Deloitte Center for Health Solutions

August 26, 2013

Monday memo

Health reform update

This week’s headlines: My take: the U.S. health care system: a mosaic of businesses and organizations

Implementation update o IRS releases proposed rules for small business exchange tax credits o Rand: impact of employer mandate delay o Gallup: opinions mixed about ACA o HHS promotes coverage for young invincibles o IRS launches ACA tax website o Update: PCORI to award $300 million for research o House committee seeks IRS background files on employer mandate delay o 80 GOP House, 14 GOP Senators pledge vote against funding of the ACA

Legislative update o FDA considers ban on online sales of electronic cigarettes

State update o Voter registration during HIX enrollment focus of debate

o CMS signs agreement to manage, protect data flow between states and federal agencies

o USA Today analysis: disciplinary actions by state medical boards against physicians fall

short o HIX update

o Medicaid expansion update

o State round-up

Industry update o Moody's outlook for hospital reimbursement problematic o Survey: employers concerned about cost, interest in wellness and private exchanges

significant o MGMA, HIMSS caution against unfair penalties in Stage 2 meaningful use implementation o Critical access hospitals get support from senators o Nursing Homes concerned about value-based purchasing, bundled payments o Private exchange enrollment update o Device reporting changes increase burden on manufacturers o Co-pays for home health increase costs: trade group

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My take: the U.S. health care system: a mosaic of businesses and

organizations From Paul Keckley, Executive Director, Deloitte Center for Health Solutions

Growing up, a movie was a rare treat. My favorites are vivid memories earmarking my journey

through life thus far—

Ten Commandments, The Parent Trap, and The Sound of Music—epics of my childhood.

MASH and Animal House—the college years, social unrest, and challenges to our national

invincibility in Vietnam.

Saving Private Ryan, Gladiator, Chariots of Fire, The Jazz Singer, Patch Adams and The

Patriot—lives lived with meaning and purpose, though at a high personal price.

And I’ll add The Butler to my list. Directed by Lee Daniels, it chronicles the life of Cecil Gaines

who served eight presidents as a butler in the White House. The portrayals by Forest

Whitaker and Oprah Winfrey are impressive. But what makes The Butler powerful is the

story—a black man born in slavery, whose dignity as a White House butler spanning five

decades serves as the backdrop reminder of our troublesome grappling with the issue of race.

Wednesday, President Obama will speak from the same spot at the Lincoln Memorial where

Martin Luther King Jr. delivered his “I Have a Dream” speech 50 years ago. And we’ll be

reminded that ours is increasingly a pluralistic society—a mosaic of races and creeds that

must learn to live together for the common good and purpose.

The same is needed in health care: we are a collective of businesses and organizations

whose impact reaches far and wide. We discover the world’s most promising medicines and

latest technologies. We educate many accomplished caregivers and scientists. But we are an

industry prone to tolerate our shortcomings and prefer incremental change.

It’s understandable: health care system transformation for the greater good is threatening to

some and hard work for all.

Cecil Gaines never stopped learning about himself—the good and not so good. He quietly

studied his conflicting worlds—at home, in the White House, and in his community—to inform

his actions. And he changed his mind when the dissonance in those worlds required him to

act.

Our health care world is as dissonant as Cecil’s. Our system works for those with insurance

coverage but not so well if without. We have the latest and best technologies but little

understanding among patients of when and how they’re most useful, or their costs. And our

changes are slow.

The Affordable Care Act (ACA) is but one chapter in the history of the U.S. health care

industry. Others will be written. And the authors will likely be those leaders who see our

industry’s challenges through the long-range lens of history. Like the butler’s story, our journey

will be difficult, but no less necessary.

P.S. One of my greatest sources of pride is to be part of an organization—Deloitte—that puts

diversity and tolerance at the apex of its values.

Announcement: the Deloitte Center for Health Solutions’ weekly Health Care Reform Memo

will now be distributed on Tuesdays. While you’ll notice a refreshed look and feel, we will

continue to deliver health care industry news to you on a weekly basis. If you subscribe to the

memo email, you will begin receiving this email on Tuesdays. If you do not subscribe to the

memo, you can do so by visiting www.deloitte.com/centerforhealthsolutions/subscribe.

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Implementation update

IRS releases proposed rules for small business exchange tax credits Last week, the U.S. Internal Revenue Service (IRS) released a 56-page proposed rule for the

ACA’s small-business tax credit for employers with 25 or less full-time equivalent (FTE)

employees purchasing health coverage through a Small Business Health Options Program

(SHOP) exchange.

