insight
Get ready to transform health care
Su s tainabl e, ac c es s ibl e c are is a gl obal
priority . H eal th s pending, h ow ev er, is on an
unsustainable trajectory, and demand for
c are is ris ing. Sev eral f ac tors are f orc ing a
c h ange in th e w ay w e th ink abou t h eal th and
h eal th c are:
• Rising demands, increasing costs:
• G l obal l y , peopl e are l iv ing l onger,
and ex penditu res on h eal th c are are
greates t f or th os e ov er 65.
• C h ronic l if es ty l e dis eas es are
ev ery w h ere and are ex pens iv e to treat,
partic u l arl y f or th os e diagnos ed at a
y ou ng age.
• H eal th c ons u mption c ontinu es to grow
as th e middl e c l as s s w el l s in emerging
nations. Massive inequalities in access
and ou tc omes remain.
• Systemic forces resistant to change:
• W ork f orc e s h ortages f or c onv entional
h eal th c are prov iders ex ac erbate
inequalities and increase costs.
• Sil oed c are del iv ery s y s tems mean
w as te and v ariation in c are w ith
u nprov en v al u e.
• T h e demand and need f or c are is not
s trongl y inf l u enc ed by c os ts .
page 17
• Policies shift risks and encourage
new models:
• R eimbu rs ement h as mov ed aw ay f rom
v ol u me and is embrac ing ou tc omes .
• O rganiz ations are f inding new model s
of c are th at mitigate ris k s , c ontrol c os ts
and max imiz e ou tc omes .
• I ndiv idu al s h av e more f inanc ial
res pons ibil ity and are more engaged in
dec is ions abou t th eir c are.
Insight
Patients will continue to
participate more actively
A t its c ore, partic ipatory h eal th des c ribes
a s h if t in th e patient- prov ider rel ations h ip.
I ndiv idu al s tak e on greater res pons ibil ity
and bec ome th e c enter of th e ac tion,
c u rating and nav igating th eir h eal th and
their care as an equal partner. Increasing
mobil ity , ow ners h ip of s mart dev ic es and
onl ine pl atf orms f or s oc ial interac tion and
inf ormation ex c h ange are c h anging gl obal
attitu des tow ard s h aring and partic ipation.
I ndiv idu al s are s h if ting th eir f oc u s to w el l nes s
rath er th an engaging onl y w h en th ey are
il l . K ey enabl ers are enc ou raging peopl e to
mak e pos itiv e c are/ l if es ty l e c h oic es and to
be engaged in, and ac c ou ntabl e f or, h eal th .
P rov iders and indu s try s tak eh ol ders are
gaining a more c ompl ete v iew of c ons u mers ,
identif y ing opportu nities to engage th em
at k ey dec is ion points . T h e c ontinu u m is
c h anging to be more el as tic and pers onal iz ed,
fitting around the individual. If this is realized
on a popu l ation- w ide l ev el , it w il l be pos s ibl e
to h av e a f u ndamental l y dif f erent model of
c are del iv ered s u s tainabl y .
T h e s h if t aw ay f rom today ’ s c onc ept of
h eal th and dis eas e and th e model s of c are
del iv ery is s u pported by th ree big trends :
matu ring c ons u meris m, s oc ial 2. 0 and
tec h nol ogy . T h es e are th e tool s th at w il l be
u s ed to bu il d an integrated h eal th ec os y s tem
ins tead of a f rac tu red c ol l ec tion of indiv idu al
s y s tems th at s il o data. T h is ec os y s tem w il l
pu t h eal th in th e h ands of th e c ons u mer.
Enablers of change
B y 2020 …
• Smartph one adoption in th e
dev el oped w orl d w il l reac h 80%
penetration, w ith 63% penetration in
th e dev el oping w orl d. 4. 1
• Sev enty perc ent of s martph ones w il l
h av e gl obal broadband c onnec tions .
• C ons u mer- generated data w il l be
44x h igh er th an in 2009. 4. 3
• T h ree bil l ion peopl e w il l enter th e
middl e c l as s , mos tl y f rom th e
dev el oping w orl d. 4. 4
Figure 4.1:
Participatory health: key enablers
Behavioral
engagement
Maturing
consumerism
New horizons: the executive briefings collection | September 2016 edition
Digital
capabilities
Social 2.0
Technology
4. 2
4. | P artic ipatory h eal th : a w orl d of al ternativ es f or c ons u mers and h eal th pl ay ers
Insight
c ons u mer- generated data, and c reate
influential communities of action.
Mobile and web tools power
patient participation
T h is iteration of s oc ial interac tion is enabl ed
by a dy namic v irtu al env ironment th at
c onnec ts peopl e and rel iabl e inf ormation
in ev en l arger netw ork s , bu il ding on th e
pl atf orms th at ex is t today .
M obil e internet c onnec tiv ity — al w ay s on,
c ontinu ou s l y u pdated, h igh l y interac tiv e
— enabl es th e v irtu al env ironment th at
u nderpins partic ipatory h eal th . O nl ine
pl atf orms h arnes s th e pow er of th e c row d,
driv e beh av ioral and s oc ial engagement,
f os ter eas y s h aring of res earc h and
Figure 4.2:
Social 2.0
“Gig”
economy
Health
consumers
Online
networks
Consumer
reviews/
experiences
Social media
disease
tracking
Patient
communities
Research
Providers
Industry
Consumer-generated
health data
Transparent
pricing
page 18
Payers
Health
Care Cost
Institute
Incentivized
health
behaviors
G row ing s oc ial and mobil e penetration l ev el s
c h ange rel ations h ips in h eal th c are. P atients
and c aregiv ers es tabl is h new netw ork s
and s ou rc es of inf ormation th rou gh onl ine
pl atf orms , s h aping th e ex pec tations and
beh av ior of patients A N D prov iders .
I n th e U nited States , 53% of
peopl e are w il l ing to s h are h eal th
data ( 61% f or th os e u nder 35) .
Sh aring and aggregation of h eal th
data w il l enabl e new l ev el s of
interac tions betw een c ons u mers
and c aregiv ers , prov iders , pay ers
and manu f ac tu rers and enabl e
th e anal y tic s th at w il l driv e
pers onal iz ed h eal th . 4. 5
C ros s - s tak eh ol der interac tion is f os tered,
l eading to new f orms of engagement
betw een c ons u mers and h eal th indu s try
pl ay ers . F or ex ampl e, ph armac eu tic al
c ompanies are dev el oping s oc ial l is tening
s k il l s to get c l os er to patients , to u nders tand
th eir ex perienc es and u nmet needs , and
to monitor c ontent f or ph armac ov igil anc e.
