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Governance: Case Study #1

Governance, Ethics & Transparency Systems Bring New Investment

Platform for Social Impact, Puerto Rico (PSI)

Independent Integrity & ESG Advisor on all things governance, ethics, and transparency for the transformation of several existing NGOs in Puerto Rico focused on achieving several key Sustainable Development Goals (SDGs) into subsidiaries of PSI. PSI is a newly created hybrid umbrella organization encompassing both the existing NGOs and new for-profit entities, including a healthcare company, a start-up incubator, and other future entities.

Implementation and continuous improvement of best in class “Governance, Ethics and Transparency” program for PSI to become the model of transparency in attracting social impact funds and other investments in Puerto Rico and elsewhere.

Governance: Case Study #2

Independent Ethics Advice Strengthens Federal Agency Transparency & Trust with Key Stakeholders

Financial Oversight and Management Board for Puerto Rico (FOMB, a US Congressionally created Puerto Rico Government fiscal oversight entity)

Independent Ethics Advisor to the Board, Executive Management and Staff of the FOMB including extensive management of conflict-of-interest issues, financial disclosures, ethics and compliance training and communications, Code of Conduct and policy areas including third party management.

6 years (and counting) of successfully navigating a highly complex, multi-faceted, multi-stakeholder environment with numerous, often first impression governance, legal, and ethical issues, risks and crises, in a fraught political and natural disaster environment (hurricanes, earthquakes, Covid).

Strategic ESG Advisory Services

Strategic ESG Advisory Services: Case Study #1

Future-proofing through Risk Mitigation & Resilience Building

Fortune 100 Global Technology Company

Provide ongoing ESG strategic risk advisory services to build forecasting, preparedness, resilience, and risk mitigation systems specifically focused on emerging social risk around the world.

Ongoing updating of risk and resilience strategy to meet the continuous challenges and crises of our times in existing and new markets globally.

Strategic ESG Advisory Services: Case Study #2

ESG Strategies for Sustainable Growth & Competitive Advantage

Privately Held, Diversified, International Family-Owned Company

Ongoing advice to the board of directors and executive management of a decentralized diversified international company with 16 different lines of business with the analysis and development of customized strategic ESG program. Teamed up with a specialized sustainability firm on the company’s first SASB self-evaluation of the entire company to provide the basis for the development of their strategic ESG program.

Creation and deployment of company-wide ESG governance, strategy and program and establishment of new SVP of ESG team for ongoing implementation specifically focused on building sustainable competitive advantage.

Tech/Cyber Ethics, Risk & Resilience

Tech/Cyber Governance, Risk & Resilience : Case Study #1

Built Risk and Resilience Profile for AI Risk Intelligence Firm

Crisp, a UK-based international real-time risk intelligence company integrating AI and human intelligence systems. 

Served for almost 2 years on the Board of Advisors of Crisp, whose risk intelligence services are designed to protect brands, assets and people from reputational damage, security threats and online harms. Prior to its successful sale to Kroll in 2022, as a member of its Board of Advisors, provided ongoing risk, resilience, ethics, compliance, and cyber strategic advice and thought leadership including authoring multiple articles and providing numerous industry seminars.

In mid-2022, Crisp successfully sold itself to Kroll, a leading independent provider of risk and financial advisory solutions.

Tech/Cyber Governance, Risk & Resilience : Case Study #2

Redefined Cyber Risk and Resilience Strategy for EU Based Bank

European Banking Cooperative

Shared cyber trends, risk, resilience, governance and leadership best practices with senior leadership and board of EU based banking cooperative.

Through sharing of best practices, redefinition and updating cyber-resilience strategy.

Tech/Cyber Governance, Risk & Resilience : Case Study #3

Created First in Kind University Cyber Risk, Resilience and Leadership Seminar for National Security & Cyber Masters Program

NYU Centre for Global Affairs – Masters’ Program in National Security and Cyber Security

Design and teaching of first graduate program-level seminar on “Cyber Leadership, Risk Oversight and Resilience” in newly launched Masters in Science in Global Affairs, specialization in National Security and Cyber Security.

The seminar has consistently received the highest graduate student ratings (4.5 or higher out of 5).

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HSBC: Embracing the cloud to lower risk exposure through rapid insight and analysis capabilities

Global bank HSBC has launched a new scenario risk-modelling tool on Google Cloud, transforming speed to decision-making for the risk management and trading teams.

Tell us your challenge. We're here to help.

Spurred by an enthusiastic commitment to innovation, hsbc has broken new ground with a powerful credit risk solution on google cloud, slashing hours from its “what-if” scenario modeling in the fixed-income business and opening the door to a wealth of future possibilities., google cloud results:.

