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Obamacare Repeal or Replace....What we Know Today

Chicago, IL, February 20, 2017 – Paracon Group, Inc., a business transformation firm that uses knowledge automation and advanced analytics powered by Expertool, comments on the early proposals for changes to the Affordable Care Act.

For millions of insured today under the Affordable Care Act (ACA or Obamacare), the repeal or replacement looks to put them in harm’s way.  The lawmakers have begun formulating legislation and we at Paracon Group are going to give you some indicators of what this early impact might mean.  

Last week Health and Human Services Secretary Tom Price, House Ways and Means Chairman Kevin Brady (R-TX), and House Energy and Commerce Committee Chairman Greg Walden (R-OR) joined speaker Ryan in reaffirming their commitment to repealing and replacing Obamacare. House Ways and Means Chairman Kevin Brady (R-TX) said, “We’re going to continue to work through this through the district work period next week. And as we come back in the weeks ahead we’re going to be moving forward with legislation.”

This is what we know so far about what the replacement proposal would include:

  • Health Savings Accounts: While positive as a before tax measure for individuals, this puts more out of pocket responsibility on the patient.
  • High-risk pools for sick people, The effect of  this is that it  'segregates' sick and well populations. Obamacare “tried” to have good 'risk pooling' to spread the cost across a larger population. It wasn’t always successful, as demonstrated by the several insurers that pulled out of the exchange markets.  This new proposal may allow insurers to avoid sick applicants or charge them more, hence making it extremely costly for those in this new pool.
  • States receiving greater control over health care. Unfortunately the states are ill prepared to accept this new burden.  Nearly  half of the states do not have money now.
  • Tax credits for individuals to buy health insurance dependent on age and family size rather than Obamacare’s income basis. First, a 'tax credit' means the patient must pay 'up front' each month in hopes of getting a credit at tax time. Many in the lower income brackets will struggle from a cash flow perspective to pay for the coverage that they need.  Second, this clearly means less subsidy than previously. That will cause many go to without coverage - again.
  • Lowers Medicaid back to each states’ traditional match rate. The proposal says, “This ensures continuity of care and coverage for low-income adults, but does not reward states that expanded Medicaid under Obamacare and allows individuals to cycle off the program into other coverage sources naturally.”  As said above, half of the states do not have money and have nothing to contribute therefore, the 'matching funds' will likewise be inadequate. This will especially hurt hospital emergency rooms but many physicians as well).  
  • States that did not elect to expand Medicaid would receive additional resources to make states more equal. This exacerbates the problem in overall less funding for Medicaid.
  • Limit per capita spending on Medicaid; however, states can elect to choose a block grant. The block grant does not include Obamacare’s expanded Medicaid funding and presumes that individuals find coverage outside of the Medicaid program. When a 'block grant' runs out, that's it, the program is over for that year, irrespective of the month. So, if the block grant is used up in say, September, there is no more healthcare for those people in that program until January. Unlike an 'entitlement' where once a person meets the test, they are entitled to the service and it's the government’s responsibility to fully fund the cost).

There is no new thinking here from past proposals. It essentially 'caps' the federal exposure and puts the shortfall back on the States and the individuals. If you back up ten years, that is how we got to 20 million uninsured Americans previously. These proposals, if enacted as is, individuals, doctors and hospitals will all be dramatically negatively affected. This is 'back to the future', the one where tens of millions had no coverage at all leading doctors to 'drop out' of programs and hospitals to go bankrupt.

In our  opinion, the fix to healthcare must come from other efficiency.  Nearly 70% of the claims processed in the United States comes from Self-Funded health plans.  Since the companies are acting at the “insurance” company – taking on the risk, what most Americans think of as insurers are really claims processing companies.  This added layer of burden could be dramatically improved.  The large intermediaries, mostly insurance companies acting in the role of third party administrators, have the means to affect the cost of coverage and improve the accuracy of the billing processing.  The American Medical Association estimates that there is a 20% error rate in the bills.  Shouldn’t these processors have the means and technology to improve that number?  