I ns u rers u s e retail - l ik e s oc ial bu s ines s
s trategies to f orm l ong- term rel ations h ips
w ith members , as w el l as c ontes ts and
gamification to change behaviors and
inc reas e engagement. I ns titu tions u s e s oc ial
netw ork s to rec ru it f or c l inic al trial s and to
s ou rc e s u gges tions f or f u tu re trial s .
Insight
Always-on connectedness
changes the dynamics
H eal th 2. 0 w il l be u s h ered in by th e nex t
w av e of digital innov ation. T ec h nol ogies
des igned arou nd th e indiv idu al prov ide a
c ontinu ou s rec ord of h eal th - s u pporting
data. T h es e data, in tu rn, empow er
c ons u mers to mak e h eal th - c ons c iou s
c h oic es , w h il e giv ing prov iders and
pay ers th e inf ormation th ey need to tail or
treatments and c ontrol c os ts .
Health care – anytime, anywhere
The near ubiquity of mobile penetration,
ev en in th e dev el oping w orl d, pu ts h eal th in
th e h ands of th e c ons u mer. B l oc k c h ain, a
meth od of u s ing a dis tribu ted databas e th at
enabl es s ec u re trans ac tions betw een parties
— th e innov ation beh ind c ry ptoc u rrenc ies —
giv es ev ery one a portabl e rec ord of al l th eir
inf ormation. T h is rec ord al l ow s c ons u mers
to s h are th eir h eal th data w h ere, w h en and
w ith w h om th ey dec ide, mak ing trans ac tions
th at inv ol v e pay ers and prov iders s eaml es s .
New horizons: the executive briefings collection | September 2016 edition
Data that systematizes serendipity
W irel es s and broadband tec h nol ogy , c l ou d
and f og c ompu ting, and c h eap, rel iabl e
sensors underpin self-quantification,
del iv ering inf ormation th at driv es prev ention
and c are. I ns igh ts into c ommu nities — v irtu al
or geograph ic — s u gges t improv ements
f or pu bl ic h eal th and medic ine, inc l u ding
disease surveillance, risk factor identification
and epidemic monitoring. A I c ompu ter
s y s tems u s ing mac h ine l earning al gorith ms
study behavior patterns, genetic profiles,
env ironmental f ac tors and h eal th ou tc omes
to u nders tand h eal th driv ers . T h ey s u gges t
interv entions and beh av ioral nu dges at k ey
dec is ion points , l ong bef ore il l nes s begins .
O u r f oc u s s h if ts to maintaining w el l nes s
rath er th an treating dis eas e.
New players and
cross-sector partnering
N ew entrants u pend traditional c are
and del iv ery model s by av oiding th em
c ompl etel y , s u pported by c entral pl atf orms
f or s toring and s h aring h eal th data and
interoperabil ity s tandards . H eal th s ol u tions
bec ome tec h - enabl ed, data- driv en and
ou tc ome- f oc u s ed. A l l ianc es betw een pay ers
and data c ol l ec tors / aggregators al l ow f or
benefit management and price estimations.
T h e beh av ioral s c ienc es pl ay a l arger rol e:
attention s h if ts to prev ention, enabl ed by
predic tiv e anal y tic s .
4. | P artic ipatory h eal th : a w orl d of al ternativ es f or c ons u mers and h eal th pl ay ers
Insight
Patients are (smart)
consumers too
I nteres t in s el f - driv en h eal th ex perienc es
is ris ing as tec h nol ogies f or data gath ering
and anal y tic s empow er c ons u mers w ith
ins igh ts . A t th e s ame time, c ons u mers are
assuming more financial risk by bearing
more of th e c os t of th eir c are. E x pec tations
c h ange, l eading to th e des ire f or a more
retail - l ik e h eal th ex perienc e. T h is means
greater c os t trans parenc y , benc h mark ed
quality metrics, accountability for results and
high-quality customer service. “Anywhere,
any time” prev ail s , as ins igh ts abou t s el f and
abou t popu l ations aris e f rom intentional and
u nintentional data v ia th e I nternet of T h ings
and Quantified Self environments.
18+ y ears . T h e data s h ow th at h eal th
c ons u mers are pos ed to adopt digital
tec h nol ogies and as s u me a h igh er degree
of inv ol v ement. F rom w eb ac c es s to h eal th rel ated f orms , to v irtu al interac tions w ith
prov iders , to u s ing w earabl e tec h nol ogy
and apps to gath er and s h are data w ith
doc tors , c ons u mers are s et to tak e c h arge
of th eir interac tions w ith th e h eal th s ec tor.
Figure 4.3:
Future interest in using digital technologies 4. 7
I f th es e s erv ic es w ere av ail abl e in th e f u tu re, h ow interes ted migh t y ou be in u s ing th em? ( P l eas e rate eac h item)
“ V ery , ” “ F airl y ” or “ A l ittl e interes ted”
N ot interes ted at al l
87%
13%
83%
17%
A t th e end of 2014, 40% of
total gl obal c onnec tions w ere
mobil e broadband ( 3G and
4G ) . I nc reas ing s martph one
af f ordabil ity and deeper netw ork
c ov erage w il l driv e an inc reas e to
arou nd 70% by 2020. 4. 6
74%
C ompl ete doc tor or h os pital regis tration detail s onl ine bef ore y ou r v is it
U s e an at- h ome diagnos tic tes t k it ( e. g. , f or s trep- th roat, c h ol es terol l ev el s ) and s end th e
inf ormation to y ou r doc tor
30%
C ommu nic ate el ec tronic al l y w ith a doc tor or oth er h eal th prof es s ional ( e. g. , email , tex t, s oc ial
media s ite)
70%
70%
30%
66%
34%
61%
60%
page 19
M ak e an appointment onl ine to s ee a doc tor or organiz e a h os pital s erv ic e/ appointment
26%
39%
I n J u l y 2015, E Y c ondu c ted a national l y
repres entativ e onl ine s u rv ey of 1, 761
randoml y s el ec ted adu l t A u s tral ians age
O pportu nities f or grow th abou nd. T h e gl obal
digital h eal th mark et, v al u ed at $ 77 mil l ion
in 2015, is ex pec ted to grow at a C A G R
of 21. 0% du ring 2016 th rou gh 2022. T h e
mHealth segment is projected to lead the
pac k at a C A G R of 34. 0% du ring th e f orec as t
period. I n th e U nited States , onl y 27% of
peopl e pol l ed in 2016 ow n a w earabl e
dev ic e ( al th ou gh 78% of th em w ou l d s h are
th e data it generates w ith th eir ph y s ic ian) .
