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Health Cyber Security
Accenture Point of View
2
Health cyber security “is the Wild
West…What’s in the news is just the tip
of the iceberg.”
Kevin Johnson
CEO, Secure Ideas
Source: “Hacker calls health security ‘Wild West’” - http://www.healthcareitnews.com/news/hacker-calls-health-security-wild-west
3Copyright © 2015 Accenture All rights reserved.
SITUATION OPPORTUNITYCOMPLICATION
4
Situation
What is happening with health cyber security?
• Over the last five years, the number of data breaches has increased dramatically with an
increase in frequency and number of impacted individuals.
• From 2010 to 2014, the number of health care data breaches impacting more than 500
individuals increased over 40%.
Copyright © 2015 Accenture All rights reserved.
2010 2015
Anthem
78.8M
Cyber Attack
UCLA
4.5M
Cyber
Attack
CareFirst
BCBS
1.1M
Cyber
Attack
AvMed Inc.
1.2M
Theft
BCBS TN
1.0M
Theft
GRM Services
1.7M
Theft
IBM
1.9M
Unknown
Nemours
Foundation
1.1M
Loss
SAIC
4.9M
Loss
Advocate
Health
4.0M
Theft
MT HHS
1.1M
Cyber Attack
Community
Health
4.5M
Theft
Xerox
2.0M
Unauthorized
Access
Premera
11.1M
Cyber
Attack
Health Care Data Breaches Impacting >1 Million
Individuals Over the Last 5 Years
Sources: Accenture analysis based on data from the HHS Office for Civil Rights breach portal. Data accurate as of July 2015.
5
• Trends vary for how different health industry stakeholders are impacted by the increasing risk and crime
related to health data security.
Copyright © 2015 Accenture All rights reserved.
Situation
How are different health organizations affected by data breaches?
Health Plans
Healthcare
Providers
Business
Associates
Total
Breaches
141 838 273
Individuals
Impacted
~98 Million
(w/o Anthem –
19.3M)
~18 Million ~22 Million
Average
Breach Size
~696,000
(w/o Anthem –
138,000)
~22,000 ~82,000
Health Care Data Breaches, January 2010 – July 2015
Health Care Data Breaches – Key Points
• Anthem Breach Outlier: Accounted for ~80% of total
individuals impacted by Health Plan breaches since
2010
• Health Plan Breaches: Occurred less frequently and
impacted the most individuals on average (even
excluding Anthem outlier)
• Healthcare Provider Breaches: Occurred most
frequently and impacted the least individuals on
average
• Business Associate Breaches: Impacted the largest
total number of individuals (excluding Anthem
outlier)
Sources: Accenture analysis based on data from the HHS Office for Civil Rights breach portal. Data accurate as of July 2015. Healthcare Clearing Houses and a small number of breaches without a designated covered entity type were excluded
from this analysis based on low reporting rate.
6
Situation
Why are health data breaches such a large risk?
• The monetary value of stolen health care data far surpasses other forms of
personal information, making it a prime target for security threats.
Copyright © 2015 Accenture All rights reserved.
Medicare Number Black Market Value
$470
$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
Credit Card Number Black Market Value
(Few quarters or dollars)
$
Sources: “The black market for stolen health care data” -http://www.npr.org/blogs/alltechconsidered/2015/02/13/385901377/the-black-market-for-stolen-health-care-data
7
Situation
How do health data breaches impact victims?
• Individuals victimized by medical information and medical identity theft suffer a variety of problems
related to the crime.
Copyright © 2015 Accenture All rights reserved.
TIME
Victims resolving crimes related to
medical identity theft spend more than
200 hours on:
• Verifying that the correct personal
health information remains in the
record and false information is
removed
• Ensuring that the criminal can no
longer use the victim’s medical
information fraudulently
• Dealing with medical invoices and
claims
WELLBEING
Fraudulent use of personal medical and
financial information can be difficult to
detect and remedy. Medical identity theft
can cause dangerous errors such as:
• Misdiagnosis
• Delayed medical treatment
• Interference with provision of the
correct medical care
Additionally, 45% of victims say the
crimes affected their reputation and were
embarrassing due to disclosure of
sensitive information.
