Читать книгу DiGA VADEMECUM - Jörg F. Debatin - Страница 26

Health insurers guard and manage insurance premiums on behalf of their members in order to provide the best possible care for each statutorily insured individual. As early as 2014, the first health insurers began to pilot digital offerings for their beneficiaries. Kassel-based Stottertherapy is one of the pioneers of digital therapy through its collaboration with the Technikerniker Krankenkasse (Germany’s largest statutory health insurer). The software solution—although not a medical device—enables speech therapy from the home PC (Institute of Kassel Stutteringtherapy 2018). In 2015, the Techniker Krankenkasse enabled its beneficiaries to use a digital medical device, the tinnitus therapy app Tinnitracks. In 2016, Barmer health insurance followed suit with apps from Mimi Hearing Technologies for hearing prevention and testing (Barmer 2018). These are just individual examples. Since then, many health insurerers have offered digital medical devices to their beneficiaries through selective contracts or prevention budgets. Contracts with manufacturers were often exclusive and time-limited. Nevertheless, since 2015, no other player has been as bold in trying out digital medical devices and gaining experience as Germany’s statutory health insurers.

The DiGA-Fast-Track changes things for health insurers. With Fast-Track approval, DiGA manufacturers now have direct access to reimbursement in the entire German statutory health insurance market. However, individual health insurers can continue to offer additional services for DiGA via selective contracts, such as coaching to accompany a mental health DiGA, or approaches to integrate a DiGA into a more complex care concept so that further parts of the patient journey are mapped. Overall, this opens up more opportunities for health insurers to improve the care of their beneficiaries through (digital) innovations. This also includes innovations in the DVG, which provide health insurers with previously unavailable opportunities:

1. health insurers can now also actively participate in the development of digital innovations, e. g., in the form of digital medical devices or telemedical care concepts, in accordance with § 68b German Code of Social Law (SGB V)]. By participating in the development of offerings for their beneficiaries, health insurers take an even more active role in managing the health of their beneficiaries.

2. thanks to the DVG, health insurers can, for the first time, also directly recommend DiGA to their beneficiaries and approve their use in accordance with section 33a (1) sentence 2 number 2—insofar as the health insurer has a corresponding medical diagnosis of the individual patient. For example, a health insurer could recommend a specific DiGA or an entire portfolio of appropriate DiGA to all of its already-diagnosed beneficiaries with back pain. Interested members then do not have to go to doctors or psychotherapists separately in order to be prescribed a DiGA as treatment, but receive the prescription -code directly from their health insurer, e. g., via the health insurer’s app.

Health insurers will continue to use digital medical devices to position themselves in the marketplace as particularly innovative and relevant compared to the competition. Through the DVG, they have additional opportunities to interact more with their members and recommend and approve diagnosis-appropriate DiGA.