40%
Order prescription drug refills using mobile apps on your phone
U s e a dev ic e th at c onnec ts to y ou r s martph one ( e. g. , temperatu re, bl ood pres s u re or h eart
rate) and s end th e inf ormation to y ou r doc tor
C ons u l t a doc tor by v ideo on y ou r c ompu ter rath er th an inpers on in a c l inic
Send a photo of your injury/health problem to a doctor using your computer or mobile device
New horizons: the executive briefings collection | September 2016 edition
M oreov er, onl y 25% of th os e s u rv ey ed h av e
a s ingl e s el f - s erv ic e portal f or th eir h eal th
inf ormation. A t pres ent, th e demand f or
c ons u mer- driv en tec h nol ogies s til l ou tpac es
s ol u tions . A s more entrants enter th e f ray ,
th e gap is c l os ing.
The participatory health paradigm:
changing what is possible in
health care
U ptak e of h eal th - enabl ing tec h nol ogies
is pic k ing u p pac e and mov ing bey ond
w eal th y mark ets and earl y adopters . M obil e
c l inic s w ith w irel es s s ens ors are inc reas ing
ac c es s to c are in A f ric a. M ac h ine l earning
al gorith ms are being appl ied to pattern
detec tion in radiol ogy , c anc er genetic s and
mac u l ar degeneration. L arge, c ros s - s ec tional
l ongitu dinal s tu dies th at l ink h eal th , genetic
and env ironmental inf ormation are u nderw ay
in many c ou ntries . N ew entrants are div ing in
and c reating new model s of c are.
Dave Roberts, EY Asia-Pacific Health Leader,
s u mmariz es it th is w ay : “ O pportu nities
emerge at th e inters ec tion of c ons u meris m,
tec h nol ogy and mark ets f or th os e w il l ing to
ex pl ore bey ond th eir traditional bou ndaries .
T o do th is , s trategy agendas — w h eth er th ey
be global, regional or local — will require
as s es s ing h ow f ar and in w h at direc tion to
reac h . ”
B rief x | T itl e
5.
The black market for medical data
I n th e dark c orners of th e internet, medic al rec ords are a h ot c ommodity ,
w ith mil l ions of peopl es ’ medic al rec ords u p f or s al e, draw ing a f ar h igh er
pric e th an c redit c ards . H eal th organiz ations al ready f ac ing tou gh
c y bers ec u rity c h al l enges are s c rambl ing to pu t th e s y s tems in pl ac e to
rapidl y detec t and prev ent attac k s on th is data, and th ey are l earning
l es s ons f rom oth er indu s tries al ong th e w ay .
Why are medical records a target?
Medical records have more personal information, contain personally identifiable
inf ormation th at is h arder to c h ange and of f er th iev es and h ac k ers more options . I n
s ome c as es , it’ s abou t s teal ing a pers on’ s identity — and th en s tic k ing th em w ith th e bil l
f or f rau du l entl y obtained h eal th c are. I n oth ers , it’ s abou t opening a new l ine of c redit,
and, in s ome c as es , h ac k ed medic al rec ords are u s ed f or bl ac k mail and ex tortion. A s a
consequence, the information can sell for as much as the bitcoin equivalent of $60 per
rec ord, w h ereas s oc ial s ec u rity nu mbers are a mere $ 15 and s tol en c redit c ards s el l
for just $1 to $3.
The perimeter is eroding
T h e ris e of digital h eal th c are is part of th e reas on f or th e s pik e in th reats , as more
th ird parties enter th e h eal th s u ppl y c h ain. B oth of f er more attac k points and more
s u s c eptibil ity to h u man engineering attac k s , s u c h as ph is h ing. D ev el opers of new digital
s el f - c are and patient- w el l nes s apps , f or ins tanc e, as w el l as oth er bu s ines s as s oc iates ,
are of ten f rom non- h eal th bac k grou nds and are u nl ik el y to u nders tand c ompl ianc e w ith
regulations (e.g., HIPAA). As a consequence, in some cases, these new points of entry
are l es s s u s pec ting or s ec u re.
B u t th e inc reas ed aw arenes s of medic al rec ords ’ v al u e on th e bl ac k mark et is th e driv er.
page 20
New horizons: the executive briefings collection | September 2016 edition
5. | T h e bl ac k mark et f or medic al data
T h e danger is real , and it pu ts patients at
ris k . A s many as 80 mil l ion c u s tomers of
th e nation’ s s ec ond- l arges t h eal th ins u ranc e
organiz ation, A nth em I nc . , h ad th eir ac c ou nt
inf ormation s tol en in 15 month s , f rom
J anu ary 2014 into M arc h 2015. M ore th an
113 mil l ion medic al rec ords w ere h ac k ed in
2015 al one, ac c ording to data c ompil ed by
H eal th and H u man Serv ic es . A dding it al l
u p, th is repres ents s ome 47% of A meric ans
w h o h av e h ad th eir medic al rec ords h ac k ed
in th e pas t 12 month s , ac c ording to a report
f rom th e I ns titu te f or C ritic al I nf ras tru c tu re
T ec h nol ogy , a c y bers ec u rity th ink tank . A
dangerou s by - produ c t of th e th ef t is th at
important inf ormation on th e patient’ s
medic al rec ord is of ten del eted af ter being
s tol en, s u c h as an al l ergy to penic il l in, or
new entries are added.
Know the enemy —
who are the attackers?
The thieves are an increasingly diversified
c ol l ec tion of s pec ial iz ed bad ac tors . Y es , th ere
is s til l a th riv ing bl ac k mark et f or h ac k ers
seeking a relatively quick cash transaction.
B u t th e more w orris ome th reat c omes f rom
new prof es s ional bu y ers w h o are aggregating
data and mining it, indic ating l arger s c al e
ambitions , s u c h as mark et manipu l ation.
T h es e pl ay ers ( s u c h as nation s tates and
organiz ed c rime s y ndic ates ) are v ery
dif f erent f rom th e c ommon traders . M any
of th es e c y ber attac k ers are s oph is tic ated,
page 21
Risk vs. risk
w el l - f u nded, gl obal and nimbl e in l ev eraging
tec h nol ogy and ex ec u ting attac k s .
What are the key challenges?