• Runs innumerable what if risk simulations simultaneously, 16x faster than before
• Empowers traders to better manage their portfolios on an intraday basis
• Enables trading teams to assess capital requirements needed to cover potential rating downgrades and default risks
• Opens possibilities in other evolving risk areas, including ESG and climate-change risk

Innovation must be nourished for it to flourish

With over 220,000 employees working across 64 countries and territories, covering all major financial markets, and serving more than 40 million customers, HSBC scarcely needs an introduction. What is perhaps less known is the incredible innovation journey the bank has been on: harnessing ideas, funding them, and turning them into impactful projects.

“If the bank finds a good idea, we want to scale it,” says Ajay Yadav, Global Head of Fixed Income for Traded Risk at HSBC. “One such project came from the traded risk function, which involves looking at all the exposure and managing the risk for the bank globally and holistically.”

The project that Yadav is referring to is the development of the bank’s Risk Advisory Tool, which harnesses the power of Google Cloud to run “what-if” scenario modeling sixteen times faster.

“The key motivation for this project was this process that took hours and hours to run and is very manual.”

Cumbersome manual process needed a data-science solution

Scenario analysis is bread-and-butter work for HSBC’s traders and risk-management teams. The idea is that traders should be able to run multiple what-ifs on market scenarios that could impact the trading book, so they can put mitigating actions in place if the numbers are not within their risk appetite. As a simple example, the bank may model how a regulatory, inflationary, or employment-rate change in a country could impact the default-risk exposure of certain products.

For a global bank the size of HSBC, these are highly complex, high-volume simulations, generating billions of data points. The existing on-premises hardware solution had limited capacity, causing each scenario to take a member of the risk management team around four hours to run. “The key motivation for this project was this demanding process that took hours and hours to run and is very manual,” Yadav explains. “And the trajectory was only going in one direction. We realized that future requirements were only going to get higher and higher. It's not linear, it's exponential.”

To get the scalability, automation, and computational speed that HSBC needed, it made sense to embrace the possibilities of cloud technologies. In collaboration with Google Cloud and utilizing a suite of Google Cloud products including Cloud Storage , Dataflow , and BigQuery , the team developed the groundbreaking Risk Advisory Tool—with transformational results.

“The speed itself is mind blowing. You should have seen the faces of some of our guys when they saw the numbers come out in 15 minutes.”

Amazing calculation speeds, 16 times faster than before

In the trading world, the faster you can make data-backed decisions, the more optimal your trades are going to be. Now, thanks to the massive computational power of Google Cloud, complex simulations can be run in minutes. This empowers traders and risk managers to use real-time data for intraday risk and capital management, something that was unimaginable before.

Yadav says, “The speed itself is mind-blowing. You should have seen the faces of some of our team when they saw the numbers come out in 15 minutes.”

Google Cloud also gives users the ability to process multiple scenario requests at the same time. Previously, risk managers would be running limited scenarios manually. With the new tool, however, hundreds of users now have the freedom to run as many scenarios as they want, whenever they want, and get the results back in minutes—and not just risk managers, but traders too.

As Yadav explains, the self-service nature of the tool is improving productivity across the fixed income business. “The traders are absolutely thrilled that they can individually look at their own portfolios, try a few things out, and see whether something works or not. That allows for different discussions between risk managers and the trading community, which become much deeper and more insightful than just pure numbers.”

For risk managers, the main value is they can now be much more confident that the portfolio is resilient to many different outcomes. “BigQuery meshes all the hundreds of gigs of data together, which means we can navigate our way through all the numbers in one place and analyze them at a forensic level,” Yadav says. He explains that risk-weighted assets—as an assessment of capital requirements needed to cover potential rating downgrades, credit default, and other risks—“are managed better, quicker, and much more efficiently now.”

Impressively fast production, built on a foundation of trust

Internally, there was some scepticism that a platform as powerful as the Risk Advisory Tool could be built. Yet from paper to production, the bank developed this innovative capability in less than five months.

Yadav chalks up the remarkable pace of the project to collaboration and to “overcoming the fear of failure, which really changes the way you are able to deliver things.” The bank innovated an agile, “can-do” workflow for this capability, which included daily 15-minute standups where everyone had to visually show their output, even if it was just a piece of code. “Just having that visualization completely changed the feedback loop because you could see what was happening in front of you. You’ve got that pace and speed. Every time I came into meetings and saw the progress, I was stunned,” Yadav says.

For Steve Suarez, Global Head of Innovation for Global Functions at HSBC, the velocity of the project was validation of the innovation culture that he and his team has worked so hard to foster. “From an innovation perspective, we want people to experiment. We want people to take calculated risks. That’s the culture and the environment we're trying to instill. I’ve seen people develop confidence through this process, and that's built them up to be bolder, try other things, and expand out.”