$
FINANCES
Medical identity theft victims are not
usually protected from health cyber
crimes and pay an average of $13,500 in
out-of-pocket expenses for:
Incorrect medical bills paid unwittingly
Reimbursement to insurers for healthcare
services obtained fraudulently
Legal costs to unravel the cyber crime
and remedy negative implications
Sources: Ponemon Fifth Annual Study on Medical Identity Theft - http://medidfraud.org/2014-fifth-annual-study-on-medical-identity-theft/
8
Situation
What is the projected financial impact to patients?
• Over the next five years, patients will suffer ~$56 billion in out-of-pocket costs due to medical
identity theft resulting from healthcare provider data breaches.
Copyright © 2015 Accenture All rights reserved.
3.47
4.13
4.93
5.87
7.00
0.87 1.03
1.23
1.47
1.75
0.56 0.67 0.80 0.95
1.14
0
1
2
3
4
5
6
7
8
1 2 3 4 5
Millions
Projected Patients Impacted and Victimized by Medical
Identity Theft due to Healthcare Provider Breaches,
2015-2019
Patients Impacted Patients Victimized Patients Paying OOP
2015 2016 2017 2018 2019
Patient OOP Costs:
$56 Billion
Accenture projects that 25% of
patients impacted by healthcare
provider data breaches between
2015 and 2019—more than 6 million
people—will subsequently become
victims of medical identity theft.
Sixteen percent of impacted
patients—more than 4 million
people— will be victimized and pay
out-of-pocket costs totaling almost
$56 billion over the next 5 years.
Source: “The $300 Billion Attack: The Revenue Risk and Human Impact of Healthcare Provider Cyber Security Inaction.” Accenture. July 2015. Projections are original Accenture analysis utilizing data from the Ponemon Fifth Annual Study on
Medical Identity Theft (http://medidfraud.org/2014-fifth-annual-study-on-medical-identity-theft/), the Ponemon Fourth Annual Benchmark Study on Patient Privacy and Data Security (http://www.ponemon.org/blog/fourth-annual-benchmark-study-on-
patient-privacy-and-data-security), and the HHS Office for Civil Rights breach database.
9
Situation
What is the projected financial impact to patients?
• Over the next five years, healthcare providers are at risk of losing over $300 billion in cumulative
lifetime patient revenue due to data breaches.
Copyright © 2015 Accenture All rights reserved.
Provider Revenue Risk:
$305 Billion
Almost half of patients say they
would find a different provider if they
were informed their medical records
were stolen. Taking into account the
estimated lifetime economic value of
a patient, Accenture analysis shows
that healthcare providers are at risk
of losing $305 billion in cumulative
lifetime patient revenue due to the
projected data breaches occurring
over the next five years.
2015 2016 2017 2018 2019
$90
$80
$70
$60
$50
$40
$30
$20
$10
$0
Billions
Lifetime Patient Revenue At Risk Related to
Projected Healthcare Provider Data Breaches
Estimated cumulative lifetime patient revenue loss
2015 to 2019 ~$305 billion
Source: “The $300 Billion Attack: The Revenue Risk and Human Impact of Healthcare Provider Cyber Security Inaction.” Accenture. July 2015. Projections are original Accenture analysis utilizing data from the Ponemon Fifth Annual Study on
Medical Identity Theft (http://medidfraud.org/2014-fifth-annual-study-on-medical-identity-theft/), the Ponemon Fourth Annual Benchmark Study on Patient Privacy and Data Security (http://www.ponemon.org/blog/fourth-annual-benchmark-study-
on-patient-privacy-and-data-security), and the HHS Office for Civil Rights breach database.
10
Complication
What are key challenges to improving health cyber security?