We will monitor the proposals as they change and post information as it becomes available.

Paracon Group, Inc., founded in 2010 and headquartered in New York with additional offices in Illinois, Florida and Connecticut, provides next generation business intelligence, technology and expertise to numerous industries and consultancies across the United States.  Knowledge Engineering services are powered by Expertool, an in memory analytics and universal modeling platform coupled with innovative knowledge automation mapping methodology and technology.  Forensic Audit services focus on traditional forensic accounting services and specialized health plan audits using the full power of ERISA and the ACA. Project management staffing and consulting expertise services provide co-sourcing or outsourcing for temporary or full-time staffing needs.   See more information at www.paracongroup.com

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Internal Audit - the next 20 years

New York, NY November 23, 2016: Paracon Group, Inc., a business transformation firm that uses knowledge automation and advanced analytics powered by Expertool, comments on the future of Internal Audit.

Where is the internal audit profession is heading in 5, 10 or 20 years from now?

We believe internal audit will remain a very important function in the future. Stricter regulatory requirements, stakeholder needs and the continued fraud, waste and abuse that occurs globally to start.

It’s a statutory requirement in many parts of the world to have an internal audit function. The global recession, corporate failures, banking crises, money laundering, corporate fraud, cyber-attacks, volatile market and disruptive innovation, etc. all necessitate the need for an internal audit function in the future as well.

What can Internal Auditors do to equip themselves and remain competitive and effective as value adding leaders in the organization?

There is a need to change the mindset of the auditor.  Our primary purpose is to help the organization to achieve its objective. Mostly, internal auditors are more focused on how to audit rather than why to audit.

It’s up to the internal auditor, to choose to act like a doctor or a police officer or strike a balance between both.

How to audit raises the element of independent and objective. How to audit also demand to consider several factors such as the nature of the business, industry norm, management style, internal culture, control environment etc.

What would be the best starting point for an internal auditor to move towards becoming a trusted strategic adviser to the business?

In future, the most successful audit professionals will be the one, who embrace the change and be ready to adapt to tackle new challenges of future risks.

The traditional approach is required, but in the current volatile environment, we have to have more innovative ideas and approach to safeguard the interest of shareholder/stakeholder. May be that’s one of the reasons that IIA revised the internal audit definition, which encompass along with audit assurance, advisory role as well.

In the very near future the audit professional will dramatically move from periodic to continuous audit, from manual or semi-automated to fully automated controls, from sampling to a 100 % population review, from providing assurance on historical data to providing assurance on emerging risk, from assessing business continuity to ensuring business resilience, from improving efficiency to recommending changes and innovation.

How auditor can equip themselves?

It’s simple - be open, be welcoming, be informed, be flexible.

In terms of technical skills, auditors should be aware of its surroundings, be its industry knowledge, global issues, political turmoil or disruptive innovation. It is important for auditor to study its impact on the business e.g. bit coin, driver-less cars, Hyper-loop travel, 3D construction printing, data transfer, hydroponics farming techniques etc.

In terms of interpersonal skills, the auditor can improve their communication, presentation, leadership and human psychology skills, without which it’s difficult to achieve desired objectives.

Paracon Group, Inc., founded in 2010 and headquartered in New York with additional offices in Illinois, Indiana and Connecticut, provides next generation business intelligence, technology and expertise to numerous industries and consultancies across the United States.  Knowledge Engineering services are powered by Expertool, an in memory analytics and universal modeling platform coupled with innovative knowledge automation mapping methodology and technology.  Forensic Audit services focus on traditional forensic accounting services and specialized health plan audits using the full power of ERISA and the ACA. Project management staffing and consulting expertise services provide co-sourcing or outsourcing for temporary or full-time staffing needs.   See more information at www.paracongroup.com

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Business Solutions Through Innovation & Technology

New York, NY, June 21, 2016 – Paracon Group, Inc., a business transformation firm that uses knowledge automation and advanced analytics powered by Expertool, leadership was featured on "The Bubba Show" on LibertyTalk.fm.  

