Health Plans

Featured thought leadership

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  The benefits of a better patient experience

  Results from the 2022 KPMG US Customer Experience Excellence Report

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  Align your Stars

  How Medicare Advantage plans can navigate the changing landscape of Star ratings

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  CMS Announces Model Concepts to Reduce Prescription Drug Costs

  Model Concepts Provide Glimpse of What May be Ahead for Drug Pricing

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  Inflation Reduction Act: Part D Benefit Reforms: Impacts on Pharmaceutical Manufacturers, Plans, and Patients

  Part D Changes Likely to Impact Stakeholder Financial Incentives and Behavior

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  On the 2023 healthcare board agenda

  Six issues healthcare boards should consider for 2023

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  Accelerated Approval Reforms in 2023 Omnibus

  Accelerated Approval Reforms Will Impact Drug Sponsors and FDA

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  KPMG 2023 Healthcare and Life Sciences Investment Outlook

  Our 2023 Healthcare and Life Sciences Investment Outlook finds turbulence, and opportunity, in this post-pandemic marketplace.

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  KPMG healthcare industry technology insights report

  KPMG reports on the state of healthcare industry digital transformation, automation, artificial intelligence, and machine learning

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  Elevate the Provider Experience

  Unlocking value through enhanced payer-provider collaboration.

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  Opportunities abound even as risks rise: M&A trends in healthcare

  Acquirers and investors seek opportunities but tread more cautiously given economic uncertainty.

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  The convergence of the tech and healthcare sectors

  How tech, NFTs, cyber security, and talent are impacting the healthcare industry

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  The future of telehealth in the post-COVID-19 world

  How providers can win in the new digital health landscape

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  Inflation Reduction Act: Healthcare provisions and impacts

  IRA will significantly impact prescription costs and insurance coverage for millions of Americans

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  Primary-care partnerships help payers boost patient outcomes

  Payers are increasingly partnering with primary-care organizations to improve patient outcomes.

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  The Great Pandemic Unwind: Five Healthcare Issues to Watch

  Unwinding federal COVID-19 policies will have significant industry impacts.

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  FDA's Accelerated Approval Program: Accelerated Pathway for Reform?

  Reforms to FDA Accelerated Approval Program could include new confirmatory study requirements.

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  Healthcare boards look toward a very different future

  Healthcare boards shape strategies around consumerism, attrition, and ESG issues from climate change to boardroom diversity.

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  2022 Healthcare and Life Sciences Investment Outlook

  Our 2022 Healthcare and Life Sciences Investment Outlook offers a look into industry innovations with the greatest investor interest.

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  Healthcare anywhere, security everywhere

  Healthcare organizations need robust identity access management to provide the anytime, anywhere care that today’s patients demand.

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  Perspectives from a payer-led pharmacy innovation lens

  Healthcare trends have created opportunities to strategically target pharmacy to make innovative and transformative impact.

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  ESG in healthcare is the new burning platform

  ESG in healthcare is a burning platform that includes telling your ESG story and making it synonymous with your brand.

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  Healthcare payors’ holistic approach to governance

  Healthcare payors should take a holistic approach to data governance to maximize valuable insights while minimizing risks.

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  Addressing social determinants through healthcare payment models

  This paper addresses how government can accelerate and fund the programs that directly address the social drivers of healthcare costs.

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  ESG Reporting in Healthcare: Driving a Connection to Health Outcomes

  Measuring Environmental, Social and Governance: Understanding connectivity to health outcomes and performance.

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  2021 Healthcare CEO Future Pulse

  200 health leaders were surveyed on workforce, digital health, partnerships, patient centricity, and delivery model changes.

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  Reenvisioning the power of technology risk management in healthcare

  The rapid pace of technology disruption in the healthcare sector is bringing on new and more pervasive risks.

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  Thriving in an AI World: Healthcare insights

  Healthcare organizations have opportunities to use artificial intelligence to improve productivity, reduce risk, and save lives.

