Part 3—From Mental Health Clinics to Tribal Casinos: EPSS in Action Across Industries

Different Industries, Same Dilemma

A mental health clinic and a tribal casino might seem worlds apart in mission and technology. One handles sensitive patient data and life-critical services, the other manages gambling systems, financial transactions, and guest information. Yet, when it comes to cybersecurity, they share a common challenge: too many vulnerabilities and not enough resources to fix them all immediately. Both must decide what to patch now and what can wait under the constant pressure of possible cyberattacks.

In any industry, executives face this risk prioritization dilemma. And in all cases, the Exploit Prediction Scoring System (EPSS) can be a game-changer. EPSS offers an objective, data-driven way to answer the critical question: Which vulnerabilities are most likely to be exploited against us? By focusing on that, a healthcare provider and a casino – or any organization—can drastically improve their security outcomes.

Let’s look at each example in turn to see how they applied EPSS, what happened, and what lessons emerged that apply to everyone.

Case Study 1: A Mental Health Provider Prioritizes Patient Data Security

Scenario :

A regional mental health services provider (with several clinics and an online patient portal) found itself swamped by software vulnerabilities. With limited IT staff and strict patient privacy obligations, they needed to avoid wasting effort on low-risk issues while ensuring critical systems were protected from ransomware.

EPSS Implementation :

The provider integrated EPSS into their vulnerability management process. Each new vulnerability detected came with an EPSS score indicating exploit likelihood. The team established simple rules: if EPSS was above ~5%, patch immediately; if it was very low (below 1%), schedule it for the next routine update. This data-driven triage meant, for example, that a moderately severe web server bug with a high 5% EPSS was fixed right away, whereas a “critical” database flaw with a near-zero EPSS was safely deferred a few weeks.

Results:

In practice, this approach paid off. The clinic’s IT team was able to preempt attacks – notably patching a Windows server vulnerability that EPSS flagged as likely, just weeks before ransomware attackers began exploiting it in healthcare organizations (Study Finds EPSS Shows Strong Performance in Predicting Exploits). Meanwhile, they suffered no incidents from the deferred patches. By focusing on the vulnerabilities that mattered, the provider reduced emergency patching by over 50%, minimized disruption to clinical operations, and improved overall security. The IT manager could confidently report to the board that they were actively addressing the vulnerabilities most likely to impact operations, rather than trying to boil the ocean.

Key Lessons (Healthcare): 

Even in a sensitive, regulated environment, EPSS allowed smarter risk-taking:

• Maximize Impact: Focusing on the few vulnerabilities likely to be exploited dramatically reduced real risk without increasing budget or headcount.

  
  

• Minimize Side-Effects: By not overreacting to every “critical” alert, the provider avoided unnecessary downtime from patches and kept clinicians online, intervening only when data indicated a genuine threat.

  
  

Case Study 2: A Tribal Casino Levels the Odds in Cybersecurity

Scenario: 

A tribal casino with a resort hotel faced a flood of vulnerabilities across gaming systems, hotel infrastructure, and corporate IT. With a small security team and compliance obligations to tribal gaming authorities, the CISO sought to focus on credible threats and filter out noise.

EPSS Implementation: 

The casino pulled EPSS scores into their vulnerability dashboard for every system. They set priorities such as: any internet-facing system vulnerability with EPSS above 3% gets immediate attention, whereas internal issues with low EPSS could wait for scheduled maintenance. This let them zero in on real risks. At one point, a flaw in their slot machine management software had a tiny 0.1% EPSS score – so initially it was logged but not urgently patched. When reports came a month later that hackers started abusing that very flaw at another casino, the EPSS score for it spiked significantly. The team sprang into action and patched their machines within days. In effect, EPSS acted as an early warning system; as soon as the threat materialized, the model alerted them via the higher score.

Results: 

Over six months, the casino experienced no security breaches. They found that often less was more – by patching fewer total vulnerabilities but the right ones, they prevented incidents. For example, some vulnerabilities labeled “critical” by vendors remained unpatched for a while with no negative impact, because EPSS indicated they were unlikely targets. Meanwhile, every vulnerability that EPSS rated as high risk was addressed, and indeed none of those led to compromise. The security team also improved efficiency; they felt in control rather than constantly firefighting. Executives appreciated being able to understand the risk landscape at a glance (EPSS gave a clear picture of which open issues truly threatened operations).

Key Lessons (Gaming): 

In a high-stakes industry, EPSS brought a strategic advantage:

• Agility: The casino’s team learned to trust EPSS but also to react quickly when scores changed. When a low-risk issue evolved into a real threat, EPSS caught it and the team adapted immediately – avoiding harm.