Brian Andreatta, Managing Partner, and Alan Hofman, SVP Business Development and Strategic Financing, appeared with Todd "Bubba" Horowitz, host of "The Bubba Show".  Brian and Alan focused on how Paracon is helping midsize and large companies identify problems before it's too late.  These firms, many times, don't even know they're leaking and the Paracon team is the one to point out the issues they are facing.  

How does Paracon accomplish this?  Through its innovative Expertool based solutions. Expertool enables Paracon's expert team to analyze the people, process and technology aspects of the organization quickly. We rapidly document and understand our client's business processes and identify opportunities to improve those processes through automated tools. Paracon delivers solutions that streamline operations while enforcing quality and compliance standards.

Further information and the full interview can be found at: http://libertytalk.fm/business-solutions-thought-innovation-and-technology/

Paracon Group, Inc., founded in 2010 and headquartered in New York with additional offices in Illinois, Indiana and Connecticut, provides next generation business intelligence, technology and expertise to numerous industries and consultancies across the United States.  Knowledge Engineering services are powered by Expertool, an in memory analytics and universal modeling platform coupled with innovative knowledge automation mapping methodology and technology.  Forensic Audit services focus on traditional forensic accounting services and specialized health plan audits using the full power of ERISA and the ACA. Project management staffing and consulting expertise services provide co-sourcing or outsourcing for temporary or full-time staffing needs.   See more information at www.paracongroup.com

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Expansion of Employee Benefit Audit Solutions

New York, NY, February 15, 2015 – Paracon Group, Inc., a business transformation firm that uses knowledge automation and advanced analytics powered by Expertool, announced additions to its growing Employee Benefit Audit and Compliance Solutions.  

Paracon's Risk Advisory approach, based in audit and transparency, focuses on helping you make the most strategic and evidenced based decisions for one of your largest expenditures.  Many auditor and employee benefit professionals can benefit from this holistic approach. Most competing firms focus on limited scope commodity based claim audit offerings that miss the key elements of what drives higher costs and are very limited in their scope. 

How does Paracon differ? 

·         Most companies assume that the Form 5500 audit that their external accountant performs is enough.  Those audits don’t focus on what is truly at risk – the financial transactions  between the TPA and provider. Paracon looks at both sides of the transaction to ensure that each and every claim is properly paid and monies that leave the plan are paid to the providers.

·       Court cases outlining ERISA violations surrounding improper payments, recoupments, undisclosed markups that go unchecked by traditional audits.  Paracon’s audit identifies these errors and helps to recover any monies due to the plan.  

·       Big shocker – hospital bills contain errors.  Everyone “knows” this but a Prepayment Compliance Review actually reviews these bills BEFORE they are paid to ensure what you are paying for is actually what was delivered and proper.  It’s a continuous ongoing audit of your healthcare spend.  

·       How do you know your claims  are adjudicated properly?  Our Plan Compliance Audit reviews every claim over the past 2 years to identify every single error.  EXPERTOOL, our proprietary artificially intelligent software, and our team of experts use discovery analytics, data science and over 20 years of expertise to ensure your claims are paid according to your plan documents.   

Paracon Group, Inc., founded in 2010 and headquartered in New York with additional operations in Illinois, Florida, Indiana, Kentucky and Connecticut, provides next generation business intelligence, technology and expertise to numerous industries and consultancies across the United States.  Knowledge Engineering services are powered by Expertool, an in memory analytics and universal modeling platform coupled with innovative knowledge automation mapping methodology and technology.  Forensic Audit services focus on traditional forensic accounting services and specialized health plan audits using the full power of ERISA and the ACA. Project management staffing and consulting expertise services provide co-sourcing or outsourcing for temporary or full-time staffing needs.   See more information at www.paracongroup.com.  