I t’ s s impl e enou gh to c anc el a c redit c ard,
bu t to c h ange a s oc ial s ec u rity or M edic are
I D nu mber is no eas y f eat. B ank s h av e tak en
some major steps to crack down on identity
th ef t. B u t h os pital s , w h ic h h av e onl y rec entl y
trans itioned f rom paper- bas ed to digital
s y s tems , h av e f ar f ew er s ec u rity protec tions
in pl ac e. T h e interc onnec ted natu re of th e
h eal th ec os y s tem means a breac h c an
h av e a rippl e ef f ec t u p and dow n th e s u ppl y
c h ain. T h e grow ing nu mber of ac c es s points
w ith in th e s u ppl y c h ain inc reas es th e ris k of
being breac h ed. T h is is a ris k th at af f ec ts
al l pl ay ers in th e h eal th ec os y s tem. A s an
ex ampl e, f or s ometh ing as s impl e as a bl ood
pres s u re monitor, th e points of ris k inc l u de
th e manu f ac tu rer of th e medic al dev ic e,
th e ph y s ic ian, th e el ec tronic h eal th rec ord
s y s tems u s ed and th e ins u ranc e organiz ation
reimbu rs ing th e ph y s ic ian or patient. A l l
are at ris k , and al l pl ay a rol e in k eeping th e
inf ras tru c tu re s ec u re.
I n rans omw are c as es , th e th ief h ol ds th e
entity ’ s data h os tage in ex c h ange f or a
rans om pay ment. A l th ou gh tec h nic al l y not
a bl ac k mark et th reat w h ere th e th ief res el l s
th e data, h eal th organiz ations mu s t c atc h u p
— fast — and use leading class techniques from
For a medical device organization
w ith w eb- c onnec ted and/ or s ens or- enabl ed
dev ic es , attac k ers c ou l d interf ere w ith
dev ic e operation, tak ing ou t a pac emak er
or a l ev el s - s ens itiv e medic ationdis tribu tion s y s tem. I f attac k ers h ac k th e
s ens or th at monitors dru g l ev el s , th ey
c an al ter th e dos e, w ith potential l y deadl y
res u l ts f or th e patient. O r perh aps th ey
w il l attac k earl ier in th e s u ppl y c h ain
th rou gh a parts s u ppl ier or at th e point of
manu f ac tu re. A l l it tak es is f or one s ens or
in th e pl ant to be h ac k ed s o th at it f eeds
inac c u rate data into th e manu f ac tu ring
proc es s , and th e produ c t c ou l d tu rn ou t to
be def ec tiv e in w ay s not dis c ov ered u ntil
it’ s on th e mark et. M anu f ac tu ring pl ants
w ere not c ons tru c ted w ith c y bers ec u rity in
mind, bu t th ey are bec oming inc reas ingl y
c onnec ted and au tomated, w h ic h mak es
th em inc reas ingl y v u l nerabl e.
For a pharmaceutical organization,
th e th reat is entirel y dif f erent. F or
ins tanc e, c y ber attac k ers may f ol l ow th e
dev el opment proc es s of y ou r new , h igh profile drug to know when and how to
interru pt y ou r proc es s . W ith y ou r f ac il ities
al l on netw ork ed c ontrol s , th ey c ou l d
h ac k th at and c ontaminate y ou r tes ting
env ironment. W ith y ou r tes ting data al l
h el d on s erv ers , th ey c ou l d attac k y ou r data
f arm and des troy or c orru pt y ou r data. O r
perh aps y ou c ontrac ted w ith a th ird- party
testing firm; cyber attackers could gain
ac c es s th rou gh th e rel ativ el y u ns ec u red
organiz ation c el l ph one of a c ontrac tor’ s
empl oy ee and mov e on to dis ru pt th e
tes ting env ironment th rou gh th at breac h .
Figure 5.1:
Attackers and their abilities/motivations 5. 1
Patient health
Adversary
I ndiv idu al / s mal l grou p
P ol itic al grou ps / h ac k iv is ts
O rganiz ed c rime
T erroris m/ terroris m org.
N ation s tates
New horizons: the executive briefings collection | September 2016 edition
Target
(specific victims)
Untargeted
( indis c riminate)
Patient records
Target
(specific victims)
Untargeted
( indis c riminate)
5. | T h e bl ac k mark et f or medic al data
oth er indu s tries to s top th ef t at ev ery point in
th e bl ac k mark et or rans omw are v al u e c h ain.
at ev ery s tep al ong th e data c ol l ec tion path .
T h e u l timate goal s are to:
Insight
• C ompl ic ate an attac k er’ s abil ity to ac h iev e
their objective
Compliance isn’t enough:
getting ahead of the threat is an
enterprise-wide endeavor
T o tru l y get ah ead of th e attac k ers ,
organiz ations need c ompreh ens iv e
s trategies c u s tomiz ed to th eir ex ac t areas
of ris k . A l th ou gh meeting th e c ompl ianc e
gu idel ines is a s tarting point, a c ompl ianc e
minds et on c y bers ec u rity w on’ t be enou gh .
C ompl ianc e is f oc u s ed on th e pas t, and
regu l ations ( in th e s u bs et of h eal th
indu s tries w h ere th ey addres s s ec u rity ) are
u s u al l y bas ed on th e ty pes of breac h es th at
h av e al ready h appened. A nd an I T s ol u tion
w on’ t be enou gh eith er. H eal th organiz ations
need an al l - enc ompas s ing f ramew ork to
mak e s mart, inf ormed dec is ions to prioritiz e
c y bers ec u rity s pending, bu il d and ins til l a
c u l tu re of s ec u rity , and protec t th e as s ets
mos t direc tl y impac ting th e bu s ines s
strategy and objectives.
T h e k ey operating c onc ept is th e idea of
an ac tiv e def ens e: probing f or, anal y z ing
and neu tral iz ing th reats bef ore th ey c an
acquire or damage a organization’s critical
assets. This requires understanding your
organiz ation’ s ris k s pec tru m — ov er time and
page 22
• D etec t an attac k bef ore meaningf u l
bu s ines s is impac ted
• R es pond ef f ec tiv el y and immediatel y to
remediate an attac k
• E du c ate y ou r w ork f orc e to inc reas es
aw arenes s , dev el op and maintain a
s ec u rity c ons c iou s nes s , and f end agains t
ph is h ing attac k s
Insight
Know the value of your data — and
start with the areas of highest risk
T o al l oc ate c y bers ec u rity dol l ars w is el y ,
organiz ations mu s t l earn th e v al u e of th eir
inf ormation as s ets , u pdating it annu al l y
and at ev ery point in th e s u ppl y c h ain. T h e
c os ts of s ec u rity breac h es in h eal th are too
ex pens iv e to ignore. A data breac h c ou l d
bring y ou r entire bu s ines s to a s tands til l ,
and a rans omw are th reat c ou l d l oc k
dow n y ou r data, mak ing dail y operations
impos s ibl e. Y et not ev ery th ing s h ou l d be
protected with equal rigor. The higher the
v al u e, th e s tronger y ou r protec tion needs
to be at th os e trans ac tion points . T h e ris k
grow s as y ou gain more data. T h e v al u e of
h eal th data may inc reas e ov er time; u nl ik e
c redit c ards , P I N s or pas s w ords , h eal th data
does not c h ange, and aggregating mak es it
more v al u abl e ( indiv idu al rec ords and data
s ets f rom mu l tipl e indiv idu al s ) . F or ins tanc e,
data is more v al u abl e ( and needs h igh er
protec tion) at th e end of a c l inic al trial .