• The healthcare industry faces unique challenges and must address how stakeholders can
catch up with other industries.
Copyright © 2015 Accenture All rights reserved.
Poor Diligence
Lack of awareness of security
breaches during and following attack
Partner Weaknesses
Vendor and partner security
weaknesses impact all
Outdated Security
Healthcare organizations tend
to have fewer defenses and
dated protection – e.g. on
premise servers are less secure
than cloud solutions
Inaccurate
Perceptions
Belief that smaller
organizations are immune
from attack is misleading –
everyone is at risk
Rich Data At Risk
Stolen health information is worth
10 times more than credit cards on
the black market due to the personal
identity data
Compliance Is Not
Enough
Impacted organizations and
the industry overall
demonstrate slow response
to rapidly increasing
vulnerability
Sources: “Hacker calls health security ‘Wild West’” - http://www.healthcareitnews.com/news/hacker-calls-health-security-wild-west, “Why health hacks are worse than credit card hacks” - http://fortune.com/2015/02/05/why-health-hacks-are-worse-than-
credit-card-hacks/?xid=yahoo_fortune, “8 reactions to the Anthem hack from health IT leaders and cybersecurity experts” - http://www.beckershospitalreview.com/healthcare-information-technology/8-reactions-to-the-anthem-hack-from-health-it-leaders-
and-cybersecurity-experts.html
11
Opportunity
How can organizations approach addressing cyber security?
• Health organizations must move to active defense and prioritize improvements of their
cyber security in order to thwart breach events and malicious attacks.
Copyright © 2015 Accenture All rights reserved.
Embrace the cloud and
other emerging
technologies to boost IT
agility and reach
customers faster,
capitalize on efficiency
and cost benefits and do
so within risk tolerances
Become agile
Determine where
the organization currently
stands and the level of
resources required to
support meaningful
transformation
Assess security capability,
identify opportunities
Develop end-to-end
delivery and sourcing
Plan a delivery and
operational strategy for
each of the security
services they offer to
make a clear-eyed
assessment of internal
competencies for
designing, building and
deploying elements of a
cyber-security program
Manage complexity and
integrate the enterprise
Evolve the security
program vision: establish
an end-to-end enterprise
security program and
integrate it with existing
enterprise architecture
processes to reduce
complexity levels and
produce outcomes valued
by the business
Source: Accenture. “Intelligent Security: Defending the Digital Business.” August 2014.
Adapt to handle new
threats to the enterprise
by developing threat-
centered operations by
developing a deep
understanding of
adversaries, their goals
and techniques
Accelerate toward security
intelligence
12
Opportunity
Accenture Thought Leadership
Copyright © 2015 Accenture All rights reserved.
The Cyber Security Leap:
From Laggard to Leader
Security Implications of
the Accenture Technology
Vision 2014
The $300 Billion Attack: The
Revenue Risk and Human
Impact of Healthcare Provider
Cyber Security Inaction
Intelligent Security:
Defending the Digital
Business
13
Glossary of Terms
• Lifetime patient revenue: Total economic value or total patient revenue over the lifetime of an individual
patient.
• Cumulative lifetime patient revenue: Total lifetime patient revenue for a group of patients.
• Medical information theft: The crime of stealing patient personal information (including clinical and/or
financial information).
• Medical identity theft: The crime of fraudulently using an individual’s name and personal identity to
receive medical services, prescription drugs and/or goods, including attempts to commit fraudulent
billing.
• Impacted patients: Patients who have their personal information stolen in a data breach (as reported to
the U.S. Department of Health and Human Services Office for Civil Rights for breaches impacting 500 or
more people).
• Victimized patients or medical identity theft victims: Patients who have their personal information
stolen in a data breach and whose information is subsequently used in a fraudulent manner.
*Security breaches impacting more than 500 people must be reported by healthcare organizations to the
U.S. Department of Health and Human Services Office for Civil Rights.