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  From payor to healthcare partner

  For payors evolving toward becoming “healthcare partners,” this paper covers six trends to watch in 2021.

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  Healthcare may be flying too close to the sun

  Learn how your healthcare organization can address the growing threat of more insidious cyber-security attacks.

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  American Rescue Plan Act of 2021: Healthcare Related Provisions

  The American Rescue Plan Act of 2021 expands healthcare coverage and provides pandemic funding.

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  2021 Healthcare and Life Sciences Investment Outlook

  Provides insights on how the political and regulatory environment, and market factors may impact investment decisions.

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  Medicare C&D Audit and Enforcement: A look back and look ahead

  Biden Administration could increase Medicare audit and enforcement in the years ahead: a review of the data

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  On the 2021 healthcare audit and compliance committee agenda

  Drawing on survey insights, we highlight the five areas that audit and compliance committee chairs rank as top priorities.

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  Revised Safe Harbor Protections for Prescription Drug Rebates

  HHS final rule requires pharmacy benefit managers to pass along prescription drug rebates to patients at the point of sale.

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  CMS and ONC proposed rule on electronic data exchange

  CMS and ONC proposed rule aims to improve health data exchange and streamline prior authorization

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  Health Plan Transparency in Coverage Final Rule

  HHS, Department of Labor, and Treasury finalized price transparency requirements for health plans set to take effect beginning in 2022.

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  COVID-19: Recovery and resilience in healthcare

  Global insights, practical advice, and tools to help healthcare leaders build and sustain a resilient new reality.

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  Connected Health: The new reality for healthcare

  High performing healthcare organizations need to evolve key capabilities and make technological investments to build on the digital momentum.

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  FDA final rule and guidance on importation of prescription drugs

  FDA finalized a rule and guidance allowing states to submit prescription drug importation proposals and manufacturers to re-label drugs for importation.

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  Price transparency: Requirements for hospitals and health plans

  Several price transparency requirements for hospitals and health plans take effect in 2021; stakeholders must prepare

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  Executive order on ‘Most-Favored-Nation’ drug pricing

  An Executive Order directs HHS rulemaking for “most favored nations” pricing for Medicare Part B and D drugs.

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  COVID-19: Telemedicine and tax

  As telemedicine accelerates, the need for greater tax clarity and updated guidance relating to virtual healthcare is evident.

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  Executive orders on prescription drug costs

  Four Executive Orders (EO) described as action to deliver lower prescription drug prices to American Patients.

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  Medicare telehealth and COVID-19

  As demand for telehealth grows during the COVID-19 pandemic, CMS must consider what flexibilities can or should be extended.

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  Expansion of Telehealth in response to COVID-19

  Access to telehealth services in Medicare has been expanded in response to COVID-19, but those changes may not be permanent.

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  Don’t open the door to another threat

  Although healthcare organizations are focused on fighting COVID-19, the need for ongoing cyber security should not be underestimated.

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  Promoting interoperability

  Virtual care is proving to be a critical tool in the fight against COVID-19. For more on how to get up and running

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  Restarting America – Practical Guide for Employers

  For businesses making decisions about when and how to reopen their businesses, here is a practical guide to key considerations.

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  Paycheck Protection Program and Health Care Enhancement Act

  Implications for Healthcare providers.

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  Reaching the other side of COVID 19 part I

  A digital pathway

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  Reaching the other side of COVID 19 part II

  The power of data and emerging technology

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  The critical role of health plans during and after COVID-19

  Health plans are seeking to address economic, workforce and remote member challenges during the COVID-19 outbreak; for more

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  Compliance can’t wait

  As healthcare providers battle COVID-19, they may need help balancing compliance obligations. For more on what to expect

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  Getting ahead of the surge

  For guidance on how to align supplies, medical personnel and clinical operations with the different stages of COVID-19

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  The time for virtual care is now

  Virtual care is proving to be a critical tool in the fight against COVID-19. For more on how to get up and running

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  Mobilizing for COVID-19

  For insight into how COVID-related payer guidelines and government regulations can impact the your revenue cycle

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  Part D senior savings model for insulin coverage

  CMS just announced alternative Part D options that lower seniors’ cost-sharing for insulin, according to the attached issue brief.