Daniel Banin, Project Program Manager in Traded Risk Transformation at HSBC, adds that the close collaboration with the Google Cloud team was critical to the project’s exemplary speed. “It’s such a close working relationship that has developed over many years, and I think that really helped. We have access to the Google Cloud team all the time, so when it comes to delivering quickly, whenever we have a challenge, we’re confident that we always have people to help us break through.” This responsiveness and level of support has helped the bank resolve complex issues on more than one occasion.

“I think the current capability is fantastic. But where it really has potential for a bigger, broader impact is the future.”

Where shall we explore next?

For HSBC, being a data-led organization is integral to unlocking new insights and value for customers and internal teams. Building on this successful Google Cloud collaboration, the focus now is to scale the platform into other areas of evolving risk. “I think the current capability is fantastic,” Suarez says. “But where it really has potential for a bigger, broader impact is the future.”

For its next project, HSBC plans to integrate rating agencies’ Environmental, Social, Governance (ESG) scores as a way to help traders understand the level of susceptibility their books have to climate-change risks. Essentially a numerical measure of how an organization is perceived to be performing on a wide range of environmental, social, and governance topics, ESG scores are a key metric as the market continues to embrace more sustainable forms of investment.

But as Suarez explains, it isn’t just about climate-change risk. “The platform’s early-warning capabilities open it up to different situations that you want to stress test and provide scenarios for, that can impact customers or credit. We can apply the scenario tool to multiple use cases with the aim of getting an earlier warning of risk at a faster pace than competitors.”

Banin anticipates from these scenarios what might follow for the Risk Advisory Tool. He concludes: “What we've delivered so far is really exciting, but in my mind, it's just the beginning of a long journey of continual improvements. We see so many avenues and areas where what we've built so far lays the foundation for a much bigger future. There’s a real appetite to do more. It’s a case of, where should we explore next? The next stage will be using machine learning to be able to analyze data so we’re able to find trends that may not be obvious at first.”

IT Assessment Risk Mitigation

In only 2 weeks of working with a university, a set of recommendations minimizing data center risk by protecting the current infrastructure and architecting for improved cooling was developed., project background.

A major renovation of the campus center (housing the data center) was beginning. As a part of the renovation, an elevator was being added to the building, and the elevator shaft needed to go through the university’s data center. The CIO wanted to understand the risk to the school’s computing infrastructure.

The Strategy

We met with members of the IT department to understand the current data center layout and inventory. Meeting with the facilities team (including architect and construction vendor), we were able to identify areas of data center risk and make recommendations for avoiding risk. Our recommendations were scaled appropriately for the size and criticality of the university’s data center.

We also provided detailed documentation of the data center layout, including equipment placement and cable paths. During our assessment, we identified opportunities for data center expansion, improved cooling, and new cable layouts.

Proven Results

• Steps were taken to reduce dust and vibration during construction and install devices to reduce EMI during the elevator’s operation.
• Plans were made to migrate racks 90 degrees, allowing for hot aisle/cold aisle operation.
• Cabinet doors were changed to grills to improve airflow and cooling.

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Terra Gaines, Senior Account Manager for Harvard Partners has been in the Staffing Industry for 17 years, supporting multiple industry verticals and market segments including: IT, Cybersecurity, Semi-Conductor, Tech Integrators, Finance & Medical to name a few. Her personal and professional passions have always been people centric and she’s extremely proud of providing white glove service to each client and manager that she serves.

Jill Gearhart, Director Client Services, has over 20 years of Account Management experience in technology service areas across IT Consulting & Staffing, Cloud, Datacenter, Networking & Communications. Jill’s focus is in Client Engagement, proposing and ensuring the successful delivery of services from the Harvard Partners Portfolio tailored to attain each Client’s desired business outcomes, including the Staffing of essential resources.

Prior to joining Harvard Partners in 2014, she held a high-level Account Management position at a global technology company now known as Lumen (formerly CenturyLink), where she was appointed to multiple Excellence Advisory boards in several Enterprise product areas, domestic and abroad, over the span of 11 years. Notably, after the Qwest-CenturyLink Merger in 2010, and the acquisition of Savvis thereafter, she was instrumental in the integration between organizations in the effort to build a seamless customer experience. Through continual engagement with Enterprise client organizations throughout her tenure, she has had the privilege of collaborating on solutions and individual resources needed to answer numerous business objectives, whether expanding into new markets or advancing operational efficiency and resiliency.

Education: Bachelor’s of Science, Business Administration, Bryant University, Cum Laude

Chris Callaghan is the Director of Architecture Services and is responsible for overseeing the architectural services arm of Harvard Partners. This includes everything from to architecture approach strategy, to candidate selection & vetting, to engagement leadership. Chris has years of technology architecture consulting experience ranging from boutique architectural services companies to larger, established consulting companies. He’s played multiple roles, from individual contribution to client and consultant management.

Prior to joining Harvard Partners, he was the Engagement Lead and Consultant Manager at Systems Flow, Inc. where he was responsible for client engagement management, consultant management, architectural services, SOW negotiation/creation/signing, training, etc. Prior to that, he worked as an Enterprise Solutions Architect for a large reinsurance firm under Fairfax Holdings.

