Health insurance app: a great opportunity for insurers and patients

The current corona pandemic presents society with unprecedented challenges. Particularly with regard to the healthcare sector, the crisis surrounding digitalization has raised a number of fundamental questions. Right now, the importance of fast, uncomplicated provision of diagnoses and the importance of flexible, confidential communication between different doctors, hospitals and insurance companies is becoming apparent. Overall, digitization in this area in this country has taken a big step forward in recent months. This is evidenced by increased opportunities in online consultations or through the Corona warning app. Because of these developments, patients are increasingly demanding greater flexibility and rapid availability when it comes to information and communication with service providers such as health insurance companies. But what about legislative efforts in general with regard to digitization in healthcare? And what are the specific opportunities for insurers here??

The medical record soon to be available digitally

In January 2021, the time has come – the electronic patient file (ePA) will come into force. According to the decision, which Federal Minister of Health Jens Spahn has initiated with the appointment service and supply law (TSVG), all legally insured persons are to receive an electronic patient file from their health insurer. This should provide information on what medications a patient is taking, provide data on previous treatments and pre-existing conditions, and include information on blood levels. In the event of a change of doctor, this important data can also be easily viewed by a doctor who is continuing treatment. The ePA is designed not only to provide vital data more quickly in an emergency, but also to avoid duplicate and thus unnecessary examinations. Each insured person decides for himself whether he wants an electronic patient file, what data is stored there at all and what exactly may be viewed by whom. All information included should be controllable by the insured at any time via app.

The following information is to be stored in the electronic patient record in the future:

• Findings
• Diagnoses
• Therapy measures
• Treatment reports
• Vaccinations
• Electronic medication plans
• Electronic doctor’s notes
• Emergency records

In addition, physicians can also enter their own data (such as a diary for measuring blood glucose, etc.) into the system.) will be created.

New laws promote digitization in the healthcare sector

In addition, with the coming into force of the Digital Supply Act (DVG), which is to be passed on 7. The German Bundestag passed a resolution on November 1, 2019, to make digital health applications via app a statutory health insurance benefit in the future. These apps can help, for example, to take medication, combat back pain or even depression. However, the costs for these are only covered by the insurance companies if the respective app has been tested by the Federal Institute for Drugs and Medical Devices (BfArM) for data protection, functionality and data security, it has been prescribed by a treating physician and, as a prerequisite, a justified diagnosis has been provided. However, these requirements pose a great challenge to IT managers at the service providers. In the course of this, from September 2020, the so-called Telematics Infrastructure Act (TI) will make it compulsory for all those involved in the healthcare sector, such as doctors, dentists, psychotherapists, hospitals, pharmacies and health insurance companies, to be networked with each other.

But the new law will also provide massive support for health research. For example, digital billing data from health insurance companies will be pseudonymized and transmitted to researchers as an anonymized result upon request. In the future, science will have access to even more up-to-date and, more importantly, more data in a protected space in this way, which in turn should ensure a significant improvement in health care delivery.

Lack of networking and different standards cause problems

Currently, the biggest challenge is the lack of connectivity in the health care system. Due to the many different data solutions and the varying systems at the service providers, there are often media disruptions. Data must be recorded several times, which – in addition to the increased effort – often leads to recording errors. The DVG is intended to create the basis for open, standardized interfaces that will make it possible to exchange data faster, more easily and on the basis of international standards in the future. Changes in legislation and the introduction of electronic personnel files are encouraging health insurance companies to expand their service offering to include digital services. In order to make the best use of the ever-advancing digitalization of the healthcare sector for themselves and for better patient care, the best thing to do here is to have your own app.

Acceptance by mobile users is high if data is safe from misuse

As a recent study by market research firm Fittkau& Maab shows that one in three smartphone users (32.9 percent) already uses at least one app from the areas of fitness, health and nutrition. The following 2 people were interviewed.600 German users of mobile devices. This means that health-promoting apps are clearly on the rise.

