Introducing EY’s Health Care Advisory Sector

1 Introducing EY's Health care Advisory Sector Uncertain ground The Health care environment is constantly changing The Health care landscape is constantly evolving, and even the most nimble executives are struggling to keep their balance as the ground shifts under their feet. Some of the forces transforming the landscape include: Innovation and competition require changes in how Health plans and providers define, drive and prove value. Social media enables closer interaction with consumers. Complex regulatory requirements challenge long-term decision-making. Unprecedented amounts of clinical and financial data must be analyzed and shared quickly and transparently.

2 Market challenges are driving consolidation and vertical integration strategies at an unprecedented rate. Payers and providers must accelerate the rate at which their technology matures and the rate at which they implement technology. Population Health management and associated outcomes will dictate reimbursement models and inform product performance. These forces are making Health care organizations take a more proactive, structured approach to their business performance efforts. We help clients respond to these transformative forces in innovative ways that help them protect their businesses, grow revenues and optimize processes.

3 Page 2. Innovation is key Grow Protect Is our growth strategy How do we influence patient-centric? regulatory reform to protect Where do we invest to our business? improve competitive position Innovate How do we balance the cost in the evolving Health care of compliance with the market? demand of regulatory needs? Which emerging markets How do we maintain or present the best opportunities improve compliance as the for our competencies? regulatory environment What is our mergers and becomes more complex? acquisition strategy to grow How do we respond to and market share and margins? act on daunting volumes of How can we plan for data?

4 Outcome-based service Do we have a comprehensive delivery and payment enterprise risk plan? models? Optimize Do we have the information we need to evaluate the effectiveness and efficiency of our company activities? How can we more effectively capture and share data with patients and providers to improve care ? Are we nimble enough to adopt new business models and technologies as they evolve? Are we positioned to deliver and manage care in an efficient and cost-effective way? How will new technologies influence the industry, and how can we stay at the front of those movements? Page 3. Industry issues Thriving through Transforming changing Health care regulation Improving Attacking operations Health care costs We draw on our broad experience and deep knowledge of the Health care industry to help clients address each of these issues from the standpoint of organization, people, technology, process and metrics.

5 Page 4. Thriving Transforming Health care through Transforming changing Health care regulation Improving Attacking operations Health care costs The shift from volume-based to outcomes-based Capabilities include: focus requires new contracting and incentive Payer-provider collaborative care models strategies to align performance and behaviors. Contracting and incentive models Population Health management New payment structures and quality measurements Change management will drive the industry to optimize electronic medical Program management records and reporting capabilities to allow Physician/clinician engagement participation in collaborative care models.

6 Strategies Clinical systems interoperability We help our clients: Clinical research office development Accelerate their transition to a data-driven, outcomes- Clinical decision support based environment Service performance measurement Craft appropriate merger and acquisition strategy Performance measurement and reporting Build integrated and comprehensive e- Health services Ventures, alliances and partnerships Build mutually beneficial payer-provider contracting Strategic digital transformation models that reward outcomes and promote value versus volume Page 5. Thriving Thriving through changing regulation through Transforming changing Health care regulation Improving Attacking operations Health care costs Regulations aimed at sunsetting certain products Capabilities include: and practices will force new compliance strategies Impact analysis and road-mapping (ICD-10, 5010).

7 And operating models. ICD-10 remediation ICD-10 post-implementation New compliance models require assessing the optimization balance between the cost of compliance and the Cost and quality reporting demand of regulatory needs and organizations. Health care reform reporting Reimbursement capture We help our clients: Health insurance exchanges Master a new set of standards for increased information Medical loss ratio (MLR) compliance flow Customer Relationship Devote greater attention to patient information security Management Billing, coding and compliance and privacy HIPAA privacy and security Craft a holistic strategy to enable enterprise compliance Regulatory and billing compliance activities Enterprise risk mapping and mitigation planning Page 6.

8 Thriving Improving operations through Transforming changing Health care regulation Improving Attacking operations Health care costs The digital Health communities demand new ways to Capabilities include: capture and share information across IT platforms and Information management organization and process design organizations. Large program and multi-phase implementations Reporting requirements and Health information System and business portfolio exchange needs are becoming more stringent with management new payment models and meaningful use criteria. Provider Health information systems Payer core administration systems Population Health strategies demand a new way of Health care metrics and measures doing business.

9 Health information integration and exchange We help our clients: Pay-for-performance programs Fraud and abuse surveillance Implement effective processes to capture, use, share and Data governance report data Incentivize care being delivered in the most optimal environment Promote matching of demand and capacity in high-cost environments Page 7. Thriving Improving operations through Transforming changing Health care regulation Improving Attacking operations Health care costs Reimbursement changes will force payers and Capabilities include: providers to re-examine the mix and sustainability of Transaction processing their core programs and services.

10 Workflow and workforce management and automation support Insurance coverage expansion introduces significant Process benchmarking and design new risk in acquiring new patients and servicing new Pricing strategy and transparency covered lives. Registration and scheduling Ancillary department management We help our clients: Demand/capacity analysis and Reassess their organizations from a customer-centric modeling point of view IT enablement Identify, analyze and manage emerging risks Government programs Engage members in new ways and incentivize desired Business scenario analysis behaviors Page 8. Thriving Attacking Health care costs through Transforming changing Health care regulation Improving Attacking operations Health care costs Mandated cost thresholds, new taxes and payment Capabilities include: reductions require that administrative cost structure Payment/reimbursement innovation and productivity standards reach the next level of IT strategy and planning efficiency.