Once a byword for unbridled bureaucracy, Germany’s statutory health insurers are transforming into 21st-century service providers, adopting digital technology to raise agility and efficiency. Early digital adopters mhplus, DAK and Audi BKK have made an impressive start.
Rainer Mueller gets out of bed, goes into the bathroom and steps on the scales: 87 kilograms. He rubs his eyes in disbelief – wasn’t his weight yesterday 85 kilograms? While he’s still pondering where the extra 2 kg have come from, his phone rings. “Good morning, Herr Mueller, your health insurance company here. We’ve just been notified about a fluctuation in your weight. It could be a sign your cardiac insufficiency is worsening. Have you taken your blood pressure this morning?” Mueller takes his blood pressure, sees that it is indeed up, and the caller from the health insurance contacts Mueller’s doctor. The doctor confirms the initial suspicion: Mueller’s heart isn’t pumping as well as it should, which has caused fluid retention and sudden weight gain. Because the problem has been detected so early, the doctor can make a timely adjustment to Mueller’s medication.
Rainer Mueller doesn’t exist; he’s a fictional person. And yet his story could so easily happen in real life. For around 100 clients of German health insurer mhplus, this form of early detection is a reality. Patients who suffer from severe cardiac insufficiency are provided with a digital scale by their insurer. Any sudden weight gain, or changes that look critical, and the software triggers an alarm. This is one of an array of digitally-enhanced services provided by mhplus: the company also offers healthcare through mobile apps such as running and nutritional coaching, tinnitus treatment and even online therapy to tide over patients suffering mild depression until they can begin a course of treatment with a therapist in person.
Empowered patients
mhplus isn’t alone with its digital efforts. The big statutory health insurers in particular, each with millions of members, now offer healthcare apps and digitally-assisted therapies as a de-facto standard service. Yet the great challenge for insurers isn’t only to find the right services within a dynamic and unpredictable new market to respond to the growing appetite of clients for information and support. They also need to remodel internal structures and processes. There’s no one-size-fits-all solution here, and each insurer sets its digital focus differently.
Patients are increasingly empowered, and we want to help them become more so.
Back to mhplus: with 550,000 members, it’s no more than a midsized player in Germany’s health insurance sector. However, its digital healthcare projects can hold their own against those of much larger competitors. “We have one person whose job it is to scout out the market, research new digital products and take them through to practical introduction,” explains Dr Oliver Gapp, Head of Heathcare Provision & Management at mhplus. Which means that staffing costs alone run to a midrange five-figure sum, in addition to the cost of the digital services themselves. mhplus puts this figure at between 150 and 1,000 euros per patient and treatment, depending on which devices have to be purchased and whether – as when online second opinions are sought on orthopedic or cancer surgery – doctors’ fees are also payable. Oliver Gapp views it as a good investment: “We see this as part of our mandate for healthcare provision.” His company can also benefit financially if patients who have sought a second opinion decide to opt out of surgery, or if early detection of a critical health issue helps to avoid a stay in hospital.
Digital scales report critical weight (Image: iStock.com/PhotoTalk) Digital transformation also has a massive impact on how mhplus communicates with its insurees, or members. As Gapp explains, many prefer to videochat with their mhplus advisor rather than calling on the phone. Around 700 inquiries per month reach mhplus via WhatsApp, and the company has around 23,000 followers on Facebook. mhplus is therefore stepping up staff training to ensure its people are prepared: “We aim to maintain close relationships with our clients. Patients are increasingly empowered, and we want to help them become more so. We want to be their point of contact for healthcare-related questions and guarantee quality-assured information.”
More service, more competition
The expression “quality-assured health information” sounds like it’s been lifted straight from a management handbook. Yet according to Professor David Matusiewicz, Dean of Health and Social Affairs at the private FOM university in Essen, it’s increasingly part of the mandate of every heath insurance company. “There are already 200,000 health and fitness apps worldwide, and most are by no means quality-assured,” he says. “Sometimes they can even be dangerous, for example when users rely on an app to diagnose skin cancer. Health insurers therefore have a duty to be active in setting the parameters for this market. There should be a common set of criteria issued either directly by the Ministry of Health or agreed through self-regulation.”
