Thursday, August 27 2020

Six Ways Technology Due Diligence Failure Can Kill Your Private Equity Investment

No matter what market you’re in, technology is a significant element of your business. Taxi companies learned this when Uber and Lyft employed sophisticated apps to topple their industry. Prior to the emergence of those two frame-breaking enterprises, few in the taxi industry would have considered themselves in the technology business.

Even a high-touch industry, like autism services, invests significant intellectual and monetary resources into computers, databases, practice management, and other critical technology.

ronit_article.jpg, Aug 2020

These systems and the people who run them are often overlooked when investors conduct due diligence before acquiring autism businesses. But they do so at considerable risk.

A 2007 study at the University of Virginia found that two-thirds of mergers and acquisitions fail to deliver their expected returns. More recent research (2016, 2017) shows this number as ranging between 50 and 85 percent. Much of this is due to poor integration of cultures and business practices. A significant piece of this is systems and technology.

In my work with private equity firms, I frequently encounter this problem. Investors acquire platform companies comprising multiple businesses that have been acquired and consolidated in a relatively short period of time. Frequently, each of the businesses within this platform is using different software for data collection, analytics and practice management. Often, it’s chaos for the employees who are charged with integrating new acquisitions into the company. Combine that with the growing failure to conduct substantial technology due diligence and what we’re left with are investors putting their investments at needless risk.

After speaking extensively with Scott Klososky of TriCorps Technologies, there are six areas of technology that investors must examine before investing in an autism business. These principles are applicable to any business, actually, but they are particularly pertinent in our field because investors often overlook the IT side of the house and focus most of their diligence efforts on reimbursement, risk and compliance, the social impact of the business, and the scalability of the clinical model.

Compromised Systems

No investor wants to purchase a company whose data has already been stolen. Consequently, it is critical to investigate the security of a target company’s data before investing. Due diligence investigations of Yahoo’s data systems saved Verizon $350 million. After discovering all three billion Yahoo email accounts had been hacked, Verizon slashed its $4.48 billion offer to cover the cost of remediation. Absent due diligence, Verizon would have paid for the email accounts and then found itself liable for the problem. Conversely, Marriott purchased Starwood and discovered a massive data breach in the reservation system that resulted in the hacking of personal data, including passport numbers, for millions of customers. Marriott failed to conduct proper due diligence during the transaction and has since incurred many millions of dollars in expenses to remedy these issues.

IT Integration

When two enterprises merge, the major concern is the integration of two distinct organizations. Most merging entities recognize the challenge of combining physical, cultural and operational systems, but often neglect or miscalculate the complexity of the required integration of IT. In my experience, the reliance on synergies and applicability of existing systems is generally overestimated; as a consequence, the cost to merge IT systems is generally underestimated. Most organizations are struggling just to integrate and optimize their own systems and would be severely challenged to assimilate a new one or to migrate the entire company to the best option available.

IT Staff Considerations

Put yourself in the shoes of your employees. An imminent merger or acquisition threatens their continued employment. Destroying documentation; changing protocols, passwords, etc.; and installing obsolescence into IT systems are just three strategies to create a level of indispensability that would protect their job or cause damage to the business once they are let go.

It’s important to remember that the overwhelming majority of people would never consider such actions. But it only takes one bad actor to wreak havoc for a company. Those closest to and with the deepest knowledge of the technology, software, systems, and processes that keep the company running smoothly are the ones with the greatest potential to do major damage. There are numerous accounts of these events in mergers and acquisitions. Companies can protect themselves: there are defense mechanisms against this kind of behavior that are the purview of IT experts.

The Leakage of Intellectual Property

Bearing in mind the same caveats about human nature, employees have been known to steal information. Not just a priority when selling the business, protecting intellectual property must be a core due diligence practice at all times. In one of my own businesses, an employee downloaded critical business information and intellectual property and used it to establish their own company, now worth a significant amount of money. During acquisition discussions, determining who is most likely to feel their job is in jeopardy can lead to defensive measures that protect intellectual property prior to completion of the purchase as well as throughout the lifespan of the business.

Social Engineering Hacks

While these sorts of attacks are an ever-present threat to businesses, smart criminals know that companies are especially vulnerable at times of sales or acquisitions and can exploit the situation to steal money. In a growing wave of cyber theft, we are seeing increasing incidents of thieves hacking into company email and sending requests for payments that go directly to an offshore account. Staff, aware that a transaction is imminent, comply with the request and suddenly large sums of money are gone. A client of mine avoided this scam only because the accounting employee questioned the CEO in person about transferring funds by wire. This is the exception that proves the rule. Oftentimes, transactions like this, that get easily flagged in the normal course of business are processed without hesitation during a sale because atypical financial transactions are commonplace during these periods.

Email Trading

The final vulnerability to look for is relevant to publicly traded companies. Before a deal is ever announced, there will be rumors circulating about the sale. More dangerously, there will be ongoing chatter between business leaders that reveals sensitive information, most especially a possible sell date.

While rare, it’s not unheard of for opportunistic employees who know their way around the company’s systems to gain access to email communications and begin monitoring leadership’s emails throughout the ensuing weeks and months to parse them for valuable details that they then use to make personally advantageous stock trades with should-be confidential insider information. Many young IT professionals have been arrested for this kind of breach.

The positive thing to keep in mind here is that these attacks are avoidable. Managers that get caught in this trap are usually using an unsecured email server like Gmail, to which some employees have full admin access. Companies in the midst of a sale or acquisition cannot afford to be naive about access to information. An added emphasis on private communication and enhanced security provisions around sale preparations can easily remedy this kind of vulnerability.