For 2014, the maximum credit will increase to 50% of premiums paid for small business

employers and 35% of premiums paid for small tax-exempt employers.

Employee’s hours of service for a year include hours for which the employee is paid, or

entitled to payment, for the performance of duties for the employer during the

employer’s taxable year (including hours for paid for vacation, holiday, illness, incapacity

including disability, layoff, jury duty, military duty, or leave of absence).

Hours of service do not include the hours of seasonal employees who work for less than

120 days a year.

General business credit is claimed on an eligible small employer’s annual income tax

return and offsets an employer’s actual tax liability for the year.

The Internal Revenue Service (IRS) will accept comments on the proposed rule until

November 22, 2013.

Background: an eligible “small employer” is an employer with no more than 25 FTEs for the

taxable year, whose employees have average annual wages of less than $50,000 per FTE (as

adjusted for inflation for years after December 31, 2013), with employee coverage that

requires the employer to pay at least 50% of the premium cost of a qualified health plan

(QHP) offered to employees through a SHOP Exchange.

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Rand Corporation: impact of employer mandate delay Last week, Rand Corporation released its study on the effects of the July 2013 IRS decision to

delay the ACA employer health insurance mandate requirements by one year. Key findings:

300,000 fewer individuals (0.2% of the population) will have access to insurance in 2014

1,000 fewer employers (0.02%) will opt not to offer health insurance

Federal revenues will be $11 billion less as a result of delayed penalties/fines of

employers that would have been assessed to employers for not providing coverage

(Source: Rand Corporation, “Delaying the Employer Mandate: Small Change in the Short

Term, Big Cost in the Long Run,” August 2013)

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Gallup: opinions mixed about ACA According to a Gallup poll conducted between August 17-18, 2013, more Americans

disapprove (49%) than approve (41%) of the ACA. Other findings:

More Americans have “no opinion” of the law now (11%) compared to June (4%). Less

than a quarter believe the ACA will improve their family’s health care situation.

12% mentioned not being familiar with the ACA at all.

Those who said they were very familiar or somewhat familiar with the law, were more

likely to disapprove than approve.

36% of young adults (ages 18-34) were “not too familiar” or “not familiar” with the ACA,

compared to the 28% of middle-aged Americans and 26% of those 55 and older.

Approval levels across all three age groups were similar.

(Source: Gallup, “Americans Still Wary of, Not Too Familiar With, Health Law,” August 22,

2013)

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HHS promotes coverage for young invincibles Last Tuesday, U.S. Department of Health and Human Services (HHS) Secretary Kathleen

Sebelius, in collaboration with the non-profit organization Young Invincibles, announced the

“Health Young America” video contest to inform young people about health insurance options

under the ACA. Young people can also use the site to join web chats or call 1-800-318-2596

toll free to get help from a trained customer service representative.

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IRS launches ACA tax website Last Thursday, the IRS launched a website featuring information about ACA tax-related

provisions, providing public information about premium tax credits, employer mandates, and

tax exemption for insurance companies: http://www.irs.gov/uac/Affordable-Care-Act-Tax-

Provisions-Home.

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Update: PCORI to award $300 million for research Last week, the Patient-Centered Outcomes Research Institute (PCORI) announced it will

award $300 million in funding before the end of this year, bringing total grants awards in 2013

to $418 million. Some funding will be targeted to high priority areas where research about

ethnic disparity in diagnosis and treatment is the focus (e.g., treatment options for African

Americans and Hispanics with severe or uncontrolled asthma). $100 million will support efforts

to improve the methods for conducting comparative effectiveness research, and $68 million

for clinical data and “patient-powered” research networks.

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House committee seeks IRS background files on employer mandate delay House Energy and Commerce Committee Republicans have requested the Department of the

Treasury Secretary, Jack Lew, turn over additional documentation by September 6 about the

agency’s decision last month to delay the employer mandate. The points of inquiry: did the

Treasury have the constitutional authority to delay the mandate, and were other federal

agencies consulted in the decision process.

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80 GOP House, 14 GOP Senators pledge vote against funding of the ACA Last week, 80 House Republicans signed a letter urging House leadership to defund the ACA

in upcoming spending bills. In the Senate, 14 GOP members have announced support for a

similar effort to defund the ACA led by Mike Lee (R-UT) and Ted Cruz (R-TX).