Data privacy is fielded as a knockout argument against a multitude of innovations.
In Matusiewicz’s view, health insurers have a lot of catching up to do in the digital space. “Business is ten years ahead of them,” he says. Vital data such as blood type or current medication could have been on digital health cards years ago – to the benefit of patients. And the reason it isn’t is down to politics. “Data privacy is fielded as a knockout argument against a multitude of innovations. What I’d like to see is a trial-and-error phase where insurers can do test runs with innovations, see what works, and do so without fear of sanctions from supervisory authorities.”
Digital transformation is in any case bringing disruptive change to the entire industry. “Insurers are increasingly becoming health management companies rather than administrative entities,” says Matusiewicz. “Health insurance companies, notably the big players, are getting more creative and investing in innovative solutions to improve care.” And they have to: clients have higher expectations in terms of service, which in Matusiewicz’s view will intensify competition, thinning out the number of players on the market even more.
Digital through and through
One of the largest health insurance companies is DAK, with almost six million clients on its books. DAK’s answer to the digital challenge? Change! DAK has enacted a comprehensive change management program that goes to the heart of how it organizes itself. A case in point: at present, phone-based contact with clients and contact via chat and Facebook are taken care of by different departments. By mid-2018, DAK aims to switch from this system of separate communication streams to an omni-channel system. Each advisor will then be available to clients through all the channels. A client can speak to her advisor on the phone, and the following day make contact with the same advisor through a chat app. To make this happen, however, DAK needs more than new technologies, as Franz-Helmut Gerhards, DAK’s Chief Digital Officer (CDO), points out: “Staff also have to be on board with the new idea, and be trained for their new responsibilities.”
mhplus consults via video chat too (Bild: iStock.com/verbaska_studio) DAK is also busy in digital healthcare, with services ranging from online coaches to telemedical assistance for dressing chronic wounds and even a trial project to cure phobias with the help of virtual reality glasses. “The goal of all these initiatives is to have happy clients and better-quality healthcare provision,” says Gerhards. “And we’re reducing our costs because we can usually reduce treatment density.” The calculation: digital services might cost money, but they help patients stick to their doctor’s treatment plan. They work out cheaper in the long run than frequent and sometimes complex treatments.
When your car sends you to the doctor
Automaker Audi has its own health insurance company for staff, Audi BKK – and the insurer is shining the spotlight on where the journey with digital healthcare could lead. Working with Audi AG, Audi BKK has plans to get cars involved in helping to make (or keep) drivers healthy. During a journey in a self-driving car, for example, drivers could potentially attend a “tele-surgery” with their doctor or watch a video about stress relief. And the vehicle itself could take an active role, says Gerhard Fuchs, Chairman of Audi BKK’s management board: “For instance, if in-vehicle sensors were to detect that the driver is slumped in his seat and might have fainted, the car could be made to stop automatically.” In future, a car could even send its driver to the doctor – having taken the driver’s blood pressure during the journey and determined it is too high.
With digital transformation, you always have to keep the big-picture view in mind.
Audi BBK appointed a digital transformation officer and dedicated workgroup at the start of this year to incubate ideas like this . Trials are due to begin in early 2018 at the latest. Assuming the tests are successful, Audi AG plans to start equipping new vehicles with these features; later it will be possible to retrofit older vehicles via a software update.
Audi forbids work chats after work (Image: iStock.com/demaerre) This lies in the future. But change is also happening right now, as administration and organization at Audi BKK become increasingly digitally-based. The management board is therefore planning a radical overhaul of working-time models and employee protection rules, bringing them into line with the reality of the mobile office. “Employee protection also means protecting people from themselves,” emphasizes Gerhard Fuchs. “We don’t want our people to work around the clock. Anyone who answers questions via chat app after hours could easily find their teleworking privileges revoked. This person will then have to come into the office every day – and go home once the working day is over!”
Fuchs explains that the management board is currently in negotiation with employee representatives to hammer out policies for the workplace of the future. “You can’t make digital transformation work just by enacting isolated projects. You always have to keep the big-picture view in mind.”
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