P rac tic es w ith f u l l el ec tronic h eal th rec ords
programs in pl ac e are more at ris k th an
th os e s til l ev ol v ing to el ec tronic rec ords .
Insight
Get a communications and
response plan in place — now
Sinc e w e are tal k ing abou t h u man h eal th ,
c y bers ec u rity is abou t protec ting patients .
Y ou mu s t be proac tiv e and preemptiv e. B u il d
a c ris is management pl an now and be ready
to execute it at the first sign of a security
inc ident. T h is pl an needs to addres s :
• C u s tomer res pons e ( and y ou r
organiz ation’ s res pons ibil ity ) to th os e
h armed by an attac k — w ith bu il t- in points
to addres s bas ed on w h at w as l os t or
dis ru pted in th e breac h
• R es pons es to oth ers in th e s u ppl y c h ain,
s toc k h ol ders and any one el s e w ith a
v es ted interes t in y ou r organiz ation
• T h e s pok es pers on — and w h eth er th is w il l
dif f er depending on th e s c al e of th e ev ent
New horizons: the executive briefings collection | September 2016 edition
• T h e res pons e and ac tion pl an ( s u c h as
notifying government officials) if the
attac k is trac ed bac k to a nation- s tate,
w h ere pol itic al and mark et s ens itiv ities
are at pl ay
• T h e res pons e to a rans omw are th reat —
w ith a dif f erentiated s trategy f or v ary ing
l ev el s of th reat and a c l ear u nders tanding
of th e demarc ation f or th es e l ev el s ( i. e. ,
direct financial loss, reputation loss
or l egal reperc u s s ions w ith as s oc iated
financial loss)
Insight
Your people are the front line of
cybersecurity
Sec u rity mu s t bec ome th e new minds et and
th e new bac k bone arou nd w h ic h operational
or del iv ery - of - c are model s are bu il t. T h e
tric k y part is th at th is inv ol v es c h anging
th e minds et and beh av ior of peopl e. I n
many c as es , it’ s c h al l enging f or s ec u rity
ex perts to c onv inc e doc tors and oth er
health practitioners to alter their workflow
to ac c ommodate a ris k mitigation ef f ort.
F or ins tanc e, many doc tors are rel u c tant to
u s e du al - f ac tor au th entic ation, as it migh t
s l ow dow n th e proc es s of treating a c ritic al
patient. I n oth er c as es , it is a matter of
edu c ating ev ery one in th e c h ain of c l inic al
c are on th e dire potential ou tc omes of a
s ec u rity breac h and s tres s ing th e need f or
5. | T h e bl ac k mark et f or medic al data
w atc h f u l dil igenc e in regu l ar, dail y h eal th
c are tas k s . Steps inc l u de:
• E du c ating y ou r w ork f orc e to be on th e
l ook ou t f or s pear- ph is h ing attac k s , th os e
s eemingl y l egitimate email s f rom a
f amil iar indiv idu al or organiz ation th at are,
in f ac t, f rau du l ent c ommu nic ations
• C h anging empl oy ee reac tions to
c y bers ec u rity f rom an annoy anc e to be
av oided w h en pos s ibl e to a f u ndamental
part of ac h iev ing th e organiz ation’ s
objectives
• M ak ing s u re y ou r w ork f orc e edu c ation
and s ec u rity meas u res do not ins til l too
mu c h f ear in y ou r u s ers
• R ais ing th e ov eral l aw arenes s of al l th e
operativ e s tak eh ol ders in y ou r bu s ines s
— f rom ev ery l ev el of empl oy ee to ev ery
c omponent of y ou r s u ppl y c h ain
page 23
Leading practices
From the aviation industry
In a January 2016 report, the Air Traffic
C ontrol A s s oc iation rec ommended th at
al l av iation partners — airl ines , pil ots and
airport au th orities — w ork togeth er to
s imu l ate and reh ears e c y ber attac k s in
an ef f ort to get ah ead of th e th reat. T h is
approac h inc l u des :
• Hardening of the systems
Build in requirements for cybersecurity
f rom th e s tart w ith th e s y s tem’ s
dev el opment l if e c y c l e, mak ing it an
integral part of th e dev el opment of a
project management plan. Threats
are eas ier to c ombat if gov erned f rom
th e ons et.
• Safe connectivity of the community
C ons ider th e operational impac ts bas ed
on h igh - l ev el th reats and dev el op a
c oh es iv e res pons e th rou gh ou t th e
av iation indu s try , inc l u ding av iation
indu s try operations , airl ines , airports ,
th e D epartment of D ef ens e ( D O D ) and
general av iation. T h is inc l u des inc reas ing
aw arenes s of c y ber th reats , as w el l as a
robu s t ou tl ine of c y ber training, pol ic ies
and proc edu res .
• Operational response
I ntegrate an av iation- w ide inc ident
res pons e pl an th at inc l u des a h ol is tic v iew
of th e av iation airs pac e and impac t to
th e airl ines and airport s erv ic es bas ed on
th e l os s of s y s tems , as w el l as a res pons e
pl an th at integrates w ith ex is ting F ederal
A v iation A dminis tration, airl ines , airports
and D O D res pons e pl ans . 5. 2
From the financial
services industry
For financial services organizations, the
potential c y ber ris k s as s oc iated w ith
partners , v endors and oth er th ird parties
topped th e l is t of c onc erns in 2015. T h e
indu s try is mov ing tow ard bu il ding s ec u rity
into ev ery produ c t, s erv ic e, s ol u tion or
s of tw are c apabil ity prov ided by a th ird
party and testing it frequently. Financial
s erv ic es organiz ations are al s o bu il ding
c y ber “ f u s ion c enters ” c ompris ed of
operations , I T and produ c t dev el opment to
better integrate teams arou nd s ec u rity and
allow for more efficient and faster threat
awareness and mitigation. Finally, financial
services firms are protecting the most
v al u abl e, s ens itiv e and regu l ated data by
l imiting its v al u e. T h e u s e of tok eniz ation,
c h ip c ards and oth er s ol u tions , f or
ins tanc e, w il l inc reas ingl y render s tol en
debit c ard P I N s u s el es s to h ac k ers . 5. 3
New horizons: the executive briefings collection | September 2016 edition
From the utilities industry
• Sh are inf ormation ex ternal l y . C ompanies
need to engage w ith ex ternal parties ,
s u c h as peer c ompanies , gov ernment
agenc ies , s u c h as H omel and Sec u rity
and the FBI, or sector-specific
I nf ormation Sh aring and A nal y s is
C enters . B y s h aring inf ormation and
l eading prac tic es , w e c an al l improv e
ou r u nders tanding of ev ol v ing th reats ,
new tools and techniques. External
aw arenes s and c ol l aboration are
c ritic al l y important. 5. 4
• E s tabl is h a s ec u rity minds et: s ec u rity is
everyone’s job, and it’s important that all
empl oy ees u nders tand both ph y s ic al and
c y bers ec u rity ris k s . J u s t as important
as h ow th ey go abou t th eir w ork is th e
w il l ingnes s to s peak u p w h en th ey notic e
s ometh ing s u s pic iou s . T h is c ou l d be
s omeone beh av ing u nu s u al l y at a w ork
l oc ation, s u bs tation or pl ant; a dev ic e
c onnec ted to a netw ork th at s h ou l dn’ t
be th ere; or an empl oy ee in a bu il ding
th ey s h ou l dn’ t be in. E mpl oy ees need
to be w il l ing to “ s ee s ometh ing, s ay
s ometh ing. ” 5. 5
B rief x | T itl e
6.
