Why Healthcare Payers and Providers Must Embrace Pervasive GRC

Multiple strict laws and regulations make Governance, Risk, and Compliance (GRC) a major concern for both healthcare providers and payers. Adopting agile, intuitive, and robust GRC solutions can go a long way toward achieving superior growth and performance.

 

The Current State of Healthcare Compliance

The healthcare industry is constantly under pressure to manage multiple compliance mandates be it HIPAA, HITECH, NAIC MAR, JCAHO, CMS or SOX - while also ensuring that patients receive the required health services with maximum ease. The ability to balance these demands effectively is imperative for healthcare organizations to survive and thrive in the competitive market today.

Despite companies’ best intentions and compliance measures, hundreds of breaches are recorded every year. At the 1U.S. Department of Health and Human Services, more than 300 breaches were reported in FY2016, covering theft or hacking of more than 114 million patient records. The matter only gets more complicated as new technologies such as cross-channel communication and cloud storage of patient records bring in their own security threats.

 

Major Compliance Challenges for Healthcare Payers and Providers

²HIPAA compliance audits are set to resume later this year targeting both data breaches as well as consumer complaints. Healthcare organizations will have to consolidate and sift through vast swathes of organizational data to be prepared for the audits.

Meanwhile, consumers are demanding seamless communication and access to information on their mobile devices. While mobility, no doubt, enhances the speed and transparency of services and reporting, it also increases the risk of data breaches, and makes it necessary for both providers and payers to build a robust security and compliance management system.

Further, with the 3 Medicare and Medicaid Electronic Health Records Incentive Program, the challenge for healthcare providers is maintaining EHRs (Electronic Health Records) in a user-friendly, yet fully compliant manner, and demonstrating that patients are using the system.

 

How Does the Healthcare Industry Manage Compliance Challenges: Diagnosis

The healthcare industry has its hands full, as it grapples with lengthy and exhaustive audits, while struggling to comply with the ever-evolving range of regulations. Let’s take a closer look at these challenges inside a payer organization:

Healthcare payers fight a four-pronged battle – keeping members satisfied, managing providers’ demands, fighting off stiff competition in the market, and above all, ensuring that regulators don’t find them falling short on compliance. Of all the battles being fought, one of the most critical ones is ensuring adherence to regulations and compliance standards, as the lack of that can cost organizations dearly, both in terms of finances and reputation.

And now let’s peek into the provider organization:

The scene is not very different here either. The primary job of the healthcare providers is to ensure that the masses remain healthy. However, many find the task of keeping both the masses and their records healthy, a bit strenuous, to say the least. Challenges include siloed departments, scattered records insufficient data visibility, and growing compliance requirements.

Healthcare payers and providers would do well to build a clear set of processes for GRC, and manage them form a single point of reference. Organizational silos not only hinder the flow of information, but also create redundancies across various GRC initiatives which, in turn, add to the costs of software, hardware, training, and roll-outs. These redundancies can be easily eliminated by integrating multiple GRC initiatives in one integrated technology solution that provides a single version of the truth, and can be made available to employees, management, auditors, and regulatory bodies, anytime, anywhere. 

 

What Does the Healthcare Industry Need?

At the turn of the century, a few standalone point solutions for compliance, risk and audit management were sufficient for GRC. However, by 2010, the concept of integrated GRC arrived, and included third-party risk management, regulatory compliance, and policy management, as well as IT GRC and security risk management.

Today the risk landscape has evolved even further, requiring a solution that can help organizations address a wider range of requirements related to risk management, compliance and audits, third-party governance, legal GRC, and much more. In short, an extensive, in-depth and prevasive GRC solution is the need of the hour.

Moving to prevasive GRC is important, and the first step in that direction is to have a robust strategy that helps healthcare organizations build a risk-intelligehelps healthcare organizations build a risk-intelligent enterprise. Technology can be a valuable enabler of this strategy. A truly unifying and pervasive GRC technology can help organizations build a centralized and transparent GRC ecosystem. It can support an enterprise-wide culture of GRC awareness and accountability by enabling and empowering each employee and business function to manage their risk and compliance responsibilities independently, while simultaneously rolling up data from across the enterprise to provide a complete top-level GRC perspective.

 

Adopting Pervasive GRC: A Business Imperative

Technology can be an organization’s biggest friend and foe. While the increasing adoption of big data, IoT, and the cloud has increased the reach and impact of healthcare, it has brought in new risks and vulnerabilities in its wake. Managing security and keeping the organization compliant and risk-intelligent is a continuous process that needs an expert hand. This is where an automated and pervasive GRC solution can help. However, choosing the right solution is critical because organizations need to not only manage their current risks, but also emerging risks.

Many visionary healthcare organizations are investing in cutting-edge GRC solutions that are highly flexible and scalable. They are also banking on experts with rich regulatory content to align to the emerging landscape better. 

While the practice of GRC is common across industries, the requirements of each vertical are very different. Particularly in the highly regulated healthcare industry, it helps to have domain experts to manage GRC, instead of a general practitioner. It is also essential to be technologically savvy, and invest in future-ready, configurable technology such as GRC mobile apps and a GRC cloud. 

Rules and regulations issued by governments, health authorities, and various industry bodies are meant to be a precaution against major threats. Being ready to embrace these requirements with a strong and pervasive GRC solution is essential for the healthcare industry to remain safe, sound, and healthy.