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  Recent CMS waivers and flexibility

  To learn how CMS is offering health systems greater flexibility and critical waivers during the COVID-19 crisis

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  Coding for COVID-19

  For an overview of how to navigate the new COVID-19 coding guidance, going into effect on April 1, 2020

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  Accelerated/advance payment for medicare providers and suppliers

  To learn more about enhancements to CMS’s Accelerated & Advance Payment Program to help providers & suppliers during COVID.

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  Coronavirus Aid, Relief, and Economic Security (CARES) Act

  Economic support and stimulus bill.

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  Living in an AI world - Healthcare insiders

  Taking the temperature of artificial intelligence in healthcare

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  The customer experience continuum

  Payers must join health systems and pharmaceutical manufacturers in efforts to improve customer experience.

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  2020 healthcare and life sciences investment outlook

  Analysis of the 2020 KPMG Healthcare and Life Sciences Investment Outlook survey sheds light on how the investment landscape will be impacted by influential disruptors, evolving market trends, and policy/regulatory developments.

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  On the 2020 healthcare audit committee agenda

  Prioritizing a heavy healthcare audit and compliance committee (audit committee) agenda is never easy, and 2020 will be particularly challenging.

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  On the 2020 healthcare board agenda

  Prioritizing a heavy healthcare board agenda is never easy, and 2020 will be particularly challenging.

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  Convenience: The new consumer healthcare imperative

  Patients have more choice than ever about where and when they seek care.

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  Healthcare 2030

  By 2030, a consumer-centric healthcare system will be an imperative. Here’s how to get there.

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  Revenue Cycle Automation

  The healthcare revenue cycle is ripe for productivity gains and cost reduction. Forward-reaching organizations are effecting real change with connected robotic process automation.

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  Pathways to Success

  Medicare Shared Savings Program

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  The Race to EU MDR Compliance Continues

  Despite progress, companies are still facing many questions.

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  Quality 2030

  Forward-thinking Life Sciences CXOs will transform Quality from a cost center to a value creator.

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  Today’s consumers demand value in healthcare

  Mandated or not, transparency is table stakes in a consumer-centric healthcare system

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  Harvey Nash / KPMG CIO Survey 2019

  Explore how digital leaders are outpacing their competitors in delivering real business results.

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  Promoting interoperability

  CMS and ONC proposed rules on the exchange of health information

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  Embracing transparency

  Instead of viewing calls for transparency as a burden, pharmaceutical companies can take steps to turn pricing reform to their advantage.

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  Opportunities in an evolving market

  2019 Health Care & Life Sciences Investment Outlook.

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  Driving value from genomics in Life Sciences

  Rising to the data challenge.

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  On the 2019 healthcare board agenda

  Board and audit committee agendas should continue to evolve in 2019 amid the game-changing implications of technology, consolidation, and new entrants.

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  R&D 2030

  Reinvent innovation and become an R&D front-runner by 2030.

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  The evolution of government programs in the U.S.

  Balancing opportunity and risk to bring your drug to this important market.

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  Navigating the U.S. government market

  Top 5 factors every biotech and pharmaceutical company should keep in mind

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  Digital transformation in regulatory affairs

  Unlocking value for life sciences organizations.

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  The race to EU MDR compliance

  KPMG/RAPS survey illustrates the ground medical device companies still have to cover.

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  Data governance

  Driving value in healthcare

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  Future of finance in healthcare

  Finance disrupted - As the industry adjusts to continuous disruption, the finance function has an opportunity to lead

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  Digital health and disruption in diabetes

  Identifying opportunities for life sciences manufacturers.

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  Insider threat in life sciences

  2018 Program benchmark report.

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  Promoting interoperability

  CMS and ONC proposed rules on the exchange of health information