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The health industry is facing a myriad of challenges
The health industry is facing enormous challenges and fundamental shifts in how it operates. Organizations are transforming how they leverage technology and manage digital capabilities in the wake of the pandemic. At the same time, they’re confronting increased reliance on third-party systems and service providers, cost pressures and an increasingly complex, evolving regulatory environment. And they’re doing all of this with heightened scrutiny from auditors, shareholders and government agencies. This broad array of challenges dramatically increases and complicates the financial, technological, compliance and regulatory risk faced by healthcare companies.
How PwC can help risk management in healthcare
At PwC, we address the complex problems and business transformations faced by our clients. The healthcare industry confronts new demands and risks daily, and our global team of more than 4,000 US and 12,000 global professionals is ready to meet the challenge these demands present.
The goal: moving from reactive — or compliance-driven — approaches to more proactive resilient growth strategies.
With cross-functional expertise, cutting-edge analytics and technology enablement solutions, PwC can help in developing healthcare controls, systems and processes, addressing key governance issues and can provide guidance on risk oversight.
PwC's health sectors
Provider
Internal Audit
Leveraging leading practice internal audit methodology in areas such as risk assessment, audit plan development, audit execution and reporting along with Provider industry leading subject matter specialists we help you enable your organization to achieve strategic, financial, and operational objectives by being a "trusted advisor."
Compliance Services
Leveraging industry subject matter specialists and leading practices, optimize compliance for your organization through regulatory response support, compliance office transformation and redesign assistance, managed services, deals due diligence, and compliance monitoring.
Enterprise Risk Management (ERM)
Reimagine and execute enterprise risk management activities, with a focus on the complex dynamics of the provider industry.
Eletronic Health Record (EHR) and Enterprise Resource Planning (ERP) Controls & Security
Utilizing our library of EHR and ERP controls, PwC specialists help design and operationalize controls to mitigate operational, financial and compliance risks.
340B
PwC’s technology and approach brings cost effective monitoring to your organization, helping you to mitigate 340B program compliance risks. PwC’s tech-enabled monitoring approach also satisfies the annual third-party audit expectation per HRSA guidelines.
Financial controls
Bring industry leading insights and technology to help drive value through your financial controls (e.g., SOX) compliance program at all stages.
Payer
Compliance & Regulatory
Helping organizations achieve operational excellence in their compliance activities through compliance program transformation, tech enablement (compliance and operational performance monitoring), and operations through managed services. We leverage industry subject matter specialists and leading practices to support compliance and regulatory activities such as appeals & grievances, utilization management, call center, care management, regulatory reporting (e.g., CMS) etc.
Contract Compliance
Serving as market leaders in providing PBM Rebate Assessments on behalf of Payers and other large Employer groups, we leverage analytics and automation to perform assessments to identify potential non-compliance related to rebate pass-through to our clients.
Financial controls
Supporting our clients through compliance with Model Audit Rule and other financial controls programs by providing a scalable delivery model with the support of technical specialists, leveraging automation and digital solutions to overall drive value, efficiency, and effectiveness.
Internal Audit
Leveraging leading practice internal audit methodology in areas such as risk assessment, audit plan development, audit execution and reporting along with Payer industry leading subject matter specialists we help you enable your organization to achieve strategic, financial, and operational objectives by being a "trusted advisor."
ERM
Supporting organizations as they reimagine and execute enterprise risk management activities, with a focus on the complex dynamics of the payer industry.
Pharmaceutical and Life Sciences
Compliance services
Build, transform, operate, and/or automate your compliance activities from risk assessment through executing on monitoring plans. Our leading class platform, Risk Detect, integrates and streamlines corporate compliance activities across the lifecycle. We also offer flexible solutions to bring expertise to operate compliance activities via cosourcing or outsourcing).
HCP Interactions
Manage interactions with healthcare providers and healthcare organizations. Designed from real-world experience, PwC’s customizable system helps pharmaceutical and life sciences companies stay current and compliant.
Transparency reporting
Simplify global transparency reporting with our holistic, cloud-based compliance solution. Our tools can connect to any system, aggregate data, and streamline compliance reporting globally.
Internal Audit
Leveraging leading practice internal audit methodology in areas such as risk assessment, audit plan development, audit execution and reporting along with PLS industry leading subject matter specialists we help you enable your organization to achieve strategic, financial, and operational objectives by being a "trusted advisor."
Regulatory
Bringing end-to-end Regulatory services to help companies navigate the complex regulatory environment and transform Regulatory functions to be a value creator. Our experienced advisors have developed and executed on effective strategies globally that resolve regulatory challenges, optimize and automate processes, and actively embed risk resilience in the DNA.
Financial controls
Bringing industry leading insights and technology to help drive value through your SOX compliance program at all stages.
ERM
Reimagining and executing enterprise risk management activities, with a focus on the complex dynamics of pharmaceutical, med device and biotech sectors.
Contract Compliance & 340B Monitoring
Bringing the best of PwC’s regulatory, compliance, and technical expertise to deliver contract compliance and 340B program Integrity services through tech-enabled, data-driven assessments of wholesalers, pharmacy benefit managers (PBMs), specialty pharmacies, and patient assistance programs including “double/triple dip” analysis for manufacturers to curtail revenue leakage and drive increased margins.
ESG
Helping companies assess existing or future state processes, controls, data and technology that support its ESG reporting processes to achieve investor grade reporting.
Cyber Managed Services
Protect your business from evolving cyber threats with PwC's Cyber Managed Services. By entrusting your cyber defense functions to us, you can minimize risks, optimize operational costs, and stay ahead of changing threats and regulations. Our skilled workforce and flexible technology ensure effective identification and response to security data, events, and alerts.
Higher Education
Internal Audit
Leveraging leading practice internal audit methodology in areas such as risk assessment, audit plan development, audit execution and reporting along with Higher Education industry leading subject matter specialists we help you enable your Institution to achieve strategic, financial, and operational objectives by being a "trusted advisor."
Regulatory Compliance
Broad support of your regulatory compliance risk activities, from assessing program maturity, to evaluating the design and operating effectiveness of your internal controls. Including but not limited to risks related to Uniform Guidance compliance, Clinical Trials, HIPAA, and export controls.
Compliance Monitoring
Supporting regulatory compliance programs with expertise in financial controls, third party risk management, electronic medical records, sponsored research, development / fundraising, diversity and inclusion, auditing and benchmarking through co-source or outsourced models and critical applications.
ERM
Supporting organizations as they reimagine and execute enterprise risk management activities, with a focus on the complex dynamics of higher education.
Health Policy and Intelligence Institute
Practical insights on regulatory and policy developments in health industries
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