Gary Gardner is the Managing Director of Harvard Partners and an Information Technology executive with over 30 years of global Investment Management experience. He has a broad range of knowledge of Investment Management systems including investment research, portfolio management, trading, compliance, back office, CRM, and client reporting. Gary has expertise with technical infrastructure, operational risk, business continuity, SOX compliance, SSAE16 certification, vendor management, and cloud services.

Prior to joining Harvard Partners, he was the Chief Technology Officer at Batterymarch Financial Management, Inc. and GMO LLC where he was responsible for IT leadership and technical strategy for high computational and data-intensive quantitative asset management environments. Gary also held senior technology positions at Santander Global Advisors and Baring Asset Management.

Education: Gary studied Management Information Systems at Northeastern University.

Steve Walsh is a Managing Partner at Harvard Partners. Steve has been a career business leader for companies such as Hewlett Packard, EMC, Centerstone Manhattan Software, ClearEdge Partners, and Alliance Consulting.

Prior to joining Harvard Partners Steve was the worldwide leader for the Storage Consulting practice at Hewlett Packard. In this role, Steve was responsible for more than 500 employees encompassing sales, pursuit, portfolio, and delivery. Under Steve’s stewardship Storage Consulting built offerings to help clients assess and design complex storage infrastructures and develop state-of-the-art backup, recovery, and business continuance strategies. Steve grew the Storage Consulting Practice at HP by over 200% and introduced 20 new value-added offerings.

In addition to Hewlett Packard Steve has worked for companies both large and small. At ClearEdge Partners Steve advised C-level Fortune 500eExecutives on their IT purchasing and supply chain strategies, saving his clients millions over his tenure. Steve also has been a business leader at Alliance Consulting, where he built a practice to more than 200 consultants and 10 strategic offerings. Steve started his career at EMC Corporation from 1986 to 1998.

Education: Boston College School of Management, Computer Science

Matt Ferm is a F ounder and Managing Partner of Harvard Partners. Matt’s focus is on IT Assessments, IT Governance, and Program Management. Prior to Harvard Partners, Matt spent 17 years with Wellington Management Company, LLP. As an Associate Partner and Director of Enterprise Technologies, Matt was responsible for managing the global physical computing infrastructure of this financial services firm. This includes data centers, servers, voice and data networks, desktops, laptops, audio/video hardware, messaging (email, IM, etc.), security administration, disaster recovery, production control, monitoring, market data services, storage systems, and capacity planning.

During his career at Wellington, Matt managed the Operational Resilience, Resource Management, Systems Engineering, IT Client Services, and IT Strategic Development groups, chaired the firm’s Year 2000 efforts and was a member of the firms IS Priorities Committee, Project Review Committee (Chair), Systems Architecture Committee (Chair), Year 2000 Committee (Chair), Operational Resilience Committee, Incident Review Committee and Web Oversight Committee.

Prior to joining Wellington Management in 1992, Matt served as Director of Financial Services Markets for Apollo Computer, Hewlett-Packard, and Oki Electric where he managed the marketing of Unix workstations to the Financial Services industry. In 1985, Matt was Manager, New Business Development for Gregg Corporation (now IDD/Dow Jones/SunGard), a small investment database software company. Matt got his start in 1981 on Wall Street, working in the Custody Department of Bankers Trust and the MIS department of E.F. Hutton. Matt received his BA in Economics from Queens College, the City University of New York in 1982, and is a member of the Society for Information Management.

Education: Queens College, City University of New York – BA in Economics

Jason Young is a Senior Technical Recruiter at Harvard Partners and has more than 13 years of experience in recruiting and talent acquisition. Jason’s focus is on leading recruiting efforts and ensuring expectations are met or exceeded between our client’s needs and our candidate’s experience to deliver. Throughout his career, he’s filled immediate needs with high-level IT and business professionals. He also developed sourcing strategies and built strong relationships with IT specialists, leaders, and executives in a variety of industries.

Prior to joining Harvard Partners in 2018, Jason had a successful career with Advantage Technical Resourcing, (formerly TAC Worldwide Companies). He began his career in IT Staffing with Advantage as a Sourcing Recruiter, finding top-tier candidates for the Sr. Recruiters. He quickly advanced to be the sole recruiter of a national high-volume staffing program. His accomplishments with this program led to him being an MSA recruiter for a large global enterprise client. He provided them with a wide range of talent for more than five years.

Education: Bachelor’s of Arts, Psychology, Framingham State University

Lisa Brody is the Talent Operations Manager at Harvard Partners and her focus is on managing the recruiting practice. Lisa has over 30 years of experience in recruiting and talent acquisition. She has successfully brought top-tier Information Technology and Business Professionals to our clients, with a purpose, to fill immediate needs as well as, create an ongoing strategy to find IT specialists, leaders, and executives in a variety of industries.