Note: a GOP-sponsored survey of 1,000 registered voters conducted July 31-August 1 by

David Winston found 71% oppose a government shutdown over ACA funding including 53%

of Republicans. Key findings in the poll:

Republican men favored a shutdown by a 48% to 44% margin compared to Republican

women opposed, 61% to 29%.

Among Republicans who called themselves conservative, those who said they are very

conservative favored shut down by 63% to 27%, while those who said they are

somewhat conservative opposed shut down by 62% to 31%. Overall, Republicans who

call themselves conservative were evenly split on the issue, 46% to 46%.

Conservative Republicans are 19% of the entire electorate. Of these, 9% call

themselves very conservative and 10% say they are somewhat conservative.

Among people who say at this point that they plan to vote for the Republican candidate

in 2014—regardless of who it is—51% said they opposed a shutdown, while 40 %

favored it.

(Source: Byron York, “GOP poll finds strong opposition to government shutdown,” Washington

Examiner, August 22, 2013)

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Legislative update

FDA considers ban on online sales of electronic cigarettes The U.S. Food and Drug Administration (FDA) is considering stopping online sales of

electronic cigarettes, according to the Wall Street Journal. The agency has been in talks with

industry stakeholders, and plans to release an official proposal in October. According to recent

estimates, e-cigarettes are expected to reach $1 billion in sales this year.

(Source: Stephen Drill, Wall Street Journal, “FDA Discusses Banning Online Sales of E-

Cigarettes,” August 23, 2013)

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State update

Voter registration during HIX enrollment focus of debate Policy experts are debating whether or not to offer voter registration alongside health

insurance exchange (HIX) enrollment―an issue that could to end up in litigation. Section 7 of

the National Voter Registration Act of 1993 states that voter registration must be offered at

“any government agency providing public assistance, including health insurance coverage.”

However, Congressional Republicans and some states disagree, contending it is

inappropriate to register voters simultaneously. Additional resources and mandatory training

for state HIX staff, volunteers, and navigators, may be necessary to ensure voter registration

requirements are met; putting states in an even tighter time crunch for the October 1 open

enrollment deadline. California, New York, and Vermont have opted to offer voter

registration as part of their HIX enrollment.

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CMS signs agreement to manage, protect data flow between states and federal

agencies Last Tuesday, the Centers for Medicare and Medicaid Services (CMS) entered into a

Computer Matching Agreement (CMA) with state-based entities to set procedures for

accessing CMS’s federal Data Hub (HUB), used to determine eligibility of insurance

affordability programs. The CMA requires any suspected data breaches to be reported to the

Center for Consumer Information and Insurance Oversight State Officer within one hour of the

suspected breach, who will notify other federal agency data sources involved. States must

also notify the Internal Revenue Service (IRS) Office of Safeguards, the Treasury Inspector

General for Tax Administration, and the office of the appropriate Special Agent-in-Charge

within 24 hours of the suspected data breach.

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USA Today analysis: disciplinary actions by state medical boards against

physicians fall short USA Today looked at data from the National Practitioner Data Bank, a federal database of

incidents of physician malpractice and patient endangerment finding that state medical boards

failed to take disciplinary action against more than half of doctors who had their hospital

privileges suspended. Almost 250 cases involved "an immediate threat to health and safety"

and 120 who were "unable to practice safely," including substance abuse problems.

(Source: USA Today, “Thousands of doctors practicing despite errors, misconduct,” August

20, 2013)

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HIX update 16 states—12 led by Democratic governors, three led by Republicans, and one

Independent—and the Democratic mayor of D.C. have announced plans to operate state-

based exchanges. Seven states—five led by Democratic governors and two led by

Republicans—will participate in state-partnership exchanges. The remaining 27 states will

default to a federally-facilitated exchange.*

State-based exchange State-partnership

exchange

Federally-facilitated

exchange

CA, CO, CT, DC, HI, ID**, KY,

MA, MD, MN, NM**, NV, NY, OR,

RI, VT, WA

AR, DE, IA, IL, NH, MI, WV AK, AL, AZ, FL, GA, IN, LA, KS,

ME, MO, MS, MT, NC, ND, NE,

NJ, OH, OK, PA, SC, SD, TN, TX,

UT*, VA, WI, WY

■ Democratic governor ■ Republican governor ■ Independent governor

*UT: individual market will be a federally-facilitated exchange; small business health options

program (SHOP) will be a state-based.

**NM & ID: federal government will help run the individual market. States will continue to

maintain plan management and consumer assistance functions; HHS will operate the IT

system. SHOP will be state-based.

