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Clearly one of the most impactful cyber events ever in healthcare. Today we look back on the last couple of weeks in the Change Healthcare ransomware event.

This incident is a stark reminder of the vulnerabilities in our health IT infrastructure. On February 21st, Optum reported widespread connectivity problems, signaling the onset of a crisis. By the next day, UnitedHealth Group suspected a nation-state was behind this turmoil.

As we tracked the developments, Black Cat, a notorious group, claimed responsibility on February 26th. Despite the legal and reputational risks highlighted by Fitch and Moody’s, UnitedHealth Group’s credit ratings remained stable, surprisingly.

The sequence of events escalated quickly. By February 27th, the Department of Health and Human Services (HHS) was alerting hospitals about Black Cat. Amid these warnings, Aetna acknowledged delays in payments to providers, prompting them to fast-track alternative payment solutions.

On the leap day, February 29th, Change Healthcare confirmed the Black Cat's involvement, collaborating with cybersecurity firms and law enforcement to mitigate the attack's effects. By March 1st, Optum had initiated a funding program to aid providers affected by the cash flow disruption, alongside implementing a workaround for its e-prescribing system.

The cyber onslaught had profound financial ramifications, with large health systems hemorrhaging over $100 million daily. In response, the HHS expedited payments to the affected hospitals. The cyberattack not only disrupted the data flow but also initiated a series of legal challenges against UnitedHealth Group.

As of March 7th, Change Healthcare had restored its pharmacy e-prescribing function, projecting a gradual reinstatement of other services through March. Meanwhile, UnitedHealth temporarily halted certain authorizations to mitigate the operational strain.

The recovery journey is ongoing, with significant financial assistance advanced to providers and new solutions being developed to streamline medical claims processing. Despite these efforts, the full recovery timeline remains uncertain, underscoring the severity of the attack's impact on the healthcare sector.

In reflecting on this ordeal, the critical takeaway is the imperative for robust business continuity planning. It's not just about reacting to incidents but proactively managing the risks inherent in our interconnected healthcare systems. This incident is a call to action for IT leaders and healthcare executives to rigorously evaluate and strengthen their cybersecurity and business continuity strategies, ensuring resilience against future cyber threats.

Transcript

Today in health. It, since there's so many stories on this. And some were really good. I'm going to do a change update. We're only going to talk about change healthcare. United healthcare and what they're doing. For today, my name is bill Russell. I'm a former CIO for a 16 hospital system and creator of this week health instead of channels and events dedicated to transform healthcare. One connection at a time. We want to thank our show sponsors who are investing in developing the next generation of health leaders.

Notable service. Now interprise health parlance. Certified health and paint a health. Check them out this week out.com/today. All right. Hey, we're getting all these new stories this week, health.com/news. If you had a chance to go ahead and check it out and have people sign up for the newsletter as well, that really helps us out.

I appreciate that. And Hey, just a quick thing on goal setting. Last year, we set a goal to raise $50,000 for Alex's lemonade stand. We raised a little over $50,000. We raised the goal this year, or we set a goal this year of a hundred thousand dollars and we've already raised $40,000 this year.

It's interesting. When you set that larger goal, how quickly you get to the old goal. And it's a pretty amazing $40,000 in the first. Three months. I think one of the things that really has impressed me is the generosity of the community. We have people coming alongside and actually giving personally to the campaign this year.

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Change healthcare. Really cool article Becker's hospital review. Didn't. I an article on the timeline. Which I thought was really good. The change healthcare, cyber attack, a timeline again, you could hit this on our website. You could hit the Becker's. A website as well. And see it. And so they go. In reverse order, it looks like yes.

In reverse order. So I'm going to scroll down to the bottom and come forward. February 21st Optima reported enterprise wide connectivity issues, February 22nd. United health group said it's suspected nation state group was behind the attack, February 26 restaurant group, where group black cat claimed responsibility. Fitch and Moody's said incident carries legal and reputational risk for United health group. But will not affect its credit ratings. Hard to believe. A lot of money.

We'll get to that in the next story. February 27th HHS warrant hospitals to be wary of black cat, the group that claimed responsibility and the message to providers Edna said it was aware of some providers and its network may not be able to receive timely payments. The insurer said it was prioritizing work arounds to get payments to providers. Fantastic.