14
For more information:
Brian Kalis
Accenture Health & Public Services
612-387-3858
brian.p.kalis@accenture.com
Janessa Nickell
Accenture Strategy
650-862-1747
janessa.nickell@accenture.com
Join the conversation:
@AccentureHealth
@AccentureStrat

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Safeguarding Patient Privacy in a Digital Age (Brian Kalis)

  • 2. 2 Health cyber security “is the Wild West…What’s in the news is just the tip of the iceberg.” Kevin Johnson CEO, Secure Ideas Source: “Hacker calls health security ‘Wild West’” - http://www.healthcareitnews.com/news/hacker-calls-health-security-wild-west
  • 3. 3Copyright © 2015 Accenture All rights reserved. SITUATION OPPORTUNITYCOMPLICATION
  • 4. 4 Situation What is happening with health cyber security? • Over the last five years, the number of data breaches has increased dramatically with an increase in frequency and number of impacted individuals. • From 2010 to 2014, the number of health care data breaches impacting more than 500 individuals increased over 40%. Copyright © 2015 Accenture All rights reserved. 2010 2015 Anthem 78.8M Cyber Attack UCLA 4.5M Cyber Attack CareFirst BCBS 1.1M Cyber Attack AvMed Inc. 1.2M Theft BCBS TN 1.0M Theft GRM Services 1.7M Theft IBM 1.9M Unknown Nemours Foundation 1.1M Loss SAIC 4.9M Loss Advocate Health 4.0M Theft MT HHS 1.1M Cyber Attack Community Health 4.5M Theft Xerox 2.0M Unauthorized Access Premera 11.1M Cyber Attack Health Care Data Breaches Impacting >1 Million Individuals Over the Last 5 Years Sources: Accenture analysis based on data from the HHS Office for Civil Rights breach portal. Data accurate as of July 2015.
  • 5. 5 • Trends vary for how different health industry stakeholders are impacted by the increasing risk and crime related to health data security. Copyright © 2015 Accenture All rights reserved. Situation How are different health organizations affected by data breaches? Health Plans Healthcare Providers Business Associates Total Breaches 141 838 273 Individuals Impacted ~98 Million (w/o Anthem – 19.3M) ~18 Million ~22 Million Average Breach Size ~696,000 (w/o Anthem – 138,000) ~22,000 ~82,000 Health Care Data Breaches, January 2010 – July 2015 Health Care Data Breaches – Key Points • Anthem Breach Outlier: Accounted for ~80% of total individuals impacted by Health Plan breaches since 2010 • Health Plan Breaches: Occurred less frequently and impacted the most individuals on average (even excluding Anthem outlier) • Healthcare Provider Breaches: Occurred most frequently and impacted the least individuals on average • Business Associate Breaches: Impacted the largest total number of individuals (excluding Anthem outlier) Sources: Accenture analysis based on data from the HHS Office for Civil Rights breach portal. Data accurate as of July 2015. Healthcare Clearing Houses and a small number of breaches without a designated covered entity type were excluded from this analysis based on low reporting rate.
