2025-06-08-Capgemini-打破障碍_确保有效医疗运营的5项合作策略（英）_9页_3mb

Breaking Barriers: 5 Collaborative Strategies for Effective Healthcare Operations

1. Dismantling Barriers

• Remove structural barriers between payers, providers, vendors, and government entities.
• Enhances patient-centric, value-based care and drives innovation.
• Ensures efficient operations and compliance with evolving regulations.

2. Effective Collaboration

• Collaboration is crucial for innovation, regulatory compliance, meeting demands, and efficient service delivery.
• Payers play a key role in facilitating cross-stakeholder collaboration.
• Needed now more than ever due to fast-paced regulatory changes (e.g., Prior Authorization API by 2027, drug price negotiations).

3. Adopting Advanced Technologies

• Utilize AI and digital tools to simplify processes like prior authorization (faster, reduced errors).
• Employ AI for risk identification (early intervention programs), claims processing triage, and resource prioritization.
• Leverage technology to integrate care delivery and provide holistic patient views, improving outcomes and efficiency.

4. Strategic Partnerships

• Nurture partnerships between providers, payers, vendors (telehealth, analytics, remote monitoring, EHR integration).
• Act as intermediaries with government entities for compliance and program alignment (e.g., HFPP, Interoperability rules).
• Collaborate across sectors (social services, housing, education) to address Social Determinants of Health (SDoH).

5. Benefits & Case Studies

• Improved Patient/Caregiver Experience: Streamlined authorization, dedicated support, simplified submission.
• Accelerated Value-Based Care: Enables success of shared savings contracts by improving outcomes and reducing costs.
• Eliminates Redundancy: Optimizes cost and administrative efficiency, improves timeliness, enhances interoperability.
• Example: Health plan partnered with providers/vendor for hypertension management → increased adherence, reduced ER visits by 30%.

Conclusion

Breaking down barriers and fostering effective collaboration is critical in the complex healthcare system. It enhances patient care, drives value-based models, optimizes operations, improves compliance, addresses SDoH, and ultimately creates lasting value for patients, providers, and communities.

Capgemini (Presenting Organization)

Capgemini is a global business and technology transformation partner focused on digital and sustainable solutions, highlighting expertise in AI, cloud, and industry solutions for healthcare.