  
  

• Noise Reduction: EPSS helped distinguish regulatory “must-dos” from genuine must-fix threats. The casino still met compliance requirements, but internally they knew which vulnerabilities deserved urgent resources and which could be safely queued. This clarity saved them time and money while keeping risk in check.

  
  

Universal Takeaways for Executives

Both the mental health provider and the tribal casino ended up in a stronger security posture by using EPSS, despite their different environments and threats. Their stories yield several broader insights for any leader:

• EPSS is Industry-Agnostic:Threat actors will target any vulnerable system, whether it’s a hospital database or a casino slot machine. EPSS provides a common yardstick of risk likelihood that applies across IT environments. If it works in these two very different cases, it can work in yours. Focusing on the small fraction of vulnerabilities that are likely to be exploited can dramatically reduce risk with a fraction of the effort (Study Finds EPSS Shows Strong Performance in Predicting Exploits).

  
  

• Resource Focus = Risk Reduction: In each case, focusing limited resources on the most likely threats made the biggest impact. It’s a classic 80/20 rule – a small subset of vulnerabilities accounted for a large portion of actual risk. By zeroing in on that subset, both organizations significantly lowered their exposure.

  
  

• Data-Driven Justification: EPSS gives security leaders a quantifiable, empirical basis for decisions. You can tailor threshold levels and responses to your organization’s risk appetite, but in all cases you’ll have data to back up why you’re fixing certain issues first. This makes it easier to explain your strategy to boards or auditors – it shifts the conversation from “we think” to “the data shows” (Exploit Prediction Scoring System (EPSS)).

  
  

• Augment with Human Insight: While EPSS provides powerful guidance, it should complement (not override) expert judgment and good practices. Maintain situational awareness: if threat intelligence or experience tells you something not reflected in the EPSS score, don’t ignore it. Likewise, a low-EPSS vulnerability isn’t a “never exploit” guarantee – it’s a sign to schedule it later, not to forget it entirely. Use EPSS to handle the heavy lifting of sorting probabilities, while your team remains ready to react to surprises.

  
  

Figure: Real-world data shows that exploitation activity is often uneven across different vulnerabilities (Study Finds EPSS Shows Strong Performance in Predicting Exploits). In the chart above, each row represents a specific CVE over the course of a year (days are colored from blue to red based on the volume of attack traffic observed). Some vulnerabilities (top rows) saw only sporadic, low-level attacks (mostly blue/white), while others (bottom rows) were under constant, heavy attack (red). EPSS helps organizations recognize these differences – focusing on the “red zone” issues that attackers actively exploit, rather than spreading resources thin on the “blue zone” issues. Both the clinic and the casino in our case studies benefited from this targeted approach.

The Bottom Line

No matter your sector—be it healthcare, gaming, finance, education, or government—the core challenge is the same: prioritize the cybersecurity work that will actually prevent incidents. The Exploit Prediction Scoring System provides a proven, data-driven way to do just that. The mental health clinic protected patient data by fixing likely exploits first; the tribal casino safeguarded operations and customer trust by doing the same. They demonstrated that when you address the most exploitable vulnerabilities, you materially reduce risk across the board.

As an executive, you can take these lessons and apply them to your own cybersecurity strategy. Start by empowering your security team with EPSS insights. Encourage them to pilot the model on a subset of systems or during an upcoming patch cycle. Use the outcomes—fewer emergencies, maybe an avoided incident—to build support for broader adoption. Also, foster a culture where it’s okay to say “we’re deferring that patch” if there’s sound EPSS data justifying it. That level of nuance in risk management is a sign of maturity.

Finally, remain engaged with the process. EPSS offers a high-level view that’s actually understandable in the boardroom. Leverage that. Ask for regular updates on the EPSS-based risk profile (“How many high-EPSS vulns do we have unaddressed this week versus last?”). Tie those metrics to your enterprise risk discussions. Over time, you’ll likely find that your organization is not just checking security boxes, but truly operating intelligently in the face of cyber threats. And that is a competitive advantage in any industry.

Where Outlaw Research Labs fits

Outlaw Research Labs is an offensive‑security specialist—penetration testers, red‑team operators, and vulnerability‑management consultants who think like adversaries.

Bottom line: you don’t need a giant platform—you need expert attackers on your side, armed with tomorrow’s probability data. That’s exactly what our OffSec team delivers.

Ready to turn overwhelming patch lists into targeted, high‑impact action? Let’s talk. Reach us at sales@orlabs.tech or visit https://outlawresearchlabs.com.