  • 6. 6 Situation Why are health data breaches such a large risk? • The monetary value of stolen health care data far surpasses other forms of personal information, making it a prime target for security threats. Copyright © 2015 Accenture All rights reserved. Medicare Number Black Market Value $470 $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ Credit Card Number Black Market Value (Few quarters or dollars) $ Sources: “The black market for stolen health care data” -http://www.npr.org/blogs/alltechconsidered/2015/02/13/385901377/the-black-market-for-stolen-health-care-data
  • 7. 7 Situation How do health data breaches impact victims? • Individuals victimized by medical information and medical identity theft suffer a variety of problems related to the crime. Copyright © 2015 Accenture All rights reserved. TIME Victims resolving crimes related to medical identity theft spend more than 200 hours on: • Verifying that the correct personal health information remains in the record and false information is removed • Ensuring that the criminal can no longer use the victim’s medical information fraudulently • Dealing with medical invoices and claims WELLBEING Fraudulent use of personal medical and financial information can be difficult to detect and remedy. Medical identity theft can cause dangerous errors such as: • Misdiagnosis • Delayed medical treatment • Interference with provision of the correct medical care Additionally, 45% of victims say the crimes affected their reputation and were embarrassing due to disclosure of sensitive information. $ FINANCES Medical identity theft victims are not usually protected from health cyber crimes and pay an average of $13,500 in out-of-pocket expenses for: Incorrect medical bills paid unwittingly Reimbursement to insurers for healthcare services obtained fraudulently Legal costs to unravel the cyber crime and remedy negative implications Sources: Ponemon Fifth Annual Study on Medical Identity Theft - http://medidfraud.org/2014-fifth-annual-study-on-medical-identity-theft/
  • 8. 8 Situation What is the projected financial impact to patients? • Over the next five years, patients will suffer ~$56 billion in out-of-pocket costs due to medical identity theft resulting from healthcare provider data breaches. Copyright © 2015 Accenture All rights reserved. 3.47 4.13 4.93 5.87 7.00 0.87 1.03 1.23 1.47 1.75 0.56 0.67 0.80 0.95 1.14 0 1 2 3 4 5 6 7 8 1 2 3 4 5 Millions Projected Patients Impacted and Victimized by Medical Identity Theft due to Healthcare Provider Breaches, 2015-2019 Patients Impacted Patients Victimized Patients Paying OOP 2015 2016 2017 2018 2019 Patient OOP Costs: $56 Billion Accenture projects that 25% of patients impacted by healthcare provider data breaches between 2015 and 2019—more than 6 million people—will subsequently become victims of medical identity theft. Sixteen percent of impacted patients—more than 4 million people— will be victimized and pay out-of-pocket costs totaling almost $56 billion over the next 5 years. Source: “The $300 Billion Attack: The Revenue Risk and Human Impact of Healthcare Provider Cyber Security Inaction.” Accenture. July 2015. Projections are original Accenture analysis utilizing data from the Ponemon Fifth Annual Study on Medical Identity Theft (http://medidfraud.org/2014-fifth-annual-study-on-medical-identity-theft/), the Ponemon Fourth Annual Benchmark Study on Patient Privacy and Data Security (http://www.ponemon.org/blog/fourth-annual-benchmark-study-on- patient-privacy-and-data-security), and the HHS Office for Civil Rights breach database.
  • 9. 9 Situation What is the projected financial impact to patients? • Over the next five years, healthcare providers are at risk of losing over $300 billion in cumulative lifetime patient revenue due to data breaches. Copyright © 2015 Accenture All rights reserved. Provider Revenue Risk: $305 Billion Almost half of patients say they would find a different provider if they were informed their medical records were stolen. Taking into account the estimated lifetime economic value of a patient, Accenture analysis shows that healthcare providers are at risk of losing $305 billion in cumulative lifetime patient revenue due to the projected data breaches occurring over the next five years. 2015 2016 2017 2018 2019 $90 $80 $70 $60 $50 $40 $30 $20 $10 $0 Billions Lifetime Patient Revenue At Risk Related to Projected Healthcare Provider Data Breaches Estimated cumulative lifetime patient revenue loss 2015 to 2019 ~$305 billion Source: “The $300 Billion Attack: The Revenue Risk and Human Impact of Healthcare Provider Cyber Security Inaction.” Accenture. July 2015. Projections are original Accenture analysis utilizing data from the Ponemon Fifth Annual Study on Medical Identity Theft (http://medidfraud.org/2014-fifth-annual-study-on-medical-identity-theft/), the Ponemon Fourth Annual Benchmark Study on Patient Privacy and Data Security (http://www.ponemon.org/blog/fourth-annual-benchmark-study- on-patient-privacy-and-data-security), and the HHS Office for Civil Rights breach database.
