Insurance Insights

How private health insurance companies achieve everyday relevance and differentiation by means of digital services

+++ Many digital health services do not make it into the everyday lives of insured persons +++ Digital networking is often not accessible as a seamless user experience +++ Private medical insurers under pressure to not lose touch with statuary health insurers +++

Telehealth applications are experiencing a boom. A variety of different offerings can be found on the market encompassing the entire patient journey: Checking symptoms with “Ada”, booking doctor’s appointments online using “Doctolib”, and support for tinnitus patients with “Kalmeda”. There has been a constant flow of new “apps on prescription”, or digital health applications (“DiGA”) since the end of 2020 – as of March, there are eleven digital health applications whose costs can be covered by health insurance companies. Examples include “M-Sense” for migraine treatment, “Selfapy” with online courses for those affected by depression, and “zanadio”, which supports lasting weight loss.

A bundled offer with real added value doesn’t exist

Private medical insurerance  companies (PMI) also want to accompany, guide and inspire customers along the entire patient journey. They offer a wide range of digital services to this end, aiming to develop from being a mere service provider to becoming a health partner. However, a bundled and integrative service offering is not generally found. Although insurers offer some apps and services, they are not consistently linked to each other. In addition these apps are not met with a particularly high level of interest – with the exception of digital invoice submission – as can be seen from low user numbers. After all, in most cases the digital offering requires separate login access instances, has weaknesses in the user experience, and often brings too little added-value overall. With these shortcomings, it is difficult to secure a permanent and sustainable position in the usage habits of insured persons, and to acquire customers for private health insurance.

The networking of stakeholders is progressing

eHealth will become an important part of medical care in Germany because of an initiative from the Federal Ministry of Health. Since 2021, the statutory medical insurance companies have been obliged to provide holders of statutory insurance – of which there are more than 70 million – with a uniform range of digital services networked via the telematics infrastructure (TI), in the form of the electronic health record (EHR). If the insured person so wishes, this can be used to store medical and treatment history, personal declarations and vitality and fitness data.

In addition, the electronic prescription (e-prescription) for the digital transmission of prescription drugs via the TI will become mandatory from January 1, 2022. The e-prescription is a necessary prerequisite for diagnosis and treatment via telemedicine, and is expected to be made available to insured parties as a separate app. Legislators are therefore driving forward the networking of stakeholders at full speed – albeit with a focus on statutory health insurance (SHI); the approximately 9 million privately insured persons will be gradually connected to the TI from 2022 at the earliest.

The private health insurance companies have reacted in recent years: On the one hand through the entry of the PHI association’s shareholders into gematik, and on the other hand through collaboration with other PHI or SHI companies. Many of the large PHI companies have joined one of the three cooperation associations (Vivy, MGS Mein Gesundheit/CompuGroup Medical, TK-Safe/IBM) which provide their own digital services relating to an electronic medical file. This increases competition and makes it more difficult for individual PHI companies to differentiate themselves.

Our recommendation: Smart further development of digital invoice submission and company-specific digital service portfolio

PHI companies are facing new challenges. They must offer their core services in digital format (previously primarily automatic invoice submission; in future, also EHR). At the same time they need to differentiate themselves from their competitors, for example through their digital services, and in this way position themselves on a company-specific basis.

The added value of digital invoice submission is obvious to insured parties, and should therefore be a digital core service offered by PHI companies. However, as a point of differentiation from the competition it can also be expanded to include smart functions that further increase convenience for customers and create moments of excitement. The submission of receipts digitally via the app can be supplemented, for example, with the immediate notification of possible contribution refunds, the status of the utilized patient contributions, the processing status and immediate reimbursement. The (fully) automated processing of submitted invoices also offers significant potential for substantially reducing throughput and therefore response times.

The electronic health record is coming – also for privately insured persons – and will be a digital core service in the future. This alone does not allow differentiation from competitors. Based on the EHR, a promising approach is to form a digital service portfolio that integrates in-house and external services for insured parties (e.g. doctor search, video consultation or medication management, but also EHR, e-prescription and DiGAs). This service portfolio must fit with the company-specific positioning, offer real added value for customers, and facilitate interconnected, digital functions with a seamless user experience. Simple operation is essential for achieving significant usage rates.

The art lies in the selection of digital services which go beyond the core services of invoice submission and EHR, to support company-specific positioning. Should administrative costs be reduced, service costs lowered, or market potential increased? There must be clarity as to which service is intended to support which objective. A digital target structure acts as a strategic compass for making the right decisions when selecting digital services, and to enable in-house resources to be used in a targeted manner during implementation.

Have we got your attention?

How effective are your digital services for achieving your business goals? How will you utilize the new possibilities of TI from 2022 to sharpen your company-specific positioning? How will you create simple, connected and value-added customer journeys for your insured parties by means of your digital services? We are happy to discuss these core questions with you and share our experience in the healthcare market with respect to successful implementation of similar issues. Talk to us!

Müller, M. / Schröder, I.