HFS Highlight: Capgemini developed a series of smart healthcare offerings to address the sector’s biggest pain points post the pandemic shock

Demand for healthcare services is outstripping the supply, and consumer confidence is shaky. By 2050, one in four people living in Europe and Northern America could be aged 65 or over[1]. Healthcare spending accounts for a whopping 17% of the US GDP, an increase from about 12% over the last two decades[2]. And yet, consumer confidence in healthcare is at an all-time low with a confidence index of 23.9/100 in healthcare affordability[3].

The COVID-19 pandemic shock has exacerbated the challenges. According to our research, nearly 70% of healthcare executives believe that COVID-19 will impact the industry’s financial health more significantly than the 2008 financial crisis. The healthcare providers are at the center of the storm with no visibility into future revenues; elective procedures were temporarily impossible, and the shrinking pool of available healthcare practitioners increased internal costs. There is a dire need to drive resiliency and compliance in an increasingly volatile world. Accelerating digitization has become a “must-have,” but at the same time, we are entering a recessionary economy where funds are hard to find.

This trifecta of challenges—demand explosion, supply shortage, and the pandemic shock—has created a burning platform for the healthcare industry to embrace change. The global technology and business service providers have taken notice of the healthcare opportunity in this crisis. We focus on how Capgemini’s emerging and smart healthcare practice is launching new services to address the current healthcare market opportunity.

Exhibit 1. A trifecta of healthcare challenges is driving major innovations in the healthcare industry

Source: HFS Research, 2020

[1] https://www.un.org/en/sections/issues-depth/ageing/

[2] https://apps.who.int/nha/database

[3] http://nrchealth.com/wp-content/uploads/2018/03/Consumer-Confidence-White-Paper.pdf

Capgemini’s innovative healthcare solutions address the cost of care, shift the focus from illness to wellness, and drive healthcare transparency

With 7,000+ healthcare-focused employees, Capgemini services 165+ healthcare clients directly or in partnership with Change Healthcare/Majesco. In the last 12 months, Capgemini has developed a series of healthcare solutions that promise to address healthcare most significant pain points.

Reduce the cost of care and improve supply. Capgemini introduced touchless claims to increase claim auto-adjudication rates and reduce costs through intelligent automation, optical character recognition (OCR), and cognitive document processing capabilities. It has also launched several cost categorization data solutions, such as a predictive model to predict HCHN (Healthcare for the Homeless Network) claimants and readmission ER visit predictors. Its Appeals and Grievances solution uses Pega to increase customer satisfaction and reduce operating costs. It can improve SLA compliance and boost quality with process controls and transparency.

Shift focus from illness to wellness to help improve demand. Capgemini’s AI-powered System of Intelligent Clinical Management provides real-time medical management, population risk stratification, and disease progression to simultaneously drive a better clinical outcome and reduce costs. It helps clients define a comprehensive strategy to transform the member digital experience and drive measurable success with improvements in NPS (Net Promoter Score), STAR ratings[4], drug expense costs, and medical costs. Capgemini’s Digitally Connected Elder Care solution is a secure, personalized, and flexible platform that collects data from smart devices and facilitates communication between care providers and families. Capgemini has also launched an Integrated Telemedicine solution, a multi-tiered solution to assess capabilities, evaluate the platform, and drive insights to enable digital care. Healthcare providers can also supplement their current staff with Capgemini’s 1,500+ nurse network as an extended army of caregivers to address health systems’ increased load.

Drive resiliency and compliance to help manage risks. Capgemini’s SMART FHIR (Fast Healthcare Interoperability Resources) interoperability solution is designed to drive better patient access and healthcare transparency. Capgemini uses data-centric wrappers leveraging FHIR resources to rapidly implement longitudinal patient records (LPR) and drive innovation in assembling data lakes and AI (artificial intelligence) applications on the fly. Its cloud-native modules can unpack Encounter, Medication, Claims, CarePlan, risk, clinical notes, and other clinical/operational datasets. The pre-built models generate a “Tree of Life,” consolidating a member’s health journeys and overall healthcare spending. The data modules use electronic health record (EHR) data in various contexts such as telemedicine, healthcare information exchanges, medical management applications, and value-based care data lakes.

The Bottom Line: Never waste a crisis!

Overnight, COVID-19 flipped the endemic, decades-old healthcare mindset of resisting change to one of advocating change. In our recent research of 150 C-level executives across industries, the healthcare C-suite emerged among the most bullish group when asked about prospects for their industry. Smart offerings leveraging emerging technologies like Capgemini’s innovative solutions highlighted here can move the needle for healthcare’s systemic problems. But let’s be honest—technology alone will not solve the problem. The mindset, culture, and politics of healthcare need to change, and the industry will not get a better opportunity than the current crisis to solve its problems!

[4] Medicare uses a Star Rating System to measure how well Medicare Advantage and Part D plans perform. Medicare scores how well plans perform in several categories, including quality of care and customer service.