February 29th, 2 29. If you will change healthcare confirms. That it was black cat. Changes changed, said it was working on cybersecurity from Palo Alto networks and Mandaean a Google subsidiary and law enforcement to address the cyber attack. March 1st Optum introduced a temporary funding assistance program for providers struggling with cashflow after the attack. Change also implemented a workaround system for its e-prescribing program.

Yeah. March 3rd, black had received a Bitcoin payment worth $20 million where. It was reported. March 4th H a. Called change. Healthcare is temporary funding program for effective providers. Inadequate. While the us Senate, majority leader, Chuck Schumer asked CMS to speed up payments to the hospitals. Larger health systems are bleeding more than a hundred million dollars daily.

These are all stories that we've covered. March 5th, HHS accelerated payments to hospitals, and that were affected elevates health CFO. Mark K said its company initially saw 15 to 20% reduction in the daily bottom volume of data. It received from providers. Following the attack. And now it's down about 10% relative to normal daily volumes. UMass. As CFO, Susan diamond said about 20% of the company's medical claims submitted. By providers go through change healthcare system before they reach the payer, making it difficult to gauge the total medical expenses. Our six lawsuits begin rolling in against United health group over the cyber attack.

March 7th, United health group releases a timeline for restoring the key. Change healthcare systems and CEO. Andrew witty confirmed to making things right as fast as possible. As of March seven changes, pharmacy electronic prescribing is fully functional. Let's see. Change is expected to have its electronic payment platform available for connection March 15th, it's medical claims network and software are expected to do star testing. For Rican reconnection on March 18th. Until March 31st United health has suspended Medicare advantage. And prior authorizations for most outpatient services. March 8th. H a American hospital association said it will take several weeks.

If not months before hospitals and other healthcare providers can fully recover from the attack. When he said the fallout will affect hospitals, credit ratings. Interesting. It will affect hospital credit ratings, but it will not affect health groups. Got it. Writings. Thank you very much. March 9th, CMS expanded its response to the attack to include advanced payments to physicians and other outpatient care providers. Experienced claims disruptions. March 10th, HHS called on United health to take responsibility ensure no provider is compromised by their cashflow challenges. For all payers, HHS asked that interim payments be made to effective providers and that their prior authorization to other utilization management requirements be put on hold. March 11th, Massachusetts hospitals are losing at least $24 million a day due to cyber attack. The state hospital association reported the AMA called for. And offered to help create a list of all payers that are offering advanced provider payments. March 12th. Officials with the Biden administration, seven United health group CEO, Andrew, witty to the white house, urging the company to provide more emergency funding to providers, Highmark health detailed and advanced funding program. For providers struggling with cashflow March 13th, federal government launched an investigation into United health and change over the cyber attack. Let's with, in the context of HIPAA compliance, ha urge Congress to consider existing statutory limitations that could limit aid from CMS and HHS to hospitals and providers. 14th AMA said it is. Dumbfounding. Dumbfounding. That following weeks of silence, any lack of assistance to struggling practices in the wake of the change, healthcare cyber attacks, a hip's response is a business as usual approach to prior authorizations. This approach is for particularly galling.

Since service outages have exacerbated the administrative burden and care delays. March 15th. And AMA a survey of nearly a thousand hospitals conducted between March 9th and 12th found that 94%. Of hospitals have felt financial impact from the attack and more than half ever report any significant or serious impact. Provider claims to payers have dropped by more than one third. So that's the that's the timeline?

I think they say they're going to keep the timeline going. So hit that story. And if they do it like others, you can keep hitting the same story. And seeing that over and over again. The next one is what has United health group restored since the attack and Group has successfully reinstated. The pharmacy system of exchange healthcare technology unit after ransomware attack.

And this is where's the story. I don't know where this story's shrub. Hold on a second. Reuters. There you go. Okay. So it's a Reuters story. They a. Changed. The unit after ransomware attack on February 21st. The conglomerate is on track to reactivate its payments platform and begin the restoration of its medical claims that work by mid-March.