 

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2016 IIA General Audit Management Conference

New York. February 14, 2016 - Paracon Group, Inc., an advanced analytics and business transformation firm that uses knowledge automation powered by Expertool, announced that the firm will be exhibiting at the Institute of Internal Auditors annual General Audit Management Conference at the Gaylord Texan Resort in Dallas Fort Worth, Texas.  Both Managing Partners, Russell Safirstein and Brian Andretta, will be connecting with over 1,200 senior audit professionals during the three day event beginning on March 7th.  Highlighting the firm's unique capabilities with regards to its Health Benefits Audit practice will be a main discussion point.  A case in point includes the following Client success story:

For a Fortune 100 manufacturer, our compliance reviews identified several very material non-billable charges (38% savings), incorrect DRG coding (8%), in hospital stay accident (80% savings), invalid trauma response (15%) and incorrect dosages (90%).  In all, over a 18 month period over $15 million of savings have been realized by the Health Plan - an average of 17% error rates. 

Paracon Group, Inc., founded in 2010 and headquartered in New York with additional operations in Illinois, Indiana, Florida, Kentucky and Connecticut, provides next generation business intelligence, technology and expertise to numerous industries and consultancies across the United States.  Knowledge Engineering services are powered by Expertool, an in memory analytics and universal modeling platform coupled with innovative knowledge automation mapping methodology and technology.  Employee Benefit Solutions focus on providing a Risk Advisory approach across the entire supply chain and utilized the full power of ERISA and the ACA. Project management staffing and consulting expertise services provide co-sourcing or outsourcing for temporary or full-time staffing needs.   See more information at www.paracongroup.com

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Connecting Strategic Risk and Internal Audit

New York, NY December 8, 2014 – Paracon Group, Inc., a business transformation firm that uses knowledge automation and advanced analytics powered by Expertool, announced that Managing Partner and President, Russell Safirstein and Senior Vice President Knowledge Automation and Advanced Analytics practice leader, Joe Glick will be featured presenters at the December 12, 2014 Long Island Chapter Institute of Internal Auditors meeting at the Marriott Hotel in Melville, New York.  Presenting on Connecting Strategic Risk and Internal Audit, Mr. Safirstein and Mr. Glick will discuss the need to change internal audit’s position in the risk landscape and provide several practical examples where this connection already exists. 

“Risk events occur all around us. Internal Audit needs to address the rapidly changing business landscape. “said Russell Safirstein, Paracon Group’s President.  “Knowledge automation and advanced analytics provide greater insights through discovery capabilities to internal audit and its stakeholders that cannot be achieved using traditional tools.”

Paracon Group continues to bring innovation to the Risk Advisory market.  “For years thought leaders in risk management have emphasized the need to look at risk management holistically, while acknowledging the lack of adequate technology. Paracon’s solution powered by Expertool makes holistic risk management a reality.”  said Joe Glick, inventor of the Expertool platform.  

Paracon Group’s agile solutions give our clients the answers they want in the time frame they never thought possible.  Contact us today for a free demonstration.  

To register for the course. http://www.cvent.com/d/p4qy97/4W

Paracon Group, Inc., founded in 2010 and headquartered in New York with additional offices in Illinois, Indiana and Connecticut, provides next generation business intelligence, technology and expertise to numerous industries and consultancies across the United States.  Knowledge Engineering services are powered by Expertool, an in memory analytics and universal modeling platform coupled with innovative knowledge automation mapping methodology and technology.  Forensic Audit services focus on traditional forensic accounting services and specialized health plan audits using the full power of ERISA and the ACA. Project management staffing and consulting expertise services provide co-sourcing or outsourcing for temporary or full-time staffing needs.   See more information at www.paracongroup.com

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COSO 2013 Toolkit saves hundreds of hours of manual labor

New York, NY October 7, 2014 – Paracon Group, Inc., a business transformation and knowledge engineering services firm , announced the release of their new COSO 2013 Toolkit.  The toolkit allows you to cut hundreds of hours of manually mapping of principles and points of focus to your organization’s operational and financial controls.  

“Paracon Group raises the bar for successful COSO 2013 implementation, while reducing the organizational burden of new regulations, “ said Russell Safirstein, Paracon Group’s President.  “Organizations both large and small can benefit from seeing a rapid COSO 2013 implementation effort.”