Getting true value from big data
A l th ou gh big data is on th e v erge of bec oming a meaningl es s c atc h ph ras e,
th e idea beh ind it is v al id, promis ing and ev en nec es s ary . T h e bas ic idea is
to h arnes s th e u nprec edented ex pl os ion in th e v ol u me, v ariety and v el oc ity
of h eal th data ( el ec tronic h eal th rec ords , pay er c l aims data, real - time
inf ormation generated by mobil e h eal th tec h nol ogies , etc . ) to h el p s ol v e th e
v ery real probl ems f ac ing th e indu s try .
A w el l - managed, more robu s t c ol l ec tiv e of data c ou l d be u s ed to:
• I dentif y and rew ard th e mos t ef f ec tiv e h eal th interv entions , th e c ritic al f ou ndation of
th e mov e to pay f or perf ormanc e
• Better understand how behavioral and environmental factors influence health
ou tc omes , w h ic h is v ital f or s temming th e ris ing tide of c h ronic dis eas e c os ts
• U l timatel y h el p ac h iev e th e magic bu l l et — predic tiv e and pres c riptiv e anal y tic s
T h e h eal th indu s try is on th e path tow ard th es e ou tc omes , and w h il e progres s is s tepw is e
versus exponential, organizations may benefit from learning a few key insights.
page 24
New horizons: the executive briefings collection | September 2016 edition
6. | G etting tru e v al u e f rom big data
Insight
The value is in the collective –
but first be sure your data is good
T h e potential of big data l ies in c onnec ting
dots betw een and ac ros s dif f erent data
s treams , anal y z ing th e l arger data s et f or
trends and patterns — by age, gender, il l nes s
ty pe and a h os t of oth er f ac tors — to begin
s ol v ing th e h eal th is s u es pos ed by c h ronic
dis eas e. T h is means th at th e w ork tru l y
begins w ith c ons ol idating data, bu t not
bef ore y ou v al idate th at th e data y ou ’ re
using is good. How do you ensure quality
data and ac c u rate bu il ding of th es e data
s ets ? W e are s eeing organiz ations f ac e th e
f ol l ow ing data c h al l enges :
• It’s coming from everywhere.
T h e f ragmented and l oc al iz ed natu re of
h eal th c are del iv ery means a dif f u s ed
del iv ery of data. O rganiz ations are
c h al l enged to integrate imaging data,
data pu l l ed f rom narrativ e s u mmaries
( doc tors ’ notes ) , I C D c odes , s onograms ,
bl ood tes t v al u es , path ol ogy reports and
oth er s ou rc es . T h is w il l get ev en mu rk ier
as w e begin to s ee th e c ons ol idation of
mobil e h eal th data f rom w earabl es ,
apps and dev ic es inc l u ding non- h eal th
data, s u c h as s pending patterns or
c redit h is tory .
page 25
• There is more of it.
T h e adv ent of el ec tronic rec ords means
th at entities are deal ing w ith mu c h
l arger v ol u mes of data, of ten in div ers e
and dis s imil ar f ormats and inc l u ding
s tru c tu red and u ns tru c tu red data. J u s t
w ith in th e h eal th s pac e, th e ty pes and
v ol u mes of data are grow ing.
• It’s not clean and pristine.
A l th ou gh it may s eem obv iou s , any
data inc ons is tenc ies at th e s tart c ou l d
s k ew anal y s es and produ c e s pu riou s
findings all along the way. For instance,
a du pl ic ate rec ord f or one patient w ith
tw o dif f erent name u s ages ( s u c h as M ary
J ane H iggins and M ary J . H iggins ) w il l
s k ew any data s et by c ou nting th is as tw o
v ers u s one. T h e impac t of bad data is onl y
c ompou nded w h en c ombining data s ets ,
and de-identified data only makes matters
more c ompl ic ated.
O rganiz ations are s l ow l y ris ing to th e
c h al l enge, es pec ial l y w ith th e grow ing
real iz ation th at data is a h igh l y v al u ed
as s et. I ndeed, th e bu s ines s model s of
many new digital h eal th s tart- u ps are
bas ed on monetiz ing data. L eading
prac tic es to c aptu re, c l ean and c ons ol idate
th e data inc l u de:
• U s ing mas ter data management to
remov e inc ons is tenc ies , w h ic h is pos s ibl e
now th at organiz ations h av e to ac c es s
l arge v ol u mes of inf ormation f rom
mu l tipl e s ou rc es
• C aref u l l y index ing and tagging th e data to
help ensure data quality is high
• F oc u s ing on s u bpopu l ations — f or
ins tanc e, by identif y ing pos tal c odes or
metropol itan s tatis tic al areas w h ere l arge
perc entages of indiv idu al s are at ris k
• Setting u p th e s tru c tu ral rel ations h ips
between different fields that provide
c ontex t and al l ow f or ric h er anal y s is
• Storing it in databas es th at are
interoperabl e, al l ow ing f or data to be
c ombined in a w ay th at c onnec tions are
transparent and flexible
I n s ome c as es , c ons ortiu m- bas ed data
s h aring or h av ing a th ird party h ou s e th e
data is th e bes t rou te. T h es e th ird parties
de- identif y th e data u s ing readil y av ail abl e
v ariabl es f rom dif f erent s ou rc es and add it
to th e c entral repos itory .