  • 10. 10 Complication What are key challenges to improving health cyber security? • The healthcare industry faces unique challenges and must address how stakeholders can catch up with other industries. Copyright © 2015 Accenture All rights reserved. Poor Diligence Lack of awareness of security breaches during and following attack Partner Weaknesses Vendor and partner security weaknesses impact all Outdated Security Healthcare organizations tend to have fewer defenses and dated protection – e.g. on premise servers are less secure than cloud solutions Inaccurate Perceptions Belief that smaller organizations are immune from attack is misleading – everyone is at risk Rich Data At Risk Stolen health information is worth 10 times more than credit cards on the black market due to the personal identity data Compliance Is Not Enough Impacted organizations and the industry overall demonstrate slow response to rapidly increasing vulnerability Sources: “Hacker calls health security ‘Wild West’” - http://www.healthcareitnews.com/news/hacker-calls-health-security-wild-west, “Why health hacks are worse than credit card hacks” - http://fortune.com/2015/02/05/why-health-hacks-are-worse-than- credit-card-hacks/?xid=yahoo_fortune, “8 reactions to the Anthem hack from health IT leaders and cybersecurity experts” - http://www.beckershospitalreview.com/healthcare-information-technology/8-reactions-to-the-anthem-hack-from-health-it-leaders- and-cybersecurity-experts.html
  • 11. 11 Opportunity How can organizations approach addressing cyber security? • Health organizations must move to active defense and prioritize improvements of their cyber security in order to thwart breach events and malicious attacks. Copyright © 2015 Accenture All rights reserved. Embrace the cloud and other emerging technologies to boost IT agility and reach customers faster, capitalize on efficiency and cost benefits and do so within risk tolerances Become agile Determine where the organization currently stands and the level of resources required to support meaningful transformation Assess security capability, identify opportunities Develop end-to-end delivery and sourcing Plan a delivery and operational strategy for each of the security services they offer to make a clear-eyed assessment of internal competencies for designing, building and deploying elements of a cyber-security program Manage complexity and integrate the enterprise Evolve the security program vision: establish an end-to-end enterprise security program and integrate it with existing enterprise architecture processes to reduce complexity levels and produce outcomes valued by the business Source: Accenture. “Intelligent Security: Defending the Digital Business.” August 2014. Adapt to handle new threats to the enterprise by developing threat- centered operations by developing a deep understanding of adversaries, their goals and techniques Accelerate toward security intelligence
  • 12. 12 Opportunity Accenture Thought Leadership Copyright © 2015 Accenture All rights reserved. The Cyber Security Leap: From Laggard to Leader Security Implications of the Accenture Technology Vision 2014 The $300 Billion Attack: The Revenue Risk and Human Impact of Healthcare Provider Cyber Security Inaction Intelligent Security: Defending the Digital Business
  • 13. 13 Glossary of Terms • Lifetime patient revenue: Total economic value or total patient revenue over the lifetime of an individual patient. • Cumulative lifetime patient revenue: Total lifetime patient revenue for a group of patients. • Medical information theft: The crime of stealing patient personal information (including clinical and/or financial information). • Medical identity theft: The crime of fraudulently using an individual’s name and personal identity to receive medical services, prescription drugs and/or goods, including attempts to commit fraudulent billing. • Impacted patients: Patients who have their personal information stolen in a data breach (as reported to the U.S. Department of Health and Human Services Office for Civil Rights for breaches impacting 500 or more people). • Victimized patients or medical identity theft victims: Patients who have their personal information stolen in a data breach and whose information is subsequently used in a fraudulent manner. *Security breaches impacting more than 500 people must be reported by healthcare organizations to the U.S. Department of Health and Human Services Office for Civil Rights.
  • 14. 14 For more information: Brian Kalis Accenture Health & Public Services 612-387-3858 brian.p.kalis@accenture.com Janessa Nickell Accenture Strategy 650-862-1747 janessa.nickell@accenture.com Join the conversation: @AccentureHealth @AccentureStrat