Enterprise Risk Management for Health Care, Fourth Edition

Health care organizations, from physician groups to large complex health systems, are operating in an environment of conflicting regulatory imperatives, shortages of critical staff, changing technology, and evolving business conditions. With limited resources, leaders and staff struggle to establish priorities among competing needs and to improve strategic planning, budgeting, and resource allocation. Enterprise Risk Management (ERM), a discipline adapted from the financial services industry, provides an analytical and philosophical framework for identifying, assessing, and strategically addressing risks and opportunities.

This Fourth Edition of Enterprise Risk Management for Health Care was entirely redesigned by members of the American Health Law Association and ASHRM to provide guidance for leaders and advisors of health care organizations at any point along the ERM journey. With the benefit of lessons from sound ERM programs in other industries, the authors closely focus on issues unique to health care organizations, examining applications of ERM in this challenging context, with consideration of legal implications present across the full range of health care risk domains.

This new edition is of value to health care risk professionals, attorneys, strategic planners, internal auditors, human resources and finance managers, and others, whether they drive change from within an organization or as outside advisors. This Fourth Edition of Enterprise Risk Management for Health Care serves as both primer and a comprehensive guide for a variety of audiences.

Table of Contents

OPERATIONAL RISK
Chapter 1     The Role of Governance in Managing Organizational Risk
Chapter 2     An Enterprise Risk Management Approach to Contracting
Chapter 3     Managing Supply Chain Risks: An Enterprise Risk Approach
Chapter 4     Peer Review and Credentialing in an Era of Enterprise Risk Management
Chapter 5     Reducing Enterprise Risk Through Diversity, Equity, and Inclusion
 

CLINICAL AND PATIENT SAFETY RISK
Chapter 6     Enterprise Risk Management Considerations Regarding Individual Rights
Chapter 7     Patient Rights: Informed Consent and Clinical Research
Chapter 8     Public Health, Infection Prevention and Control, and the Law
Chapter 9     The Benefits of ERM-Based Approaches for Health Care Investigations
 

STRATEGIC RISK 
Chapter 10     Risks Related to Emerging Health Care Delivery Models
Chapter 11     Using Enterprise Risk Frameworks to Advance Population Health
 

FINANCIAL RISK
Chapter 12     Managing Risks Related to Federal Reimbursement
Chapter 13     Health Insurers’ Enterprise Risk Management Techniques
Chapter 14     Private Equity Investment in Health Care Enterprises
Chapter 15     Captive Insurance Company as an ERM Driver
 

HUMAN CAPITAL RISK  
Chapter 16     The Employment Relationship: Identifying and Managing Risks
 

LEGAL AND REGULATORY RISK
Chapter 17     Managing Fraud and Abuse Risks Through an Effective Compliance Program
 

TECHNOLOGY RISK
Chapter 18     Enterprise Risk Management Considerations for Electronic Health Records, Personal
Health Records, and Health Information Exchanges
Chapter 19     Cybersecurity Risks for Health Care Enterprises
Chapter 20     Managing the Risks of Telehealth Practice
 

HAZARD RISK
Chapter 21     Environmental Risk Management