E x is ting and new c h al l enges inc l u de:
• Ongoing concerns about privacy and
data uses – I n many mark ets , priv ac y
regu l ations , s u c h as H I P A A ( H eal th
Figure 6.1:
The four V’s 6. 1
•
•
•
•
•
•
•
•
Click stream
Active/passive sensor
Log
Event
Printed corpus
Speech
Social media
Traditional
• Speed of
generation
• Rate of analysis
Volume
• Unstructured
• Semi-structured
• Structured
Big
data
Velocity
New horizons: the executive briefings collection | September 2016 edition
Variety
Veracity
• Untrusted
• Uncleansed
6. | G etting tru e v al u e f rom big data
I ns u ranc e P ortabil ity and A c c ou ntabil ity
Act), strictly limit data sharing or require
h eal th c are entities to remov e patient
identifier information before data is
shared. Despite de-identification, trust is
of ten a k ey is s u e among patients . P eopl e
w ant to k now th at th eir data is priv ate
and are beginning to question how the
c ol l ec tiv e data w il l be u s ed. W h il e many
c ons u mers u nders tand th e potential
f or prec is ion medic ine, th ey are al s o
c onc erned th is c ou l d l ead to dif f erential
f ees f or h eal th s erv ic es .
• Balancing compliance with access to
collective data – O rganiz ations of ten
ov er- c ompl y w ith priv ac y l aw s . W h il e
easing up to find the right balance,
organiz ations s til l h av e a tendenc y to
be ov erl y c ons erv ativ e abou t s h aring
even de-identified information — and run
the risk of de-identification to the point
w h ere c ombining data f or meaningf u l
anal y s is is impos s ibl e.
• Managing new concerns about data
sharing – A n emerging bl ac k mark et f or
c ol l ec tiv e data ( s ee E Y th ou gh t l eaders h ip
piec e, N av igating th e bu l l bl ac k mark et)
means th at organiz ations are bec oming
ev en more c irc u ms pec t abou t w h en and
h ow th ey s h are data. T h is c ou l d s l ow
anal y tic s progres s .
page 26
Insight
Findings are only as good as your
analytics and algorithms
E v en as s u ming th e data is c l ean, big data
doesn’t analyze itself. In fact, it requires
more c are and h u man interv ention th an
s tatis tic al anal y s is of s mal l er data s ets .
W ith v as t v ol u mes of data and l arge
nu mbers of independent v ariabl es , th e
likelihood of finding spurious correlations
inc reas es s h arpl y . O u tl iers c an s k ew res u l ts ,
and al gorith ms , l ef t u nattended, c an ru n
w il d. T h e s ol u tion to better anal y tic s is to
bring togeth er th e bes t of mac h ine l earning
and h u man ov ers igh t. T oday ’ s anal y tic al
techniques use algorithms that:
• Are designed by data scientists using
large amounts of medical knowledge and
context. A l gorith ms h av e tremendou s
k now l edge bu il t into th em abou t
s y mptoms , dis eas e progres s ion, c omorbidities , dru g interac tions and more.
• Aren’t static. Through the use of artificial
intel l igenc e and mac h ine l earning,
algorithms now adjust over time, in
res pons e to new data and c h anging
c onditions . H u man anal y s ts ru n real ity
c h ec k s on al gorith ms as th ey ev ol v e and
can nip spurious findings in the bud.
New horizons: the executive briefings collection | September 2016 edition
6. | G etting tru e v al u e f rom big data
Insight
Leveraging big data requires
focus and flexibility
H eal th entities are operating in a s pac e
that is constantly in flux, as organizations
enter and ex it partners h ips , w ork w ith new
s ou rc es of data and res pond to c h anges
in inf ormation tec h nol ogy ( I T ) s tandards
and capabilities. The question facing
organiz ations is : h ow do y ou bu il d a h eal th
analytics architecture that is both flexible
and scalable? The major challenges include:
• Slow rate of change is a huge barrier.
H eal th ev ol v es at a gl ac ial pac e, w ith
h eal th I T inv es tments of ten tak ing month s
or ev en y ears to impl ement. T h e w orl d
of data anal y tic s mov es mu c h f as ter,
f ol l ow ing th e rapid pac e of c h ange f or
tec h nol ogy s tandards and pl atf orms .
G iv en th at h eal th entities in many mark ets
are also undergoing major reforms in their
s tru c tu res and operations , organiz ations
run a very real risk that an IT project is
obs ol ete by th e time it is c ompl eted.
• Analytics is not a core competency for
health. Data analytics requires complex
s k il l s , s pec ial iz ed k now l edge and deep
ex perienc e th at many in h eal th c are l ac k .
page 27
Questions to consider
How to proceed?
A s trategic approac h to h eal th anal y tic s
inv ol v es th ree el ements :
• Accepting the new reality: analytics is a
must-have for organizations – A nal y tic s
c apabil ities are both nec es s ary and
ongoing. This is not just a one-time
inv es tment, and organiz ations need to be
s mart and s trategic abou t w h at to bu il d —
to addres s w h at is needed now and w h at
is arou nd th e c orner.
• Getting a clear focus – H eal th
organiz ations need an ac tiv e data
anal y tic s pl an and approac h . T h is is a new
ef f ort f or mos t in th e indu s try . F u rth er,
since analytics requires complex skills
and l arge inv es tments , th e bes t path is
to identif y and f oc u s on c aptu ring and
anal y z ing data onl y f or h eal th f u nc tions
th at are tru e c ore c ompetenc ies , not f or
ev ery ac tiv ity or proc edu re.
• Building in flexibility – T o av oid th e pitf al l s
of traditional long-term IT projects (risk
of obs ol es c enc e bef ore impl ementation) ,
h eal th organiz ations need a dif f erent
model . A more nimbl e, s c al abl e and
res pons iv e data anal y tic s s tru c tu re and
approac h are nec es s ary to k eep u p w ith
rapidl y c h anging tec h nol ogy and an ev erc h anging bu s ines s env ironment.
Organizations are asking questions around big data, including:
Before I even start to think about answering larger questions,
what could I do to ensure my data is good and reliable?
How do I build a health care analytics architecture that is both
flexible and scalable?
What are the skill sets my organization needs to understand
both the analytics and the medicine?
What are the top five patient outcomes we could positively
impact with the right collective data sets?
How do we start now to build the right relationships and data
sets to get there?
What fail-safe measures do we need to ensure our data is
protected from a security breach?
What does the future look like for our organization if we could
really answer the big questions with big data?
New horizons: the executive briefings collection | September 2016 edition
B rief x | T itl e
EY Global
Health Sector
Leadership team
biographies
Jacques Mulder
EY Global Health Sector Leader
[email protected]
EY’s mobile-friendly site
for health executives
H av e y ou v is ited E Y H eal th R eimagined B l og?
