Group Assignment Group AssignmentWill post update tonight - 5/12/2019 @ 9:00 pm. Please see your email from this afternoon for updates.  Group Assignment TopicsGROUP 2 – Healthcare Payer (i.e. Anthem

Group # 2

Topic Area: Healthcare payer

DIRRECTIONS: Answer these seven questions as best as you can using peer-reviewed literature, well respected news sources (New York Times, Washington Post), textbooks, government cited articles etc. You cannot use blog postings, wiki postings, or Websites unless they are from an authoritative source

Helpful hint:

This assignment is a stepping stone to begin your research towards your final paper. I HIGHLY suggest you look at the requirements for TEAM ASSIGNMENT #3 each time you complete an assignment to try and capture as much as you can in your work. This will help enrich your response a great deal. You should also save many of the references you use for this assignment for Team Assignment #2 as this will likely save you time for the annotated bibliography!

Who are the key industry players that raise a red flag in your industry segment? Why?

Key Industry players in the HealthCare payer industry are Government, American Medical Association (AMA) United states Food and Drug administration (FDA) and Providers like Athena, United health Care. These are the key Players in Healthcare Industry that raise red flags. Government using both Executive and Congressional Privileges uses its authority to Regulate the Policies. American medical association plays an important role in the Policy making for the Health care for Congress. Food and drug administration is one of the federal executive departments that raises red flags and Regulates the Industry. Larger Healthcare providers like Athena, united Healthcare and Anthem use their Lobbying Power to regulate the Healthcare Payer Industry.

Why is this industry causing disruption? Cite 3-5 explicit examples.

An article written in Forbes by Murphy and Jain (2018) and a group of researchers from Journal of Medical Internet Research (2018) mentioned that The Amazon effect, the digital revolution, regulatory changes, consumerism and personalized medicine are causing disrupters in the Healthcare. As chief technology giants like Chase, Amazon and Berkshire Hathaway announced their plans to establish firms to provide healthcare to their workers. When the disruptive potential of these giants was evaluated it was found that the modern technology expertise of these organizations, can bear competitors in areas of focus like pharma distribution, retail clinic and insurance. PE (Private Equity) funds are aware that category these giants are in good position to invest in, and get profited from, if their industries have a good grip of the digital technology world.

Kalis and Trulsen (n.d.) and Sarasohn-Kahn (2018) explained that the other reason of the disruption are the patients. After a long fight with minimum options they had about getting their care, patients now have choices of picking the healthcare model most suitable to them and also comprises of telemedicine, home health, concierge care and online assistance. Hence, the PF funds are making good use of such healthcare domain industrialization by participating in HCIT and medical devices makers that help in remote care and home care services.

When you conduct an internet search on your topic pertaining to regulatory and compliance issues, what are some of the key regulatory and compliance issues in your business area of concern?

The key regulatory and compliance issues in my business area of concern comprise of; safety; this one of the main regulatory in my industry of concern as it applies in the healthcare industry in general. The second key compliance issues in my business of concern are the privacy of clients information; the business is supposed to ensure that all the client's information is kept private and confidential. The last regulatory issue which affects my business is billing practices; this is meant to ensure that no complaints from clients (Boaden,2017).

Has the federal, state, or local government had to develop specific law or develop measures of compliance to protect citizens and businesses from harm?

Rights Act of 1871, this law is known as Section 1983. It specifically prohibits anyone acting under the authority of the law from violating another person's civil rights under the U.S. Constitution. To run a smooth business, Federal Trade Commission's mission has introduced fair trade law is to promote competition and protect consumers from unfair, fraudulent practices in the marketplace. Us federal law has regulated data protection consumer privacy on a sectoral basis, focusing on financial services and health are of individual. The federal government has developed a law known as privacy law, which is meant to protect the citizens from harm and their privacy. In general, the law protects citizen's information from being shared to another person.

Evaluate 5-10 Internet Website Privacy Statements for the industry you have been given. Do you see a trend on the type of data that the vendor is concerned about? If so, please state what is the most evident in the statements?

Internet Website Privacy Statements for the industry are mostly on website, in emails, text, and other electronic messages, third party website Internet advertising, operate any web site are personally identifier like Name, postal address emails address, telephone number etc. when we provide our personal information may use that information to service account and send News Send information related to production service. That information will be provided for the companies. We may disclose our personal limited to, billing Services providers. We should not sell personal

Information to third party Provide certain usage information helps with relevant advertising. Information which you provide us in website may filling the form on the website is information provide by filling the form and information at time of requesting information. When enter the information they also ask us for promotion. Correspondence may record and copies. The surveys say that might ask the complete for research. Queries may available in the website. Data collect from the Automatic Data collection technologies.

1. Encrypt your data.

2. Anti-malware protection is a must.

3. Automate your software updates.

4. Use a firewall.

5. Disable file and media sharing if you don't need it.

6. Don't forget to delete old files from cloud backups.

7. Take care of privacy settings immediately upon setup.

How does/has your industry handled its last major data breach? Which legal mechanism is most relevant to your industry of concern?

Last major Data breach in the Health care Industry has occurred in end of 2018 where Acccu Doc Solution Inc. A provider of Healthcare Payer billing services has experienced a Major data Breach where records of almost 2.8 million users has been exposed. It has stated that no PHI was downloaded, and the data was view only. ACCU DOC solution stated that the issue has caused because of a security vulnerability on a third-party vendor network to which it has ended ties with. Accu Doc has taken necessary steps to block the Hackers and enhanced their securities to prevent future attacks. They also notified the users whose data has been compromised along with their SSN numbers. It is also helping with credit monitoring services for the users. Health Law is the Legal mechanism that is relevant to Health care Payer industry.

What does literature and your research suggest about how the industry will need to deal with the regulatory concerns over time?

Various researches suggest that the industry can deal with regulatory concerns by ensuring that only qualified personnel is deployed in the industry to enhance privacy. They have also suggested that the industry can deal with regulatory concerns through ensuring that the industry has a strong backup, which can be used in the event of a data breach.

References

https://www.ama-assn.org/about-us/ampac - AMA

https://cdn1.sph.harvard.edu/wp-content/uploads/sites/114/2012/10/rp146.pdf - Harvard

https://www2.deloitte.com/us/en/pages/life-sciences-and-health-care/articles/us-and-global-health-care-industry-trends-outlook.html - Deloitte

Murpy, K., & Jain, N. (2018, May 01). Riding The Disruption Wave In Healthcare. Retrieved from https://www.forbes.com/sites/baininsights/2018/05/01/riding-the-disruption-wave-in-healthcare/#172817a72846

Journal of Medical Internet Research, Boehme, P., Mondritzki, T., Ehlers, J. P., Kavadias, S., Truebel, H., & Herrmann, M. (2018, March 27). Digital Transformation and Disruption of the Health Care Sector: Internet-Based Observational Study. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5893888/

Kalis, B., & Trulsen, N. (n.d.). Big Bang Disruption in Healthcare. Retrieved from https://www.accenture.com/us-en/insight-healthcare-bigbang-disruption

Sarasohn-Kahn, J. (2018, August 22). Disruption is Healthcare's New Normal. Retrieved from https://tincture.io/disruption-is-healthcares-new-normal-adad99f7cd7e

Furnival, J., Walshe, K., & Boaden, R., (2017). Emerging hybridity: comparing UK healthcare regulatory arrangements. Journal of health organization and management, 31(4), 517-528.

https://www.factset.com/privacy

https://heimdalsecurity.com/blog/cyber-security-tips/

https://www.hipaajournal.com/2-65-million-atrium-health-patients-impacted-by-business-associate-data-breach/ - HIPAA