Capgemini-打破障碍：确保有效医疗运营的5项合作策略（英）

Breaking barriers: 5 collaborative strategies to ensure effective healthcare operations 1Breaking barriers:5 collaborative strategies to ensure effective healthcare operations Breaking barriers: 5 collaborative strategies to ensure effective healthcare operations 2In brief:010203Dismantling barriers between payers, providers, third party vendors and government entities enhances patient-centric, value-based care and drives innovation.Effective collaboration is crucial for driving innovation, meeting regulatory requirements, and addressing market and customer demands efficiently.Payers are one of the key facilitators of collaboration across all stakeholders.Today’s fast-paced healthcare environment requires payers to quickly acclimate to new rules and regulations, whether financial, compliance or communication related — and often on short notice. For example, the latest White House executive orders mandate that hospitals and insurers disclose treatment prices to patients and delaying the selection of small molecule drugs for Medicare drug price negotiation. These and other new executive orders may impact existing payer and provider operations and will require timely communication to members to achieve compliance.More sweeping mandates like these are likely on the horizon, and current administration will expect swift compliance from payers, healthcare systems, providers and vendors. In this fast-acting political landscape, successful digital transformation and effective collaboration between payers and providers is critical to the quick and successful implementation of new mandates and simultaneous delivery of value-based healthcare services. Payer and provider collaboration is not only a priority for optimal patient care and outcomes, but also now a mandate. The CMS Interoperability and Prior Authorization Final Rule aims to improve patient access to care through more efficient and expedited prior authorization processes and exchange of health information. Payers and providers must comply with the new Prior Authorization API requirements by January 2027. In addition, beginning in 2026, payers must provide a specific reason for a denied prior authorization request to both providers and patients. As the deadline approaches, payers and providers with outdated healthcare systems and inefficient processes must reassess their strategies to enhance operational efficiencies and modernize their technology to better meet federal regulations. Improving the patient and member experience is essential, and for many, achieving compliance while fostering a collaborative environment among providers, payers, and members will hinge on successful digital transformation. Payers who are strategizing and working towards digital transformation will be well positioned to comply with regulatory requirements, elevate value-based patient outcomes, reduce costs, improve diagnostic accuracy, streamline care delivery and empower patients to take a more active role in managing t