Prior to joining Harvard Partners in 2016, Lisa reveled in an accomplished career with Advantage Technical Resourcing, (formerly TAC Worldwide Companies) from the rise of the organization, serving in several specialized recruiting and talent management roles. She was a lead MSA recruiter for large global enterprise clients for over a decade, providing a wide range of talent. Throughout her advancement, she has consistently, cultivated a strong reputation among candidates and clients for competency, professionalism, and results.

Education: Massachusetts Bay Community College, Wellesley, MA Associate of Science, Retail Management

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Case study: How to choose PAC partners to ensure coverage for high-risk patients

We outline how to identify specialist PAC partners that complement your health system’s areas of expertise

Given regulatory pressures and incentives, hospitals are forming narrow networks with the highest-quality post-acute care (PAC) providers to maximize the number of patients treated by top-quality providers. The problem: health systems typically struggle to develop and run these networks successfully. As health systems’ post-discharge accountability increases, the need for a high-performing post-acute network to support system goals also increases.

Below, we outline how to identify specialist PAC partners that complement your health system’s areas of expertise. We also review a case study on how TriHealth launched an initiative to address the post-acute needs of their orthopedic patients, and the variables they used to identify 13 select partners from a population of over 100.

To learn more strategies about how to optimize your post-acute network, download our guide: 10 Keys to an Efficient Post-Acute Episode – Part 2: Achieve effective patient management post discharge.

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Infographic: We surveyed nearly 4,000 consumers about their care preferences and outlined the top four things post-acute patients and families want from their health care experience

An effective post-acute network must be able to care for the full range of patient types the health system serves. As such, once systems have identified providers capable of caring for their most common patient types, the network should expand to include providers with complementary expertise. Such providers may include sectors with defined admissions criteria (IRF, LTACH, and hospice), providers strong in particular specializations (e.g., traumatic brain injury), or provider types supporting high-risk areas (e.g., pharmacy).

When assessing candidates for closer post-discharge partnerships, hospitals should inform all providers in the market of the initiative and request relevant information from them to determine partnership viability. This can be done via a request for proposal (RFP). In addition to the RFP, health systems should also gather data on top providers through additional means—for example, through conducting in-person interviews or tours—rather than rely solely on the RFP to make decisions.

Implementation Advice from our Experts

• Assess hospital-specific data to determine areas for specialty alignment, including diagnosis-specific payment programs and patient volumes
• Collect data to evaluate partnership viability for the specific service line or capability in question
• Involve hospital staff (e.g., service line leaders) for the specific service line in the selection process

Case Study: How TriHealth launched an initiative to cover their orthopedic patients

TriHealth, a two-hospital system in Ohio, launched an initiative to select orthopedic Skilled Nursing Facilities (SNF) partners, given high volumes in its orthopedic service line.

To select preferred SNF partners, TriHealth analyzed the performance of each SNF receiving TriHealth joint replacement patients in the last year, collecting data and eliminating SNFs that did not meet minimum quality standards. An internal team with representatives from the service line (e.g., Program Director of Orthopedics) then conducted tours of remaining SNF facilities and completed evaluations.

Ultimately, the team selected 13 orthopedic partners, down from over 100, who now receive 88% of discharges.

TriHealth's SNF Selection Process for Orthopedic Service Line

TriHealth's Initial Review Process

• Geography *: Four-county area including Hamilton, Butler, Warren, Clermont
• Attending TriHealth Physician : Physician with TriHealth Privileges
• Gather and Analyze Initial reports : Analyze report of all patients which have been referred to SNFs (preference to those with the greatest current volume) and reports ran based off diagnosis codes assigned upon discharge from the hospital.
• Initial Selection : The top 30% of the facilities are then chosen for preliminary evaluation.
• Data Gathered : These facilities are then evaluated based off Medicare.gov data, which is a combination of State Survey Results as well as staffing and quality measure data submitted by the facility through the Caspar Report.
• Data Screening : Any facilities which had poor survey results, defined at 7 or more Quality Care and/or Mistreatment citations will be excluded.
• Facility Tours : The remaining facilities are toured by a team, which includes TriHealth Care Management, representatives assigned by the specific service line, and Senior Services. During tours an evaluation is completed by each person touring.
• Selection of Facilities : After tours are completed, the team discusses and votes on which buildings are selected based off of all the information provided by the State Surveys, information reported through CMS, and information collected through the tour.

*As geography is important to this program, a facility will be chosen based off the highest quality per region. All facilities are chosen based off the data specified in the information above.

We can help you improve your post-acute strategy.

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Jared Landis

Posted on August 20, 2019

Updated on March 17, 2023

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Deloitte financial risk advisory - case experience.

