Three letters carry enormous weight when it comes to keeping your healthcare organization running smoothly, ethically, and legally: GRC is an acronym for governance, risk, and compliance.
As healthcare organizations become healthcare enterprises and increasingly adopt advanced technologies to help manage their operations—whether that means complying with regulatory mandates or improving the patient, provider, and patient experience—they invite new risks and vulnerabilities. A strong GRC strategy paired with the right technology can make all the difference.
What is GRC?
The issues under the GRC umbrella are vast, complex, and touch many departments—from quality and IT to HR, finance, and legal. GRC issues even affect how an organization's board and corporate governance is structured and operates. Establishing a comprehensive GRC framework is critically important for any company to achieve business objectives.
In addition, organizations employ GRC strategies to mitigate risks, including preventing fraud and malicious activity, and to stay compliant with rules and regulations like the Sarbanes–Oxley Act. Other elements of GRC include process controls, health and safety issues, and environmental considerations.
But healthcare enterprises face added complexity in the form of rules and regulations that come with caring for patients. The additional considerations stem from quality and safety risks and compliance requirements that other industries don’t face. For example, to abide by regulations and to maintain accreditation—and the privilege to care for patients—hospitals and healthcare organizations must:
- Carefully handle sensitive protected health information
- Have strong processes in place for provider and vendor credentialing
- Maintain patient-centered staffing and workforce policies
- Satisfy stringent billing and fraud prevention guidelines
- Vet all visitors coming into large, porous facilities
- Incorporate spend and risk data into the contract management process
A technology-driven approach
Such complex and varied requirements require a comprehensive, technology-driven approach to keep GRC objectives on track. The sheer volume of laws and regulations, and the data required to comply with them, mean that healthcare organizations cannot rely on manual or siloed processes to manage their GRC strategies and activities. Instead, they employ GRC software that automates and integrates all of the roles and responsibilities within the GRC functions.
Rather than viewing GRC as an initiative separate from the business side of healthcare, the industry long ago shifted to make these controls and processes a seamless, continuous part of regular business operations.
GRC software also affects the way provider organizations deliver and enable care services. GRC software solutions monitor and flag potential problems early and automatically to ensure that the workflows within run smoothly. Using technology and alerts, issues are identified and corrected before they have a chance to cause damage in the form of poor patient outcomes, noncompliance fines, lost revenue, and more.
For example, with regard to potential lost revenue:
- There are serious consequences for healthcare organizations that employ or contract with an individual excluded from federal healthcare programs. The offending healthcare organization can lose access to all Health and Human Services programs, including Medicare and Medicaid funding. In addition, violators are subject to civil monetary penalties that can reach into the hundreds of thousands of dollars.
- Value-based care is transforming the healthcare payment system—captured by the popular buzz phrase “no outcomes, no income.” In other words, reimbursement by government or commercial payers increasingly depends on the quality of care delivered as measured by quality and performance indicators.
In these two examples, a holistic GRC software system drives vendor management and provider success, respectively, by maintaining strict control over physical/virtual access and care-quality measures like targets, indicators, and benchmarks—and matches the controls to larger organizational improvement efforts.
A technology-driven approach also helps organizations make their GRC programs more streamlined and more robust by infusing compliance and solid business practices into the everyday fabric of how an organization operates. Rather than employing siloed, ad-hoc tools that hinder communication across departments or facilities, an enterprise GRC solution provides consistency, thoroughness, and clarity. It’s no exaggeration that a healthcare organization’s inability to connect the data “dots” across GRC jeopardizes its survival long term.
Healthcare's unique challenges
GRC software helps companies manage these requirements, and more—from monitoring user privileges and access within their IT systems to flagging suspected fraud in real time.
However, there are countless other risks and compliance requirements that are unique to healthcare organizations, from the Health Insurance Portability and Accountability Act (HIPAA) to physician credentialing, and GRC software can assist in managing them.
For instance, unlike in other industries where hiring employees is relatively straightforward and may include a few upfront tasks and background checks, healthcare workforce management and provider data management are far more complicated and require ongoing administrative work.
For hospitals, health systems, group practices, retail clinics, telemedicine companies, and other organizations on the healthcare provider side, GRC software with integrated directories can simplify and digitize provider lifecycle data: contracting, (re)credentialing, payer enrollment, privileging, performance monitoring, EHR, patient access, patient-provider matching, referral management, and claims data management. The result is the achievement of true enterprise provider data management
Likewise, payers and managed care organizations walk a fine line to save costs yet ensure their ability to deliver healthcare benefits promised to enrollees. For them, GRC software streamlines and automates provider data management requirements, including credentialing, plan management, network adequacy assurance, provider relations, and contract management.