Although a complete recovery is anticipated to take several months, despite the resumption of most pharmacy and payment systems. With over 99% of pre-incident claim volume flowing. Challenges persist from some pharmacies, particularly infusion ones and some Medicaid fee for service customers. Additionally, United health is addressing issues related. To the processing of prescription drug coupons and insurance claims with most electronic coupons now being processed again, and a phased reconnection and testing of the claim system planned for the week. Of March 18th.

Wow. That's there's just so much going on with these stories. It's really incredible.

All right, let's close with this one. This is a Becker's as well change attack. Update United health launching medical claim solution United health group as advanced more than $2 billion to providers. And as launching software for medical claims preparation, beginning of March 18th, following the cyber attack on exchange healthcare subsidiary. Software will be made available to thousands of providers in the next several days with third-party at a station available prior to the services becoming operational, following this initial phase. Remaining service registration will continue. Through ongoing phases of activation until all customers have been connected. We continue to make significant progress in restoring the services impacted so forth and so on. And the rest you've already heard about because it's a rehash of some of the things I just. Just talked about, i, a lot of times I end these today's shows with a, so what. And you already know that.

So what you're living the, so what, so it's it's the question I've been asking. And with several CEO's and others that I'm talking to it, and it is what is your business continuity plan going forward? The first time you have a outage like this, it is easy to point the finger it's change healthcare it's fill in the blank, whoever it might be. The second time.

It is a problem where you are not really holding the wheel. Of the ship. So right now, if I were a CIO, I'd be analyzing all the different systems we have that are in our data supply chain or in our payment supply chain or, or processed supply chain that leads to effective care, quality care. And leads to the flow of patients effectively through our system.

I'd be looking at all those interdependencies and I would have them all mapped out so that I could say. Okay. What happened with change could happen with this, or this? Whatever those five systems are. And then I would be having a conversation with the team around what is our business continuity plan around those five things.

I'd be looking at the contracts. I would be having conversations with those partners, with those vendors. Again, the first time it happens, it's easy to just point and say, look what happened at change healthcare? And aren't you proud of us? We responded within five days or three days or whatever number of days that you did, which again is a big deal.

I'm not minimizing that. But when it happens again, they were going to be looking at you saying, didn't this just happen? And you can say no change healthcare. And this time it's filling the blank. This other system over here. And there's really not us. It's outside of our control. It isn't outside of our control.

We at least have to make the organization aware of the risks. That are associated with the various systems and interdependencies that we have. And once we have made them aware of the risk, we give them a plan for remediating that risk. We could either have an, a three tier plan. One is remediating all risk.

Microsoft Mechanics

remediating the rest that we feel is plausible.

And that is something that we can afford and attainable, and that we can have the one that's like the bare minimum of at least we did this to minimize the impact on our system. That's what I'd be doing as a CIO. That's what I think affective CEO's are doing today. If they have not done it already is identifying all those risks for the leadership. This is not an it decision.

This is a leadership decision. Leadership needs to be made aware of the risks that are associated with the various systems within the health system. That's it that's all for today. That's a lot that's changed. Healthcare thing is just goes on and on. It's really amazing just to make you guys aware, we're going to start dropping a Trex is two and a half minute drill on this same station. If you are interested in cybersecurity and what's going on in cybersecurity and want to get two and a half minutes from Drex on that, he has been putting those out on LinkedIn.

We've gotten a request from people that they want to listen to it on their podcast channel. And so that will be going on here. We're going to be releasing this at midnight generally. So you'll have these in the morning. And directs we'll be releasing at noon. So they will show up at different times and these will always have today at the start of them.

And directors will have two and a half minutes or two and a half or some facsimile. You'll be able to look at them very easily in your podcast player and say, I'm looking for Drex or I'm looking for bill and you can listen to them that way. Just want to make you aware of that and really excited about the content that directs us putting out there, getting really good feedback from the industry.

Appreciate your feedback. Keep it coming. All right, again, that's all for today. Don't forget to share this podcast with a friend or colleague. Use it as a foundation. To keep the conversation going. We want to thank our channel sponsors who are investing in our mission to develop the next generation of health leaders. Notable service now, enterprise health parlance, certified health and 📍 Panda health.

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