Hello PreLounge-Community,

does any of you have experience with Deloitte's interview process in Zurich?

I will soon have a second interview (case interview) for the Risk Advisory department and I would be happy if you would share your experiences with me on the following topics: - Experience with zoom - Experience regarding case style / topics - Preparation recommendation

Looking forward to hearing from you. Thank you!

Overview of answers

• Date ascending
• Date descending

Two main things here:

• In terms of content, it is the same as in-person interviews, since the skillset that interviewers are looking for is exactly the same
• What changes is only the format, with minor details and ensure looking at the camera constantly, having a professional background in the image, etc. Minor details as in the in-person interview there were too (e.g., clothing, way to sit down, etc.)
• FIT part -for sure!-
• Business case, that won´t be different than the ones used for MBB -indeed, it can be the very same-.

Hope it helps!

In terms of what to expect versus strategy consulting interviews

You will still get a prompt, you will still need to read/interpret charts, you will still need to be hypothesis driven, create a solid framework, drive the case, communicate clearly, think in a structured manner, etc. etc.

Make sure you understand the major Financial Risk/Advisory themes and work through cases on these topics.

In terms of what to prepare for with a virtual interview

• Make sure you have a strong internet connection
• Make sure your sound+video work
• Get multiple monitors so you can look at 3 things at once (1 screen makes thought linear which is tough),
• Have a good desk space and keep using paper for solving the case,
• Make sure you'll be in a quiet space with no distractions
• Still dress for the occasion

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Deloitte Case: Footloose

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Espresso, Whatelse?

McKinsey Digital / BCG Platinion: Oil & Gas Upstream Technology

Bain 1st round case – blissottica, related companies.

Related Case Interview Basics article(s)

Discover the secrets to Goal setting, Reality checking, Options exploring, and Way forward planning that will redefine your path to success.

Preparation for Case Studies

Learn how to best prepare for case interviews at the world's largest consulting firms. In our Case Interview Basics, you will find everything you need!

How to Start The Case Interview Preparation

Learn the basics of a real consulting case interview and repeatedly train the skills you need to ace your real case interview at MBB or the Big Four.

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Price formula help, when to formulate an hypothesis, bcg finance formulas.

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Revenue recovery and credit risk prevention, key takeaways.

• A large West Coast municipal utility needed help improving revenue management and meter-to-cash functions after issues with a customer information system ( CIS ) implementation held up billing for 18 months
• E Source’s customized collection strategies recovered $44.7 million in direct revenue
• Targeted customer segmentation and return mail enhancements also reduced outstanding payments by 25%

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A large West Coast municipal utility had to hold bills for 18 months because of complications following a CIS implementation. Once these issues were resolved, the utility needed help defining a strategy for customer outreach and payment collection.

The solution

The utility contacted E Source, who had a team of utility consultants with expertise in data analysis, revenue management, customer segmentation and payment stimulation.

E Source helped the utility analyze arrears data and segment customers by payment behavior and credit risk before redesigning the credit and collections process, developing outreach and collection strategies customized to each segment.

This redesigned process mitigated arrears inventories and settled outstanding payments through:

• A defined bill collections process
• Credit risk behavioral modeling and risk segmentation
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• Increased cash flow from arrears reduction and write-off recovery

E Source also fixed the utility’s workflow management inefficiencies and implemented a change management process to train their staff on the new procedures to sustain results.

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Finalized guidance drops breast cancer screening age to 40 for women with average risk

Prior USPSTF recommendations said women should start screening no later than 50.

Breast cancer screening guidelines have been finalized by a major task force, bringing the recommended age to 40 for most women of average risk in a report published Tuesday.

The U.S. Preventive Services Task Force, a major task force consisting of expert physicians providing recommendations in the primary care setting for routine medical screenings, behavioral counseling, and preventive medications, is now recommending breast cancer screening with mammograms every other year for women with an average risk of developing breast cancer, starting at age 40. This guidance was previously drafted in May 2023 , and nearly one year later, these recommendations have been finalized without major changes.

Previously, the USPSTF guidance said screening should start no later than age 50. The Task Force recommended that women in their 40s talk to their doctor about their individual risk. The age for routine screening was dropped to account for the 2% increase in breast cancer diagnosis rates each year among women in their 40s.

By lowering the screening age, the USPSTF predicts this change has the potential to avert 1.3 cases of death from breast cancer per 1000 women over a lifetime of screening. The recommendations are otherwise consistent with prior 2016 guidelines.

MORE: Video New hope for breast cancer patients unable to get surgery

The updated guidelines also addressed ongoing racial disparities in breast cancer diagnosis and survival rates, particularly for Black women . According to the USPSTF, Black women are 40% more likely to die from breast cancer compared to white women. In addition to calling for more research on racial disparities and screening strategies in breast cancer, the USPSTF additionally noted this drop in screening age was included to hopefully address these disparities.