(Source: HHS)

Last week, California state officials announced a back-up plan if its HIX infrastructure

isn’t ready October 1. “If the system is not ready, the exchange would at first use an

‘aided enrollment’ in which counselors help California residents sign up over the phone

or in person.” The delay would be similar to a move by Oregon to put off online

enrollment in its HIX while technical kinks are ironed out.

Related: the California Endowment announced a $9.2 million, three-year grant to help

educate low-income Californians about their health insurance options. Endowment

funding will be awarded to the Health Consumer Alliance, which provides legal aid to

poor Californians.

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Medicaid expansion update To date, 23 states and DC have said they will or are likely to expand their Medicaid programs;

24 states have indicated they will not expand their programs in 2014:

Expected to expand

Medicaid

Will not expand at this

time Maybe

AR, AZ, CA, CO, CT, DC, AL, AK, FL, GA, ID, IN, KS, NH, OH, PA

DE, HI, IA, IL, KY, MA, MD,

MN, ND, NJ, NM, NY, NV,

OR, RI, VT, WA, WV

LA, ME, MI, MO, MS, MT,

NC, NE, OK, SC, SD, TN,

TX, UT, VA, WI, WY

■ Democratic governor ■ Republican governor ■ Independent governor

(Sources: NASHP and Kaiser Family Foundation. Updated as of July 1, 2013)

Friday, Iowa Governor Terry Branstad (R) formally submitted a Medicaid expansion waiver to CMS, requesting an expedited approval as the state’s current waiver is set to expire at the end of the year. The plan would expand coverage to all individuals earning up to 138% of the federal poverty level.

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State round-up Texas legislators approved Senate Bill 1175 to establish a program facilitating the reuse

of durable medical equipment (DME) to Medicaid recipients. The reused equipment

must meet applicable standards, and Medicaid recipient participation in the program is

voluntary. In 2012, Texas spent $781.5 million on Medicaid DME. Also, the Perry

Administration is preparing a formal application to capture funds from the Community

First Choice program—an ACA-created plan to help states deliver better quality services

in the community for long-term care patients.

The California State Assembly passed Senate Bill 21 requesting The School of

Medicine at the University of California, Riverside (UCR) to use recently acquired funds

($15 million) to address southern California’s need for more primary care physicians.

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Industry update

Moody's outlook for hospital reimbursement problematic “The modest increase next year in reimbursement rates for inpatient services in hospitals is

not enough to address the rates of rising hospital costs and is a credit negative for not-for-

profit hospitals,” per Moody's Investors Service. In early August, CMS announced the rate for

acute hospitals would increase by 0.7% in 2014 vs. 2.8% increase in 2013. Hospital costs are

expected to grow by 2.5% next year.

(Source: Jaimy Lee, ModernHealthcare, “Reform Update: PCORI to award $300 million for

research,” August 21, 2013)

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Survey: employers concerned about cost, interest in wellness and private

exchanges significant Highlights of the Towers Watson survey of 420 mid-sized and large companies representing

8.7 million in the U.S. workforce:

Employers believe health care costs will increase by 5.2% in 2014 over 2013’s costs,

down from an expected 5.9% increase in 2013. Projected 2014 per employee total cost

is $12,769, compared to $12,136 in 2013.

Nearly three quarters believe health care reform will drive up the cost of providing health

care to their employees.

98% plan to keep their active medical plans for 2014 and 2015.

82% agreed that coverage is and will continue to be “an important part of their employee

value proposition.”

Approximately 70% agreed they “have a stronger commitment to improving employee

health because of health care reform”

10% of employers plan to cut back on pre-retiree coverage, increasing to 38% in 2015.

88% lack confidence in state HIXs in 2014 and 61% felt the state exchanges wouldn’t

be working well in 2015. Private exchanges were preferred as a viable alternative in

2014 by 37% and by 57% by 2015.

60% of employers report that the “Cadillac tax” will be an important factor in framing

health care strategies over the next two years.

(Source: Wall Street Journal, “Health Care Reform Heightens Employers' Strategic Plans for

Health Care Benefits,” August 21, 2013; Dan Cook, BenefitsPro, “Large employers committed

to health coverage,” August 21, 2013)

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MGMA, HIMSS caution against unfair penalties in Stage 2 meaningful use

implementation Friday, two influential trade groups issued statements cautioning HHS about Stage 2

implementation of the Meaningful Use program because providers will not be ready and

penalties for circumstances beyond their control would be unfair. The Medical Group

Management Association (MGMA) is asking HHS to give providers more time to attest to

Stage 2, and the American Hospital Association (AHA) and American Medical Association

(AMA) want HHS to delay the start date for Stage 2. The vendor trade group Healthcare

Information Management and Systems Society (HIMSS) urged HHS to start Stage 2 on

schedule but to push back the attestation period to April 2015 and June 2015 to give providers

a longer time to show they are successfully using the certified medical record technology.