The COSO 2013 Toolkit easily and quickly identifies any gaps in your control organization and will allow you to quickly move to implementation and integration.  Paracon Group continues to bring innovation to the Risk Advisory market.  “The COSO 2013 Toolkit enables real-time discovery analysis and navigation across multiple disparate documents, “ said Joe Glick, Paracon Group’s Knowledge Engineering practice director.  

Paracon Group’s agile solutions give our clients the answers they want in the time frame they never thought possible.  Contact us today for a free demonstration.  

Paracon Group, Inc., founded in 2010 and headquartered in New York with additional offices in Illinois, Indiana and Connecticut, provides next generation business intelligence, technology and expertise to numerous industries and consultancies across the United States.  Knowledge Engineering services are powered by Expertool, an in memory analytics and universal modeling platform coupled with innovative knowledge automation mapping methodology and technology.  Forensic Audit services focus on traditional forensic accounting services and specialized health plan audits using the full power of ERISA and the ACA. Project management staffing and consulting expertise services provide co-sourcing or outsourcing for temporary or full-time staffing needs.   See more information at www.paracongroup.com

 

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Past Speaking Engagements

Paracon's team presents at various industry conferences around the county.  Our past presentations have included (copies available upon request):

  • Connecting Strategic Risk and Internal Audit - Long Island IIA, December 2014 - Presented by Russ Safirstein, Managing Partner and Joe Glick, SVP
  • Assessing and Transforming Internal Audit - IIA Northeast Regional Conference, September 2014 - Presented by Russ Safirstein, Managing Partner
  • Strategic Enhancements for Internal Auditors - Chicago IIA, April 2014 - Presented by Russ Safirstein, Managing Partner
  • Effective Audit Communication - Philadelphia IIA, May 2014 - Presented by Russ Safirstein, Managing Partner
  • Internal Audit Transformation - Philadelphia IIA, November 2013 - Presented by Russ Safirstein, Managing Partner
  • Prescription for Change - Why Employee Benefits Needs to be on Your 2014 Audit Plan - Long Island IIA, October 2013, Russ Safirstein, Managing Partner
  • Knowledge Engineering For Auditors - Chicago IIA, May 2013, Russ Safirstein, Managing Partner
  • Self Funded Health Plan Forensic Audits - Philadelphia IIA, April 2013, Russ Safirstein, Managing Partner
  • Audit Report Writing - Philadelphia IIA April 2013, Presented by Russ Safirstein, Managing Partner
  • Health Plan Recoupments - Long Island IIA, October 2012
  • Knowledge Engineering for Auditors - Long Island IIA, April 2012, Presented by Russ Safirstein, Managing Partner and Joe Glick, Managing Director
  • Auditor Tool Kit (Auto WPs, Sampling, Report Writing, Data Analysis, Continuous Monitoring)
  • October 14, 2011 – Long Island IIA
    Presented by Russ Safirstein & Colleen Schmitt – Paracon Group (Download presentation  )
  • The Convergence of Internal Audit and Enterprise Risk - a Case Study
    May 17, 2011 - BCBSA 2011 Internal Audit; Anti-Fraud; Compliance and Ethics; Privacy Conference
    Presented by Russ Safirstein, Managing Partner (Contact Russ for more information)
  • Converging Auditing and Enterprise Risk Management
    September 17, 2010 – Long Island IIA
    Presented by Russ Safirstein, Managing Partner – Paracon Group and Al Berg, Chief Risk Officer –Liquidnet Holdings, Inc. (Download presentation  )
  • How the 5 Cs can help you Compose a Successful Audit Report
    December 10, 2010 – Long Island IIA
    Presented by Russ Safirstein, Managing Partner – Paracon Group (Download presentation  )

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Job Corner

Using LinkedIn To The Fullest Extent

I talk to recruiters regularly in my role for the IIA employment committee.  They all speak very highly of LinkedIn.  They find good candidates, get to know them and approach them with job opportunities that are geared towards the right candidates.  To a recruiter this is extremely helpful in mining the right candidates for a job rather than just blindly posting a job and being pounded with hundreds of unqualified applicants.  

