In This Report

TripleTree’s research agenda and strategic advisory assignments across healthcare’s technology and outsourced services segments over the past twelve years have made us acutely aware of the broad, deep reaches and mounting financial, clinical and legal implications of healthcare compliance. While historically viewed as a regulatory function across the provider, payer, and life sciences sectors, compliance extends beyond government oversight and is tightly woven through most aspects of the healthcare system; a reality which consistently adds new layers of complexity and cost across the industry.

Our advisory work affords the opportunity to collaborate with many of the industry’s next generation compliance solution providers – a dynamic that has impacted our appreciation for the complexities of healthcare compliance which has, in turn, helped us build an analytical framework for benchmarking the many relevant touch points that comprise the healthcare compliance space.

This report defines the many sides of healthcare compliance by identifying and discussing the trends, solutions, and businesses emerging to solve the large unmet needs brought on by regulatory, legislative, financial, and industry-wide ‘calls to action’ for safer, cheaper, and higher quality healthcare delivery.

Compliance is an evolving concept that incorporates a multitude of regulatory, contractual, incentive, and other mechanisms designed to align patient, provider, payer, and other stakeholders around the central goal of improving outcomes while controlling healthcare delivery costs. Although we will not endeavor to cover all of the potential topics related to compliance in this report, we expect future reports will pick up on many of the themes set forth ahead.

Most of the analysis in this report focuses on compliance topics that drive reimbursement and related facets of the provider-payer relationship. For simplicity, we frame our discussion by providing separate analyses of compliance in the provider versus the payer sectors. This approach enables us to focus more extensively on a few key topics that are more germane for those customer sets. We should note, however, that most of the over-arching themes we cover have ramifications for both providers and payers such that both constituencies are frequently managing opposite sides of the same coin.