Healthcare

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Protiviti's healthcare industry team helps payer and provider leaders make better decisions by managing the risks they face today, as well as illuminating the risks and unforeseen consequences inherent in their strategies for future growth and opportunity.

Healthcare is a strategic industry at Protiviti with dedicated professionals and a Healthcare Center of Excellence that is organized to innovate industry-specific solutions with a primary goal of becoming a mission-critical strategic partner to each of the organizations we serve.

 

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Whether the top concern is payment reform, regulatory compliance, improving margins, evaluating and safeguarding protected health information, leveraging new technology, or developing digital transformation strategies, Protiviti brings deep industry knowledge and skills to help healthcare organizations manage risks and maintain their financial health.

Our professionals have expertise across all healthcare ancillaries and delivery sectors, including physician operations and all acute and post-acute specialty areas through the project and advisory services we provide.

 

 

 

Our key industry-specific healthcare solutions are listed below:

Clinical Excellence

Clinical and operational performance is top of mind for healthcare systems and executives. Pressure is growing for organizations to lower costs, increase market share, improve clinical outcomes, and eliminate waste. Protiviti is your partner in designing innovative and effective solutions for improving operational efficiencies and clinical effectiveness. Our strategic roadmap design and tactical execution plans achieve and sustain results and incorporates Design Thinking, Lean, and Six Sigma methodologies.

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Digital & Advanced Analytics

Protiviti helps healthcare organizations make the promise of digital transformation a reality. We help organizations create a deep understanding of the risks and opportunities presented by emerging technologies and think creatively about how these technologies can be used to improve performance. Avenues of rapid transformation are driving the need for consistent innovation throughout health systems that strive for a competitive market presence. Protiviti supports our clients in recognizing and effectively responding to the need for consistent innovation through training, discovery and ideation workshops, prototyping, and implementation and execution. Whether leveraging artificial intelligence / machine learning to support advanced analytics, developing telehealth strategies or implementing intelligent automation/robotic process automation across the enterprise, we help deliver confidence and value across a wide range of digital innovation initiatives today and into the future.

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Enterprise Applications/ERP Modernization

How do you evaluate and select the right ERP system? What will it take and cost to implement? What approach should be utilized to ensure the system helps meet your strategic objectives? How do you do all of this and still keep your current operations going? How has COVID-19 impacted the organization’s plans, and what needs to get adjusted if you are leveraging a remote workforce? Protiviti can help you answer all these questions.

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Financial & Operational Performance

Performance & Operational Performance services increase enterprise value by transforming business processes and driving sustainable change. The best Finance, Revenue Cycle and Performance Management professionals deliver proven results in challenging environments by effectively leveraging technology and leading practices, using tested and proven program management techniques and capabilities, and bringing an intense focus on change management. Concurrently, Protiviti and Robert Half partner together to share the workload/burden with our clients to address performance or project issues in key business functions while also filling operational roles in a unique arrangement, using proven results-oriented professionals.

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Information Technology & Cybersecurity

Emerging technologies, an ever-evolving threat landscape and changing business models continue driving a shift in the role of IT in healthcare. Protiviti helps healthcare organizations design and implement advanced solutions in IT strategy, security/privacy, cloud, enterprise applications, data and analytics, as well as through custom software services.

Information Technology & Cybersecurity

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Healthcare Cybersecurity Services

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Innovation Services

Innovation is translating ideas into solutions that address your challenges and produces value. Protiviti Innovation Services enables you to design and implement new ideas that improve outcomes for people, processes and the overall delivery of healthcare services.  As part of our innovative culture, we leverage our deep healthcare expertise across internal audit, risk and compliance, clinical and operational excellence, security and privacy, data analytics and revenue cycle.  Our approach enables us to partner with you to find opportunities of innovation in all areas of your organization.

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Mergers & Acquisitions

Coming off a record year in 2019, M&A activity was expected to hold steady in 2020, surpassing nearly $2.0 trillion in deal volume. The arrival of COVID-19 has since brought unforeseen challenges to the market and forced organizations to shift their priorities as it pertains to transactions. However, healthcare cannot pause for the long-term, creating opportunities for large hospitals and health systems and Private Equity firms once hesitant to acquire are now see favorable opportunities and strategic opportunities in the market as valuations enter correction phases. Unprecedented times can seem daunting, and even threatening, however, with the right mindset and proper team in place, organizations can face the future with confidence.

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Next-Gen Internal Audit

Protiviti’s world-class internal audit (IA) services provide effective insight and confidence to leaders that their organizations can meet the demands of the ever-changing business environment.  Management is leveraging IA more than ever as a strategic resource to provide guidance based on broad and deep skill sets and perspectives; analytical and digital capabilities; and internal knowledge of operations, strategic goals, and risk and control structures.  Our IA services help ensure that healthcare organizations become more innovative and explore new technologies, identify and mitigate emerging risks, develop creative solutions to address complex business challenges, and encourages best practices to enhance business functions.

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Pandemic Response

Coronavirus disease 2019 (COVID-19) continues to expand its global impact on individuals, businesses, communities, and governments. We understand the resource and operational burden in meeting a wave of demand, changing regulatory requirements, and stimulus legislation (e.g., CARES Act). Protiviti stands ready to assist with implementing and leading COVID-19 Response Teams to assist with risk mitigation across a variety of areas and to organize Board communications and education. We are well positioned to provide top tier talented interim resources to fill vacancies and to manage critical tasks to ensure financial health during the pandemic.

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Payer Operations

Protiviti’s payer operations specialize in assisting health plans, dental & vision plans, and PBMs operationalize and execute solutions to enhance business performance and drive sustainable growth.

Whether we are assisting with process improvements, strategic planning, or design initiatives, we apply innovation, collaboration, and technology acumen across your organization.

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Revenue Integrity

It is imperative for today’s healthcare providers to maximize the revenue received for the services they provide. Ineffective internal controls for key revenue cycle processes can affect net revenue by as much as five percent on average annually. Protiviti’s revenue integrity solutions help organizations prepare for payment reform and enhance revenues and margins by improving strategy, processes and system controls. Improvements include charge master accuracy, enhanced charge capture, cash acceleration, reduced denials, identified reimbursement variances, reduced write-offs, increased patient satisfaction, enhanced compliance, and overall optimized revenue cycle performance.

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Risk & Compliance

Protiviti provides solutions to help providers ensure they have a robust, effective compliance program to prevent and detect instances and events of legal and regulatory violations.  Key areas of expertise include the following:

  • Compliance Program Effectiveness, Assessment & Remediation
  • Compliance Risk Assessments
  • Independent Review Organization
  • Interim Compliance Officer / Supplemental Staffing
  • Compliance Projects, Audits & Investigations
  • Enterprise Risk Management

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