Digital Health Services

User-centric solutions for the private health insurance sector

We can help you become a partner of the healthcare transformation

Digitalisation presents companies with the challenge of having to provide customer-oriented services at ever shorter intervals, and to do so with increasing quality requirements and at competitive prices. The healthcare system and in turn the private health insurance providers are also affected by this development.

In addition, the market is changing, and what’s more, the demands of policyholders on their private health insurance provider are changing too. Policyholders are not longer happy with just receiving reimbursement for the bills they submit in case of illness. They are demanding tangible added value through customised and flexible supply options. These can be created, for example, through customer-oriented services such as mobile and digital solutions or self-services for the settlement of insurance matters.

Digitalisation as the means to fully exploit potential for processes in the private health insurance sector

Insurance companies need to offer digital and networked processes in order to meet the changing expectations of policyholders. However, in reality, many processes at private health insurance providers are not yet automated, but are performed manually. One example of this is how claims for benefits are handled. Longer processing times are caused when the steps are handled manually and in turn the payment of any claims for benefits may not be made within a period of time that people find reasonable. As a result, this leads to customers being dissatisfied.

It requires a holistic approach and reliance on professional expertise to shift current structures and processes towards digitalised, automated processes. Digital transformation can be challenging for companies, but it is an important factor that leads to competitiveness and advantages over competitors in the long term.

The experts from adesso will help you stay one step ahead of the competition

adesso has bundled its activities in order to support companies in this transformation and to meet the increasing demand of policyholders for customised and flexible care options in the German healthcare market. Experts with specialist know-how in the field of healthcare are available for all requirements, for anything from planning to implementation. Their expertise covers private health insurance in particular, but also the areas of process optimisation and digital transformation.

Specific examples of our activities

Electronic Patient Record (ePA)
Company health insurance (bKV)
App strategy consulting
Inpatient service management (DRG)

Added value for patients and insurance companies

The statutory health insurance providers have made the electronic patient record (elektronische Patientenakte, or ePA for short) available to their members since 2021. And since 2022, private health insurance providers have been also following suit. However, the number of people applying to use an electronic patient record is still low. However, there should be a significant uptake with the introduction of digital identity by gematik and the opt-out procedure announced by the German government as well as other accompanying measures.

The introduction of the system for the electronic patient record has advantages not only for policyholders, but also for insurance companies. These include:

  • More efficient processes through the use of structured data
  • Earlier preventive measures and support and rehabilitation services reduce the costs of illness
  • Customer retention through proactive communication

In partnership with RISE, adesso offers the integration of the electronic patient record into the system landscape of private health insurance providers as well as other services.

Would you like to discuss this with us and analyse where you may need more support? If so, please get in touch with us.

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Great potential for growth among insurance companies

  • There were approximately 21 insurance companies that offered occupational health insurance policies in 2021.
  • Since 2015, the number of companies offering occupational health insurance (OHI) has almost tripled (13,500 companies).

Employees can take out an OHI policy without the usual health check and also include their relatives under favourable conditions. The insurance companies try to automate invoicing using dark processing to the greatest extent possible since the premiums for an OHI policy are manageable. There is an invoicing app that leverages the power of AI for document recognition and processing to provide the best support. Ideally, all correspondence is handled via the app, which is an important contribution to sustainability, in addition to the convenience factor for policyholders.

adesso offers the development of a platform for all OHI services, which enables the automation of processes via suitable interfaces and direct and convenient access for employees and employers via a portal or app. There are already plans to expand into an ecosystem with complementary services in the area of health.

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Would you like to discuss this with us and analyse where you may need more support? If so, please get in touch with us.

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Digital offer for health-conscious customers

There was a clear mismatch that was revealed when, in conjunction with a survey of private health insurance policyholders, existing apps used by private health insurance providers were analysed. Most apps used by private health insurance providers do offer information about policy coverage and a system for submitting invoices. However, convenience services such as information on premium refunds and rate changes, transparency in the reimbursement process or extensions regarding prevention offers were missing. Advanced offers can be found on the portals of some private health insurance providers. The expectations of policyholders are clearly different and fit into the overall picture of the changing healthcare system and the digitalisation of society. In terms of usage, mobile usage outperforms desktop usage. (source: GS.STATCOUNTER.COM/PLATFORM-MARKET-SHARE/DESKTOP-MOBILE-TABLET/)

For this reason, a digital strategy is needed in order to expand the apps used by private health insurance providers. adesso can provide suitable advice based on its experience in a wide range of app development and health insurance expertise in this field.

Would you like to discuss this with us and analyse where you may need more support? If so, please get in touch with us.

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The future of benefits management with adesso smile

adesso has developed the smile platform for DRG (diagnosis-related groups) hospital billing audits. The platform is an open and integrative benefits management system that can automate the audit process. The interfaces are used for integration into the insurance company’s benefits system landscape, in which an audit of the rates can then be carried out accordingly. Additional services allow benchmarks to be determined and forecasts to be made.

The first version of the platform is available for statutory health insurance providers. The adjustments for private health insurance providers will follow. We work with development partners to determine the adjustments and will place particular emphasis on the highest possible flexibility.

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Feel free to contact us if you want to discuss this with us in greater depth. The selection of development partners has not yet been completed.

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What we offer

We have the right experts for your concerns. We will work together with you to analyse your individual support needs and reveal your optimisation potential. Benefit from our knowledge of the industry and processes, our experience in the field of mobile solutions and our comprehensive solution portfolio. We use our Quick Check questionnaire so we can quickly find out where we should enter the analysis process together. Request a questionnaire.

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Do you have any questions?

There is no website or brochure which can replace a personal meeting to talk about your goals and topics. We are looking forward to an appointment on site.

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