Benefits of GRC automation in the ranks
The top-level benefits of GRC software are clear: continuous compliance to maintain accreditation, the preservation of fiscal health, and the ability to keep patients safe and at the center of care. But with GRC software, burdensome, multi-step tasks at all levels of the healthcare organization become aligned within regular workflows—streamlined, automated, faster, and more secure.
Consider GRC software’s positive effects on these roles in your organization:
Risk assessment manager
GRC software adds security to sensitive risk management and compliance functions. It eliminates paper files and data silos, allows users to see a full audit trail, maintain HIPAA privacy and security, and control user access by job function. Risk professionals can regularly conduct risk assessment to identify weaknesses in operations that may lead to compliance violations and lost revenue. Areas ripe for analysis include:
- Billing practices
- Provider financial arrangements and transactions (including gifts and other non-monetary compensation)
- Privacy and security issues covered by the HIPAA
Chief nursing officer
In addition to directing nursing and patient care services to provide the level of care required by current medical and nursing standards, with GRC software, the CNO has the tools and data at hand to partner with executive leaders on strategic plans, as well as to partner with physicians to ensure a smooth workflow. Integrated GRC software provides the CNO with views into:
- Compliance and regulatory requirements
- Cost controls to ensure maximum effectiveness of funds
- The nursing employee selection process, work assignments, performance evaluations, and staff development
Medical staff services professional
Primary source verification, credentialing, enrollment and privileging require near-heroic due diligence and attention to detail. Credentialing software, for instance, automates a rigorous follow-up process that doesn’t end until the credential is approved or resolved. If any requirement or piece of information is missing along the way, the software will catch and flag it.
GRC software with integrated credentialing functionality can help MSPs move more efficiently—and therefore realize revenue more quickly—even through the most cumbersome administrative tasks. It can also speed other important requirements, like granting clinical privileges, conducting performance evaluations, securing state licensure, and onboarding new practitioners.
Quality director
The quality director serves as advisor for all activities related to the evaluation of patient care based on statistical analysis and best practices. Integrated GRC software enables them to:
- Analyze data for trends and recommend to hospital leaders corrective action
- Monitor recommendations until action plans are in place and improvement is proven effective and included in facility policy
- Maintain a close working relationship with the risk management department to monitor adverse event reporting/responses and corrective action for compliance
HR and payroll professionals
Human resources has the critical job of workforce management, which, in many hospitals, surprisingly still relies on manual tasks and paper records. For them, GRC software eliminates this dependence. More importantly, it connects these widespread areas stemming from workforce management: clinical, financial, staff engagement, patient satisfaction, and compliance.
Integrated GRC software links these critical roles and functions, and others, enterprise wide and can proactively and efficiently assess, communicate, and mitigate operational and financial risks even in the midst of frequently shifting requirements in a way that even the best employees cannot.
The added control of GRC software
In addition to helping manage employees, contracts, and other internal matters, GRC software can help healthcare organizations better control over outside factors such as patients, visitors, and vendors.
For example, when it comes to working with vendors, healthcare organizations must take precautions that organizations in other industries don’t face. When allowing a vendor to access a medical facility or health system, organizations must work carefully to ensure continued patient safety, information privacy, and other policies. GRC software can enable vendor background checks, credentialing, training, and policy reviews and even provide insights into which vendors are most compliant with an organization's policies.
Software can enable similar controls for other visitors, too, with features like easy check-ins and dashboards that give users insight into which vendors and visitors are currently onsite.
Finally, GRC software can also help keep patients' health and information safe thanks to tools that enable quality monitoring and safety and incident reporting. Among them are software solutions that not only allow users to access automated, online, and customizable forms for easy reporting on any device, but also ones that provide additional analysis and monitoring. Such follow-up functions enable interventions, tracking, audits, and other controls that ensure providers and staff learn from every incident and improve individually and as a team over time.
The bottom line
Having a GRC structure in place is critically important for any company, but the stakes are higher and the requirements are stricter for healthcare organizations. GRC software makes that process easier by ensuring that every box is checked, every requirement is met, every dollar is secure, every physician is credentialed and licensed, and every patient is safe.
That's especially important when considering how quickly requirements can change and policies can shift. With an enterprise-wide GRC software solution in place, healthcare organizations can get on with the business of taking care of patients and trust that their GRC framework is automated, fast, streamlined, and secure.