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Critical access hospitals get support from senators Last week, 20 senators sent a letter to the Senate Finance Committee defending critical

access hospitals (CAHs) in the aftermath of an Office of the Inspector General’s (OIG) report

that said two-thirds of the CAHs did not qualify for the designation costing Medicare $449 million in 2011. (See the Monday Memo from August 19 for additional background on the

OIG’s CAH recommendation.)

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Nursing Homes concerned about value-based purchasing, bundled payments Last week, officials of the American Health Care Association (AHCA) representing post-acute

providers issued a response to a letter sent by the House Ways and Means and Senate

Finance Committees, stating their members could support value-based purchasing and

bundled payments, but first more research is needed and on-going demonstration projects

need to be modified.

Background: Ways and Means and Finance Committees are looking for sources of funding to

offset the Sustainable Growth Rate (SGR) formula fix ($139 billion). AHCA discouraged cuts

from post-acute providers as a means of funding the SGR.

AHCA is urging Congress to consider its site neutral payment proposal, which it estimates

could save $15 billion to $20 billion over 10 years. AHCA's plan would group beneficiaries by

clinical conditions and severity, and payments would be the same regardless of where

beneficiaries are treated.

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Private exchange enrollment update A study by Accenture predicts that enrollment in private exchanges will be 1 million in 2014

and surpass HIX enrollment by 10 million members in 2018.

Background: there are two private HIX models: single-carrier and multi-carrier. The employer

selects the carrier, and the employee selects from among the benefit plans offered by that

carrier. The multi-carrier model allows an employee to select from among several carriers and

benefit plans.

(Source: Margaret Dick Tocknell, HealthLeadersMedia, “Private HIX Pose Challenge to Public

Health Insurance Exchanges,” August 15, 2013)

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Device reporting changes increase burden on manufacturers Medical device adverse event reporting requirements will likely increase under draft guidance

released last month requiring manufacturers to notify the FDA when their products have

caused or could cause serious injury or death to patients, including problems associated with

device malfunctions. Under the old system, companies were required to report all

malfunctions over a two-year period after the device first caused or contributed to a death or

serious injury. In the current draft guidance, the FDA removed the two-year time frame and

requires firms to file and receive an exemption to cease reporting related to previous device

incidents. Further, contract manufacturers will now have to seek an exemption from the

reporting requirements, whereas previously the contract manufacturer and the specification

developer/distributor would enter into an agreement about which firm would do the reporting.

Foreign manufacturers will also have to get an exemption if the importer files a report.

The FDA guidance also implies that a surgical team's error in choosing a device could result

in a report, and a report should be filed if an alarm alerts a user to a malfunction but the health

care provider intervenes before the device can harm a patient. The draft guidance also

suggests manufacturers may need to investigate adverse events identified in scientific articles

and other publications.

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Co-pays for home health increase costs: trade group In comments to the Senate Finance and House Ways & Means Committees, the National

Association for Home Care and Hospice (NAHC) says home health co-payments do not

reduce Medicare spending. Instead, the industry recommends fraud-and-abuse fighting

measures, such as strengthening Medicare provider eligibility standards.

NAHC cited a 2009 Avalere study that found the early use of home health was associated

with a $1.71 billion reduction in Medicare post-hospital spending from 2005 to 2006, and

24,000 fewer hospital readmissions resulting in $216 million reduction in Medicare costs.

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Quotable “I love nurses…one of the keys to reducing our health care costs overall is recognizing the

incredible value of advanced practice nurses and giving them more responsibilities because

there’s a lot of stuff they can do in a way that, frankly, is cheaper than having a doctor do it, but the outcomes are just as good.”―President Obama speaking of the ACA at Binghamton