F or one- s top ac c es s to E Y ’ s breadth of
material s pu bl is h ed rel ev ant to th e h eal th
s ec tor — reports , res earc h , artic l es , gu es t
pers pec tiv es , bl og pos ts , pres entations ,
inf ograph ic s , s u rv ey s , c h arts and anal y s is —
v is it H eal th R eimagined.
Browse the easy-to-use navigation to quickly
find the latest insights and perspectives on the
topic s mos t important to ex ec u tiv es in today ’ s
c ompl ex and ev ol v ing h eal th ec os y s tem.
W h il e v is iting H eal th R eimagined, c l ic k on
“ s u bs c ribe” to rec eiv e onc e- a- w eek email al erts
( eA l erts ) w h en new pu bl ic ations are pos ted on
H eal th R eimagined.
Jacques is the Global and United States Health Sector Leader for EY. He leads teams around
th e gl obe h el ping c l ients s trategic al l y addres s th e trans f ormational f orc es s h aping th e
h eal th indu s try . H e is res pons ibl e f or grow ing th e E Y peopl e, netw ork s , and c apabil ities in
the Health sector, and for developing industry-specific solutions and thought leadership.
For over 20 years, Jacques has helped some of the world’s leading companies undergo
dramatic , s trategic trans f ormations and gl obal ex pans ions , ov erc oming c ritic al mark et and
business challenges and guiding them toward growth. In his various roles with EY, Jacques
has developed service offerings to solve clients’ growth issues, identified key emerging
bu s ines s model s th at w ork ac ros s c onv ergent s ec tors , and brou gh t grou nd- break ing
innov ations and s trategies to top l if e s c ienc es , h eal th c are and c ons u mer produ c t c l ients .
ey . c om/ H eal th R eB l og
page 28
New horizons: the executive briefings collection | September 2016 edition
B rief x | T itl e
Jim Costanzo
David Copley
Gregg Slager
Petr Medvedev
EY Global Health Advisory Leader
EY Global Health Assurance Leader
EY Global Health TAS Leader
EY Global Health Tax Leader
[email protected]
[email protected]
[email protected]
[email protected]
J im C os tanz o is th e G l obal H eal th A dv is ory
Serv ic e L ine L eader f or E Y . H e h as ov er 32
y ears of ex perienc e in th e h eal th c are and h eal th
ins u ranc e indu s tries , w ork ing w ith s ev eral of th e
l arges t and mos t c ompl ex c l ients . H e h as w ork ed
on projects developing full lifecycle systems,
c apac ity pl anning, operations and l arge s c al e
bu s ines s trans f ormation f or al l as pec ts of h eal th
pl an organiz ations . J im h as ex tens iv e ex perienc e
managing th e des ign, dev el opment and
ins tal l ation of th e indu s try ’ s l eading managed
h eal th c are pac k ages , w ith as pec ts inc l u ding
claim adjudication, membership, billing, ID cards,
coordination of benefits, provider, capitation,
dental and explanation of benefits.
D av id C opl ey is th e G l obal H eal th A s s u ranc e
L eader f or E Y . H e brings ov er 30 y ears of
ex perienc e in th e h eal th c are indu s try , w ork ing
w ith integrated h eal th c are
organiz ations , ac ademic medic al c enters ,
ph y s ic ian grou ps , managed c are and c ompl ex
pay ment model s , l if e s c ienc es and oth er
organiz ations . D av id’ s ex tens iv e ex perienc e
inc l u des h el ping h eal th c are organiz ations
and emerging c ompanies th rou gh v ariou s
trans ac tions , inc l u ding initial pu bl ic of f erings
( I P O s ) , tax - ex empt bond of f erings , mergers and
acquisitions, and international expansion. He has
s erv ed as c oordinating partner f or s ev eral pu bl ic
c ompanies th at h av e s u c c es s f u l l y impl emented
al l as pec ts of Sarbanes - O x l ey ( SO X ) .
G regg Sl ager is th e G l obal H eal th T rans ac tion
A dv is ory Serv ic es ( T A S) L eader f or E Y . G regg h as
ov er 25 y ears of ex perienc e adv is ing c ompanies
on trans ac tions , and h as managed or partic ipated
in approx imatel y 500 engagements f or c orporate
and nonprofit acquirers, private equity clients and
inv es tor grou ps .
P etr is G l obal T ax L eader of th e G ov ernment,
P u bl ic and H eal th Sec tor f or E Y . P etr h as deep
ex perienc e w ith both priv ate and pu bl ic s ec tor
is s u es , in traditional is s u es , as w el l as emerging
is s u es s u c h as l oc ation of intel l ec tu al property
righ ts , l egal treatment of c ros s - border medic al
data trans f ers , pers onal tax and s oc ial s ec u rity
l iabil ities of mobil e pers onnel , etc . H e h as been
prac tic ing tax f or more th an 23 y ears , and l ed
th e E Y T ax and L aw prac tic e in th e C I S ou t of
M os c ow prior to mov ing to G l obal E Y team. H e
h ol ds a degree in T ax ation and a M as ter’ s degree
in Economics and is fluent in Russian, English
and F renc h .
page 29
His focus area is financial and accounting due
dil igenc e, and h e h as ex perienc e w ork ing w ith
v irtu al l y al l ty pes of h eal th c are organiz ations —
inc l u ding h os pital s y s tems and s pec ial ty
h os pital s , managed c are organiz ations ,
ph y s ic ian prac tic es , ambu l atory s u rgery
c enters , l ong- term c are f ac il ities , h ome h eal th ,
pharmacy benefits management, diagnostics,
ph armac eu tic al manu f ac tu rers and oth er h eal th
c are rel ated entities .
New horizons: the executive briefings collection | September 2016 edition
B rief x | T itl e
Attribution
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New horizons: the executive briefings collection | September 2016 edition
ssets
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New horizons: the executive briefings collection | September 2016 edition
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E Y | A s s u ranc e | T ax | T rans ac tions | A dv is ory
About EY
E Y is a gl obal l eader in as s u ranc e, tax , trans ac tion and adv is ory
services. The insights and quality services we deliver help build trust and
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of ou r s tak eh ol ders . I n s o doing, w e pl ay a c ritic al rol e in bu il ding a better
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by gu arantee, does not prov ide s erv ic es to c l ients . F or more inf ormation
abou t ou r organiz ation, pl eas e v is it ey . c om.
©
2016 E Y G M L imited.
A l l R igh ts R es erv ed.
E Y G no. 02966- 164G B L
C SG no. 1608- 2013827
E D N one
T h is material h as been prepared f or general inf ormational pu rpos es onl y and is not intended to
be rel ied u pon as ac c ou nting, tax or oth er prof es s ional adv ic e. P l eas e ref er to y ou r adv is ors f or
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