Becoming the health partner of the insured

Into a networked future with the ePA and adesso

Accelerated digitalisation in the healthcare market

The digitalisation of the healthcare sector is in full swing and has arrived in the consciousness of those involved. Health apps are available on prescription, telemedicine solutions save the trip to the doctor, and the electronic patient file (ePA) is available for those with statutory health insurance and some with private insurance. However, there are still some challenges to overcome for all those involved when it comes to implementation. Many private health insurers (PKV) are reluctant to offer the ePA.

With our expertise in the healthcare sector, we support our customers in selecting and integrating the right solution and creating added value for the insured.

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What do policyholders expect?

In a survey conducted by Bitkom Research, four out of five respondents stated that they have been aware of the importance of digitalisation in the healthcare sector since the coronavirus pandemic. Insured persons are hoping for concrete added value for their everyday lives. Thanks to telemedicine and e-prescriptions, visits to the doctor are becoming superfluous or easier and more convenient for them. Insured persons also expect digital support from their insurance company when searching for a specialist or accessing health apps.

In addition, policyholders are demanding more speed in digital expansion. This is also a result of their view that a pandemic could have been better overcome with digital technologies.

Source: https://www.bitkom.org/Presse/Presseinformation/Digitale-Gesundheitsangebote-werden-den-Deutschen-waehrend-Corona-sehr-viel-wichtiger

Insured persons expect the ePA to improve the coordination and quality of their own medical care. This is to be achieved by ensuring that every healthcare professional has the information they need at the right time and that a smooth flow of information is guaranteed. In this way, duplicate examinations or medication interactions can be avoided. Furthermore, insured persons hope that the ePA will provide them with a transparent insight into their own health data, such as medical reports, medication plans, etc.

One of the key success factors is that the insured person's health data is protected in the best possible way in the ePA and that they can freely decide at any time which data is made available to whom. The solution must also be implemented in a user-friendly way, as otherwise the added value for the insured person will be overshadowed. The decisive factor here is simple and fast access to the ePA, ideally via the PKV app.

Why should private health insurers act?

Since 1 January 2021, statutory health insurers (SHI) have been obliged to offer their members the opportunity to store medical findings and information from previous examinations and treatments comprehensively in the ePA across practice and hospital boundaries. From 1 January 2025, the ePA will be made available to those with statutory health insurance using the opt-out procedure and doctors will be obliged to fill it in. This will significantly increase the level of utilisation in statutory health insurance.

Private health insurance has long seen itself as a "driver of innovation" in the German healthcare sector and as a role model for statutory health insurance. After all, statutory health insurance is often strictly limited in the care it provides, while private health insurance also agrees insurance cover for newer treatment methods. This constant competition between innovative and restrictive has constantly established new medical standards and improved medical care over the past decades.

It is now up to private health insurers to position themselves in the area of ePA and further differentiate themselves through intelligent services.

An innovative combination of ePA with topics such as electronic invoicing (eRechnung) or electronic sick notes (eAU) is one way of achieving a competitive advantage. The focus is also on economic efficiency, as digitalisation will help to save administrative costs.

What challenges and added value arise in practice?

The ePrescription for people with statutory health insurance shows insurance companies the way forward: The prescription is issued electronically so that the insured person no longer has to carry it from the doctor to the pharmacy. They accept the current situation (the prescription can be called up at the pharmacy) and rate it favourably. The biggest challenge lies in the technology, as it has to function consistently. This was achieved with the ePrescription for statutory health insurance holders after a few teething problems: operations are now running smoothly.

The same applies to eHealth applications, whose benefits for health have been confirmed, and this is also foreseeable for the electronic patient file. As soon as the technical challenges such as frequent authentication when using the electronic identity, availability of the platforms or integration into the IT systems have been overcome and the electronic filling of the file can be carried out by the practitioner or the practice software, the added value for insured persons and insurers will arise automatically.

Practical benefits, such as rapid diagnostics in emergency situations, will quickly contribute to acceptance. An example: A patient was brought to the emergency room with chest pain. The ePA contained the medication plan as well as information on previous cardiac examinations and diagnoses. This helped the doctors to make a quick and accurate diagnosis and initiate the right treatment in good time.

Added value for insurers

  • More efficient processes through the use of structured data
  • Faster and more secure communication
  • Earlier preventive measures, support and rehabilitation services reduce medical costs
  • Healthier insured persons cause lower costs
  • Reduced duplicate examinations save expenses
  • Customer loyalty
  • Additional business through customised product offers for policyholders

Added value for policyholders

  • Avoidance of duplicate examinations
  • Faster diagnosis on a broader information basis
  • Consideration of interactions and intolerances, even in emergencies
  • More targeted therapies
  • Faster and secure communication with the insurer and the doctor
  • Transparency of medical information
  • Automatic reminder functions for vaccinations and check-ups

What does an exemplary customer journey look like?

In the video you can see a best-practice illustration in which an insured person opens their ePA, looks at their medication plan and then uploads a document to their file in order to store it there and make it available to service providers.

What is next for the ePA?

Since the foundation stone for the ePA was laid in 2015 with the E-Health Act, the technical and content requirements for the ePA have been constantly evolving. Concrete steps are currently being taken to drive forward the introduction for private health insurers too. With the approval of the Digital Act (Drs 20/9048), the Bundestag 2023 has defined further requirements for the coming years. The aim is to firmly integrate the ePA into medical care and healthcare processes.

The planned improvement in interoperability will increasingly make the ePA a central tool for patient-centred care. To this end, it is planned to introduce binding standards. At the same time, this will enable the further expansion of digital healthcare applications and thus the connection of own services.

Source: https://www.kvno.de/fileadmin/shared/pdf/online/terminunterlagen/20240228_epa-veranstaltung-handout-sebastian-zilch.pdf?v=1709200679

adesso - the right partner

adesso has extensive experience in all areas of private health insurance, and our employees also know the processes in private health insurance very well. With in|sure Ecosphere Health, we offer standard software that is already used or currently integrated in many private health insurance companies for policy and benefits management. Together with our telematics infrastructure experts, we identify the necessary steps for the integration of the ePA, based on experience from ePA projects in the SHI system.

The front end of the ePA, the ePA app, is the "centrepiece" of the solution from the user's point of view. It must be easy to use and ideally linked to the corresponding PKV app. With our user-centred app development strategy, we can implement this requirement efficiently.

We form interdisciplinary teams from all relevant specialist areas to take a holistic view of an ePA project. When selecting the ePA provider, we remain open to all technologies and providers. We have extensive experience with the solutions of both ePA providers on the market and have also entered into a "preferred partnership" with the technology manufacturer RISE.

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Our offer

Analyse your ePA readiness with us in a workshop. Based on the results of the analysis, we work with you to develop a customised implementation strategy for all areas. We will show you the possibilities of the ePA in conjunction with your app and other services - also with regard to the further development of the ePA. You will receive a roadmap with which you are optimally positioned for the future of the ePA.

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Do you have questions?

We look forward to engaging in conversation with you.

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