The updated recommendations will not impact insurance coverage, but by law, mammograms should be covered by insurance for all women 40 and older.

The finalized guidelines for routine screening mammograms apply to cisgender women and those assigned female at birth who are between the ages of 40 and 74 with an average risk of developing breast cancer.

The guidance also notes that almost half of all women have dense breasts, which places them at risk for breast cancer.

"In patients with dense breast tissue, addition of MRI may reduce cancer risk and false positive recalls," said Dr. Nancy Chan, Medical Oncologist, NYU Langone Perlmutter Cancer Center, in prepared remarks.

These recommendations do not apply to women with a personal history of breast cancer, those at very high risk for breast cancer following genetic testing, or a history of high-dose radiation therapy to their chest at a young age, or those with a history of breast lesions requiring one or more biopsies. Therefore, considerations should be made to start screening at an even earlier age.

MORE: Higher breast cancer risk among Black women shows need for earlier screening: Study

For women aged 75 or older, the USPSTF continues to recommend that they speak to their healthcare providers on whether to continue routine screening, based on their medical history and personal preferences.

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"Millions of women over age 75 are in very good health and are expected to live many more years during which their risk of breast cancer remains high. The ACS does not support stopping screening for anyone with a 10+ year life expectancy irrespective of age," said Dr. Karen Knudsen, Chief Executive Officer at the American Cancer Society (ACS), in prepared remarks.

For now, the USPSTF guidance recommends every-other-year screening, rather than annual screening. Some debate still exists about the appropriate rate of screening, with an accompanying JAMA editorial citing ACS that there is enough evidence to recommend annual screening for most women.

"The USPSTF decision today is a critical change concerning women's health and the fight against breast cancer, acknowledging that women in their 40s will benefit from mammography screening, and sending a strong message to referring physicians and women that breast cancer screening should begin earlier than age 50," Knudsen said in prepared remarks.

"Mammography screening is the cornerstone of our strategy to find this potentially deadly disease early, when it's easier to treat successfully," Knudsen continued.

Dr. Jennifer Miao is a cardiology fellow at Yale School of Medicine/Yale New Haven Hospital and a member of the ABC News Medical Unit.

Editor's Note: This story has been updated.

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• Online First
• Is tooth extraction as proxy for periodontal disease related to the development of RA? Lessons from a longitudinal study in the at-risk stage of clinically suspect arthralgia
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• http://orcid.org/0000-0001-5953-6844 Sarah J H Khidir 1 ,
• http://orcid.org/0000-0002-9618-6414 René E M Toes 1 ,
• http://orcid.org/0000-0003-1900-790X Elise van Mulligen 1 , 2 ,
• http://orcid.org/0000-0001-8572-1437 Annette H M van der Helm-van Mil 1 , 2
• 1 Rheumatology , Leiden University Medical Center , Leiden , The Netherlands
• 2 Rheumatology , Erasmus Medical Center , Rotterdam , The Netherlands
• Correspondence to Sarah J H Khidir, Leiden University Medical Center, Leiden, The Netherlands; s.j.h.khidir{at}lumc.nl

https://doi.org/10.1136/ard-2024-225688

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• Anti-Citrullinated Protein Antibodies
• Arthritis, Rheumatoid
• Autoimmunity

Emerging evidence points to the involvement of periodontal disease (PD) in the pathogenesis of rheumatoid arthritis (RA), especially in anti-citrullinated protein antibodies (ACPA)-positive RA. The bacteria Porphyromonas gingivalis , involved in oral mucosal inflammation and PD, can citrullinate proteins via prokaryotic peptidylarginine deiminase. 1 Systemic translocation of oral bacteria has been found in RA-patients with PD. These bacterial translocations have been implicated in the generation of anti-modified protein antibodies (AMPAs) as ACPA can also recognise modified bacterial proteins. 2 Nevertheless, the ‘cause-consequence’ relation between PD and RA remains debatable as PD may be a risk factor (PD→RA; scenario 1; figure 1A ) but also a consequence of RA (RA→PD; scenario 2). 3 Additionally, the relation PD→RA may be confounded by related factors (eg, body mass index (BMI), smoking or other factors related to socioeconomic status (SES); scenario 3). Increased prevalence of periodontitis and P. gingivalis were reported in ACPA-positive/autoantibody-positive at-risk individuals in case–control/cross-sectional studies. 4 5 Longitudinal studies on PD in at-risk individuals could elucidate temporal relationships and provide further insight into the relation of PD in RA-development. Therefore, we longitudinally analysed the relation between tooth loss as proxy for (preceding) PD and progression to clinically apparent inflammatory arthritis (IA) and RA in patients with clinically suspect arthralgia (CSA). We also studied whether this relation is independent of SES and SES-related factors.