University in New York Thursday, August 22, 2013

“Our large, employment-based insurance system has historically been propped up by tax

subsidies that make it cheaper than directly purchasing individual insurance. For the lower-

middle-income population, the ACA reverses this distortion, potentially shifting the inequity in

the opposite direction. Group coverage has some merits: when managed by a well-run,

attentive benefits department, it can be less administratively costly than individual insurance,

better tailored to workers' needs, and less prone to adverse selection. Economically, it would

be ideal to offer equal subsidies regardless of how a person obtains qualified coverage,

creating efficient choices between individual and group coverage. Perhaps the current threat

to the employer mandate and target efficiency will induce us to confront the full fiscal cost of

fair subsidies. Making subsidies available on a uniform basis at each income level would

ideally lead to better choices of insurance products, less heated political rhetoric, and an

opportunity to focus on other pressing problems in our health care system.”―Mark V. Pauly,

and Adam A. Leive, “The Unanticipated Consequences of Postponing the Employer

Mandate,” New England Journal of Medicine, August 22, 2013

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Fact file ACO update: of the 488 ACOs in the U.S., 253 (52%) have contracts with CMS (ACA

Section 3022, Medicare Shared Savings Program). (Source: Leavitt Partners report,

"Growth and Dispersion of Accountable Care Organizations: August 2013 Update”)

Physician acceptance of Medicare patients: the number of physicians accepting new

Medicare patients increased by 3% between 2007 and 2012 and is higher than the

number of physicians accepting new private insurance patients per an HHS report.

(Source: HHS Office of the Assistant Secretary for Planning and Evaluation)

Global health care IT outsourcing market: forecast to grow at a compound annual

growth rate (CAGR) of 7.6%, to $50.4 billion by 2018 from $35 billion in 2013: 72%, of the

current global health care IT outsourcing is in North America and will reach $36 billion by

2018 from $25 billion in 2013. Asia-Pacific and rest of the world are expected to register

CAGRs of 8.1% and 7.8% (2013 to 2018) respectively, followed by North America at 7.6%

and Europe at 7.2%. (Source: Markets and Markets Research)

Premiums increases 2013 vs. 2012: family premiums increased 4% in 2013 — same as

in 2012 and individual premiums increased 5% vs. 3% in 2012. (Source: Kaiser Family

Foundation, “2013 Employer Health Benefits Survey”)

Health care cost trend: health care prices increased 1.1% from July 2012 to July

2013―the lowest recorded growth rate since 1990. National health care expenditures

increased 4.3% in June, and 4.1% from January to June 2013―slightly higher than the

historically low rate recorded in 2009. Health care spending as a part of gross domestic product (GDP) decreased from 18% to an average of 17.4%. (Source: Altarum Institute’s

Center for Sustainable Health Spending, Health Sector Economic Indicators, August

2013)

U.S. physicians trained in family medicine: more than 67% of family medicine residents

graduated from U.S. allopathic or osteopathic medical schools this year vs. 58% in 2009.

(Source: American Academy of Family Physicians)

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Deloitte Center for Health Solutions research To learn more about recent Deloitte thought leadership, please visit Deloitte University

Press at www.DUPress.com.

Coming soon: Physician-hospital employment: This time it’s different

Currently available: Update: Privacy and security of protected health information: Omnibus Final Rule and

stakeholder considerations—August 2013. Available online at www.deloitte.com/us/protectedhealthinfo

Hospital Consolidation: Analysis of Acute Sector M&A Activity—May 2013. Available

online at www.deloitte.com/us/2013hospitalconsolidation

Physician adoption of health information technology: Implications for medical practice

leaders and business partners—May 2013. Available online at

www.deloitte.com/us/2013physiciansurveyHIT

Breaking Constraints: Can incentives change consumer health choices?—March 2013.

Available online at http://dupress.com/articles/breaking-constraints/?coll=3024

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Deloitte contacts

Paul H. Keckley, Ph.D., Executive Director, Deloitte Center for Health Solutions

(pkeckley@deloitte.com)

Jessica Blume, U.S. Public Sector National Industry Leader, Deloitte LLP

(jblume@deloitte.com)

Bill Copeland, U.S. Life Sciences and Health Care National Industry Leader, Deloitte LLP

(bcopeland@deloitte.com)

Jason Girzadas, National Managing Director, Life Sciences & Health Care, Deloitte

Consulting LLP (jgirzadas@deloitte.com)

Harry Greenspun, M.D., Senior Advisor, Health Care Transformation and Technology,

Deloitte Center for Health Solutions (hgreenspun@deloitte.com)

Mitch Morris, M.D., National Leader, Health Information Technology, Deloitte Consulting LLP

(mitchmorris@deloitte.com)

George Serafin, Managing Director, Health Sciences Governance Regulatory & Risk

Strategies, Deloitte & Touche LLP (gserafin@deloitte.com)

Rick Wald, Director, Human Capital, Deloitte Consulting LLP (rwald@deloitte.com)

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