Furthermore, a survey by management consultants PwC showed that many people in Germany are open to digital health services. According to the survey, around three quarters of respondents find digital administrative processes “good” or even “very good. In principle, 60 percent support the increased promotion of telemedicine, and there is just as much support for setting up a central health database that scientists can use to analyze and evaluate therapies. With regard to electronic prescriptions that users could call up directly on their smartphone, a full 41 percent said they could “definitely” imagine using them, while 35 percent answered “maybe” here. However, the importance of data protection was clearly rated – 93 percent of respondents stated that personal data should not be disclosed without consent. This once again underscores the importance of users being truly confident that unauthorized parties cannot view their data. Specifically surveyed for the study were around 1.000 people from the age of 18.

Health insurance app: the advantages and opportunities at a glance

The fundamental openness and desire within the population for more digitally available healthcare services represents an opportunity for health insurance companies to take on a pioneering role here and actively help drive digitization within the healtcare sector. There are a number of advantages here for both patients and insurers.

Advantages for the insured

• Simplified document submission
• Electronic transmission of certificates of incapacity for work
• All documents / information at a glance
• Quick and convenient change of personal data
• Overview of common service numbers
• Free use at any time in any place
• Practical tips and information on health

Advantages for health insurance companies

• Support for prevention
• On-demand medical care for patients
• Better control / support
• More accurate analysis of patient data
• Reduction of costs through “healthier insureds
• Reduction of the administrative burden

Despite all the plus points, it is important to note that the potential of health insurance apps can only be fully exploited if sensitive patient data is protected to the maximum at all times. Top priority should therefore be given by health insurance companies, but also insured persons, to the secure storage location of data. If these requirements are taken into account, health insurance apps deliver mutual benefits and take an important step towards digitalization in the healthcare sector.

What health insurance companies should pay attention to during implementation

For the actual implementation of the app, it is often a good idea to use a provider from the enterprise file services sector, which supplies the infrastructure for the application. Precisely because the issues of data security and protection play a central role in the app’s success, insurers should take the time to critically examine technical solutions to ensure that patient data is not compromised at any time. Security of sensitive information must be ensured not only at the storage location itself, but also during the data transfer process.

First, it’s important to verify that the provider’s security is backed by recognized certifications and that government requirements for health data privacy are met. This includes the BSI C5 certification (Cloud Computing Compliance Criteria Catalogue). This set of deliverables specifies minimum requirements for secure cloud computing and is aimed primarily at professional cloud providers, their auditors and customers. Testing may only be carried out by an auditor as an independent third party. Also important is the ISO/IEC 27001 certificate, the leading international standard for information security management systems. Furthermore, the auditing standard 951 of the Institute of Public Auditors in Germany e.V. – abbreviated as IDW PS 951 – of great importance, because it also testifies to independently audited security. The standard involves testing the internal control system at the service company and the functions outsourced for it. Client-side, open end-to-end encryption is also important for security. With this technology, data is already encrypted at the end device – this enables maximum data security. Ideally, encryption is provided open-source. This means everyone can use them and convince themselves that they are without gaps.

For easy implementation and timely integration, it is advantageous if the file service has an open API interface, because in that case it can be easily connected to the app. Thus, all receipts and documents necessary for the exchange between the insured and the health insurance company are now securely received and managed in the app. The file service, at its best, is invisibly in the background, the secure repository for all data. Ideally, the upload and download for the insured is straightforward via app. It is also advantageous for daily handling if health insurance companies use the enterprise file service, which is used for the app, at the same time also for internal use. If the employees work with the same solution, for example, submitted invoices can be processed directly and securely even more easily – this can be done manually or fully automatically.

When health insurance companies take these points into consideration, they can safely meet customer requests for more flexibility. They also better meet the current need for fast communication among service providers – especially in times of pandemic. At the same time, they make an important contribution to digitalization – both for their own company and for the healthcare sector as a whole.