How can you use this information to help you?

A LinkedIn Profile is NOT your resume

What used to work doesn't anymore.  A resume was your sales brochure summarizing your "features and benefits", listing out your skills, experience and education.  Not only is that out-of-date, it doesn't work for LinkedIn.  

What should you have?

  • A nice professional photo with a simple background.  No other people, kids, significant others or anything else that doesn't present you in the best professional light.
  • A professional heading that should describe who you are.  Be descriptive and not just the title from your last job or the fact that you're unemployed.  Use professional keywords.
  • A Summary which describes the professional "you".  Use keywords here again in conversational paragraphs and not a billeted list of responsibilities.  
  • A Skills section filled with keywords.  You can choose 50.  Anything less your shorting yourself.
  • Anything else that may be of interest.  A professional blog or public presentations via SlideShare.

Be Active

Once you've set up your profile, don't forget about it.  Actively engage in updating it, adding new insights and sharing, professionally, any insights and updates that your connections and others who view your profile might be interested in.  Remember this is a social professional network. Just by posting a minimal profile is not going to have the offers rolling in.  LinkedIn doesn't work that way.  

What should you do?

  • Get connected!!  The more connections you have the greater your visibility.  Try to add 20 connections a month, at least.  
  • Groups can be very important to helping others know who you are and what you think. They're online meet and greets. Treat them as such.  Be active and insightful.  Join those groups that have meaning to your current and future profession.  You're allowed 50 Groups - go find 20 that are valuable to you.  
  • Keep those updates coming.  Post something intelligent at least once a week.  Get your connections interested in you and what you have to say.  

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Job Corner

Russ Safirstein, Managing Partner, Paracon Group

rsafirstein@paracongroup.com

December 2013 – Many of us go into job interviews cold.  We do our periphery research and get an update from the recruiter or from a colleague that we know, but truth be told we really don’t know enough to make an informed decision.  You need to do your homework and ask deep-level questions of your interviewer, otherwise you won’t know what you’re signing up for.  Let’s all avoid that unsavory situation.

So picture this, you go find the “dream job” from an online posting or recruiter.  Sounds just like the job you wanted.  You’re sold before you even submit your resume for consideration.  Now you get called for an interview and you have stars in your eyes – laser-focused on the final outcome: Impress the interviewer and land the job.  You nod enthusiastically at everything they say, recite your scripted responses and ask a few obligatory questions.

For some, scripted responses may make them sound like a robot, for you it works out well as you land the job.  You’re excited but you’ve neglected one crucial step – asking the right questions that would actually help you evaluate if the job was the right fit for you.  

What are some of these questions you ask?  Deeper questions about the company itself and what it is like to work there.  Here are some pointers from the experts:

  • Use online resources such as Glassdoor to see what former employees are saying about the company.
  • Ask who your supervisor will be and ask what type of manager they are.  See if they sound like the three bad classes of bosses: micromanagers, neglectors or yellers.  Avoid these at all costs.
  • Ask if there are any divisions of the company where you’ll have the greatest impact.  Certain impact can lead to another line on your growing resume or a future talking point.  Remember we’re building a career here.  The greater the impact the better chance you have of being fulfilled and enjoy what you’re doing.
  • Ask about the skills you could develop. These are important as your career evolves to match your skills development to the needs of the market.  Don’t just look at the skills today, but look to tomorrow’s needs and make sure you’re ready for the next phase of your career.
  • Ask to speak to a peer.  They can fill you in on the day to day aspects of the job.  Peers also help you evaluate where and how you fit in.  Do you like this person?  Can you see yourself spending your quality time with them and others like them?
  • Ask about culture.  The quality of life there and outside of work is important to you fitting in with the team.  What is the quality of the hours not just the quantity of hours?  Is there some fun in the workplace or is it all seriousness?  What environment works best for you?

Good luck in your job search. 

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