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Conceptual framework of hypotheses on periodontal disease and RA (A) and the development of inflammatory arthritis in ACPA-positive and ACPA-negative clinically suspect arthralgia according to tooth extraction (B). (A) The coloured circles represent the three hypotheses on the relation between PD and RA, inspired by de Pablo et al. 3 Scenario 1 in blue: PD is a risk factor for RA. Scenario 2 in orange: RA is a risk factor for PD. Scenario 3 in green: the association between PD and RA is driven by confounding factors such as smoking and SES. (B) Development of IA in ACPA-positive and ACPA-negative patients with clinically suspect arthralgia is shown according to tooth extraction, which is a late-stage of periodontal disease, showing a relation between tooth extraction and IA-development in ACPA-positive CSA-patients. ACPA, anti-citrullinated protein antibody; CSA, clinically suspect arthralgia; IA, inflammatory arthritis; PD, periodontal disease; RA, rheumatoid arthritis; SES, socioeconomic status.

Supplemental material

At baseline, 306 CSA-patients (44%) had previous tooth extraction. These patients were older than patients without tooth extraction (48.7 vs 41.4 years; online supplemental S2 ), more often had a low educational attainment (15% vs 8%), a higher BMI (27.8 vs 26.3), more often smoked (66% vs 51%) and had subclinical joint-inflammation (57% vs 47%). ACPA-positive CSA-patients with tooth extraction more often progressed to IA than ACPA-positive patients without tooth extraction (HR=1.91, 95% CI 1.10–3.32, p=0.022), while this association was not significant in ACPA-negative CSA (HR=1.41, 95% CI 0.85–2.34, p=0.19; figure 1B ). After correcting for SES, smoking, BMI and age, tooth extraction remained significantly associated with IA-development in ACPA-positive CSA-patients (HR=2.22, 95% CI 1.23–4.00, p=0.008). This association remained after additional adjustment for subclinical joint-inflammation (HR=3.10, 95% CI 1.57–6.10, p=0.001). The association between tooth extraction and RA-development was similar, as every ACPA-positive CSA-patient who developed IA also developed RA according to classification criteria. Within ACPA-positive CSA-patients (n=96), ACPA-levels, RF-positivity and number of AMPA-isotypes did not differ between individuals with and without tooth extraction ( online supplemental S3 ). Analyses stratified for autoantibody-positivity/autoantibody-negativity (negative for ACPA and RF) showed similar findings ( online supplemental S4 ).

To our best knowledge, this is the first study that longitudinally evaluates individuals with arthralgia at-risk of RA. We show that tooth extraction is a risk factor for progression to ACPA-positive RA and that this association is not confounded by environmental or SES-related factors. We acknowledge that tooth extraction has different causes among which end-stage periodontitis. This means it is a proxy, but not a perfect proxy. The finding that the risk effect is only present in developing ACPA-positive RA and not in ACPA-negative RA, suggests that tooth loss is partly related to prior PD (potentially present long before CSA-onset or recently). Future clinical and translational studies are needed to substantiate this finding. Interestingly, there were no differences in ACPA-levels and number of AMPA-isotypes as markers of autoantibody-maturation between ACPA-positive patients with and without tooth extraction. Whether antigenic triggering of autoreactive B-cells by bacteraemia plays a role in the trajectory towards ACPA-positive RA remains to be determined. 7

In conclusion, this is the first longitudinal study with data on tooth extraction as proxy for late-stage PD in both ACPA-positive and ACPA-negative at-risk patients. Tooth extraction, a late-stage of PD, associated with RA-development in ACPA-positive CSA-patients. Although our study does not show causality, it deductively supports the hypothesis that PD could confer risk for ACPA-positive RA and provides clues for future clinical and translational studies.

Ethics statements

Patient consent for publication.

Not applicable.

Ethics approval

• Pisetsky DS
• Brewer RC ,
• Hale CR , et al
• de Pablo P ,
• Chapple ILC ,
• Buckley CD , et al
• Do T , et al
• Mikuls TR ,
• Thiele GM ,
• Deane KD , et al
• Broers DLM ,
• de Lange J , et al
• Kristyanto H ,
• Blomberg NJ ,
• Slot LM , et al

Supplementary materials

Supplementary data.

This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

• Data supplement 1

Handling editor Josef S Smolen

Contributors SJHK and AvdH-vM designed the study. SJHK and EvM accessed and verified the data. SJHK analysed the data and acted as guarantor. All authors interpreted the data and wrote the report. AvdH-vM was the principal investigator. All authors approved the final version of the manuscript and were responsible for the decision to submit the manuscript for publication.

Funding This work was supported by the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation program (Starting grant, agreement No. 714312) and by the Dutch Arthritis Society.

Competing interests None declared.

Patient and public involvement Patient partners were involved in the design of the CSA-cohort, and in the design and execution of the TREAT EARLIER-trial

Provenance and peer review Not commissioned; externally peer reviewed.

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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