Understanding these six elements of due diligence facilitates a process of digital risk mitigation that can save investors millions of dollars and secure the viability of entities, in our industry, that provide critical services to a population in serious need.

Wednesday, August 19 2020

Digital Transformation in the ABA Space.

The US healthcare system is typically made up of physicians, nurses, technicians and administrators that manage an ecosystem that is designed for sporadic visits by many different patients. The focus in this environment is around how many new referrals, consultations and tests for new and existing patients are delivered each year, averaging around 3-6 interactions per patient annually. This infrequent service model is in stark contrast to that of young patients receiving treatment for autism where appointment frequency is high, daily in most cases, and the number of individual specialists is many, being comprised of therapy from Applied Behavior Analysis, Speech, Occupational, Physical, Music and Nutrition. Patients require ongoing services for several years starting with early intervention defined by a diagnosis of autism by age 2 and subsequently starting therapy. Early intervention has been identified as being a key factor in the success rate of the patient achieving age-appropriate development standards and maintaining those goals throughout their adolescent years.

plowmanb1.jpg, Aug 2020

While most of us consider it an occasional hassle to make an appointment to go see our doctor, either for an annual physical or for a specific ailment, it usually ends up being nothing more than a general inconvenience for those infrequent instances. For families with children diagnosed with autism this slight inconvenience is a mere dream as parents and caregivers struggle to find the time and energy to coordinate multiple care providers and locations of therapy nearly every day and for years on end. Caregivers have to manage their health insurance, often requiring specific plans for their child that provide additional coverages and higher limits for frequent appointments and services. Care coordination historically has entirely been left up to the caregiver who has had the burden of locating and scheduling various therapies across their local, and sometimes not so local, geography, needing to make calls to an ABA clinic and inquire about insurance coverage, scheduling an assessment, waiting on prior authorization for services and then dealing with endless waitlists before their child can receive services. Also needed are separate appointments for occupational, physical and speech therapy which can all be separate clinics and sometimes even more for nutritional diagnostics and various other forms of therapy all in the hope to provide their child with the best life possible.

All of these activities and services become overwhelming for caregivers to juggle, making it a full time job just to schedule appointments, transport their children back and forth from home to school to ABA therapy to speech therapy to occupational therapy and back home. And that is just with one child let alone add in one or more other children that must also be cared for during this stressful time. These parents and caregivers need tools and organizations to find and create solutions to make their lives easier since their interactions with the healthcare system are significantly different from most. The autism services industry has over the last five years or so been attempting to simplify the care delivery model and provide multiple services in one clinical setting, reducing some of the complexities for parents geographically. However, while the availability of multiple autism specialties in one clinic has become more common it has not become easier for caregivers to track their child’s progress towards goals, manage scheduling and appointments, monitor costs/payments and track their expectations of treatments. This is the place that technology can make a big difference. So much of the treatment delivered to children is now electronically managed in Electronic Health Records systems (EHRs) and is available to clinics to manage the internal operations processes necessary to efficiently deliver these services. It should, therefore, be simple to provide this information to caregivers using modern mobile device technology and apps, however there are not any effective systems out there today that deliver this.

Sidis Health recognized that there were problems in this area as well as the design and delivery of technology solutions for autism services organizations to manage their internal operations and therapy. We set out to develop a better platform on which advanced companies could transition their operating model to better serve their therapy and business needs while delivering superior service quality to the caregivers who have taken on the challenge of providing care for their loved ones. By designing a platform that integrates all aspects of clinic operations and therapy delivery Sidis Health also provides an advanced mobile application interface for caregivers to manage their child’s health profile, availability for services, insurance information and clinic locations where they prefer to receive services from. This revolutionary Sidis Health portal provides detailed information for caregivers to not only see and manage their appointment schedules but also receive feedback from their child’s providers and easily monitor progress towards the short-term and long-term goals laid out by the treatment plan. Communication between the clinic staff and providers is secure and fast, with a mobile notification system that keeps caregivers up-to-date on what is coming up, simplifying their lives while improving visibility into care quality. Bringing modern, fully integrated technology into the unique world of autism services for the benefit of patients is the mission of Sidis Health and we strive to always be two steps ahead of the curve in delivering the best clinical solutions.

Enterprise Platform vs. Practice Management

As the behavioral health industry has seen the emergence of organizations whose mission statement includes the desire to provide treatment and services to meet an ever growing demand, the realization that traditional methods of business and practice management quickly become overburdened in the process. While Practice Management Solutions may have been explicitly created in the interest of serving the particulars associated with how the organization operates, as the business grows two things become abundantly clear. The inability to scale the business strategically and the inherent inadequacies that become obvious as growth occurs where oversight, visibility, process management and accurate data collection and validation are concerned.

shieldsb1.jpg, Aug 2020

Ultimately this creates problems throughout the organizational workflow beginning with the assurance of service quality through to the validity of vital information collected for patients/payers/compliance etc. and ultimately to the recognition of Financial Results and the questionable reliability of all of it.

An Enterprise Solution by contrast removes the rigidity of Practice Management process definitions by introducing an intelligent platform design engineered to both provide best practice capability as well as the assimilation and adoption of the organization and its practice, workflows and oversight needs in every aspect of the business. The solution becomes the conduit and connective pathway for all processes and is specifically configured and tailored to meet the needs of each role in the organization creating a user experience and management platform that reflects directly the intentions set forth in the Organizational Mission Statement.

The Enterprise Platform represents the only scalable strategy capable of providing these critical functions while additionally creating the necessary metrics needed for decision support in the interest of growth management, organizational health, planning and guidance.