Capgemini in Healthcare

Capgemini: Helping Clients Build the Capabilities and Skills for the Modern Healthcare Operating Platform

Our Perspective Healthcare companies are reacting to significant trends across the healthcare industry. Aging population, increased emphasis on health equity, cost pressures, healthcare access needs, increased regulations, and more. These environmental trends are driving systematic changes across the healthcare ecosystem.

Health system patients and health plan members are becoming educated healthcare consumers with high expectations about when, where and how healthcare should be delivered. These expectations span access to digital health, telehealth, retail clinics, and traditional clinics and hospitals. But with increasing treatment channels, care is fragmented more than ever. Leading healthcare companies address the high demands of consumers by creating a holistic experience with personalized guidance while supporting collaboration and increasing accountability of all healthcare providers.

Cost and competitive forces are driving reconfiguration of healthcare companies. The shift to value-based arrangements, guaranteed outcomes, increased mergers and acquisitions to achieve greater local market share, and the entry of new competitors are requiring healthcare companies to reimagine and reconfigure who and how they operate.

Reconfiguring healthcare companies is driving changes to care teams. Care teams must now span organizational boundaries (often beyond the limits of their siloed technologies) to support data sharing and collaboration across multiple providers, payers, and social services.

Covid pressures have accelerated an already dire clinician shortage, putting a priority on addressing clinician burnout. This includes the need to streamline processes and reduce administrative friction throughout the healthcare system. Reconfiguration of how healthcare companies collaborate creates an opportunity to completely reconceive the basic care journey for all stakeholders. One interesting place to start is reconsidering the role prior auth.

Collaboration, new data access rules, and new sources of data (e.g., legacy claim and EMR data, health IoT, genomics, and lifestyle data) all demand that data be used more effectively. For health plans, siloed data within the organization was once a barrier to entry against competitors. But today data access rules tear down those barriers and put an urgency on maximally using data before new competitors do.

Finally, new well-funded competitors are entering the market. They take advantage of new access to previously unavailable data and start with new operating platforms unencumbered by years of technology debt.

Healthcare companies are reacting to these trends with various business strategies. Interestingly, regardless of the specific strategy, there are common capabilities that we see in the modern healthcare operating platform.

1 – Engage & collaborate with stakeholders in holistically designed member and clinician journeys
2 – Proactive orchestration of coordinated behaviors across stakeholders often in different organizations
3 – Insights and guidance powered by data ingested from diverse sources into data meshes able to support flexible consumption needs
4 – Optimization and automation of core systems and operational processes
5 – Enabling technology services: cloud architecture, integration, interoperability, API design, high velocity development services, and trust services

Our Experience

Capgemini is helping our clients to build out these capabilities and skills necessary for the modern healthcare operating platform.

For a large Southwestern healthcare system, Capgemini expanded the digital front door to the patient creating a comprehensive digital-access journey. Via eight development towers, each delivering two releases every month, we have increased new patient contacts by 5x, increased self-service appointment bookings by 38%, increased online booking of urgent care services, and improved call center performance.

At another large healthcare company, we took over maintenance and modifications of the client’s CRM to support continuous improvement resulting in improved patient experience and more efficient call agent services.

For that same healthcare company, we are building a population health portal to orchestrate collaboration with network physicians to improve quality by sharing patient attribution and gaps in care.

At a Midwestern client, Capgemini is helping a multi-state health plan design, architect and implement their overall data strategy. This has included defining a data mesh architecture, rationalizing and reimplementing the data ingestion layer from all sources, and finally helping in the selection and implementation of new data lake technology which supports a data consumption service for data feeds, real-time access, and BI services.  

Gone are the days of a single enterprise data warehouse supporting all data uses. With our Capgemini healthcare reference data architecture, we help our clients define their data platform architecture to enable their unique needs. Our architecture has been used to create bespoke platforms for some clients, select turnkey vendor offerings where appropriate, and support a hybrid approach when a vendor-offering works for a certain “sweet spot” while augmenting the legacy data lake where there are particularly unique needs.   

Use of modern software, data, architecture, and technology is critical for achieving any of the capabilities above. Capgemini has deep experience in and outside of healthcare in moving to the cloud, creating API-based service-based architectures and supporting various levels of integration, as well as healthcare specific interoperability solutions. 

Integration is more than just technology integration. It often must span data, business processes, and stakeholder experience. In this enabled hybrid world of legacy and new technology, we’ve enabled innovation by integration. Interesting integrations into various patient portals have included integrating access to telehealth, use of an AI bot for symptom checking, and self-scheduling of appointments via a unified scheduling interface which spanned multiple EMRs. 

Turning our attention to the back-office, Capgemini has deep experience in process re-engineering and automation. At a national health insurance company, we have built and run RPA-as-a-Service which has identified, built, and deployed 70+ bots which have on-going annual savings of $4 million.

All of the above require high velocity development as a core competency. At nearly every customer we work with, we are enhancing their ability to adopt agile development practices, create and operate DevSecOps automations for push button creation and promotion of environments, and wrapping it all with quality assurance capabilities at scale which includes high degrees of test automation, test data generation and effective overall QA management.

In closing, Capgemini is helping our clients build the capabilities and skills of a Modern Healthcare Operating Platform.