The digital turnaround in healthcare: cost stability through efficient care management

Statutory health insurance (GKV) faces immense challenges: demographics, inefficiencies in care, shorter innovation cycles, and medical advances are causing costs to rise inexorably. In the long term, neither contribution rate increases nor cosmetic cost-cutting measures will be enough to secure financing. That is the reality.

There is broad consensus among experts that digitalization—alongside other necessary measures—is one of the key levers for keeping healthcare sustainable. It can have an enormous impact, especially in hybrid form, provided it is implemented consistently and in a practical manner.

In our work, we gain valuable insights every day into the opportunities and scope for shaping digital healthcare in practice. We see how targeted digitalization can enable high-quality healthcare and thus avoid unnecessary costs in the long term. The following ideas are based on our experience. We believe that regulatory and organizational frameworks must be created to bring about positive change through digitalization. Our goal is to show how we can all contribute to making the healthcare system stable and sustainable in the long term.

Our proposal: Key digital proposals to the GKV Finance Commission

As a leading partner in the German healthcare industry, we expressly welcome the BITKOM position paper to the GKV Finance Commission of the Federal Ministry of Health. We see it as an important contribution to the debate. We regard the commission as a central authority for constructively discussing urgently needed reforms and translating them into concrete measures. Our core demands target the areas of greatest inefficiency in the statutory health insurance system: lack of care management, fragmented identity systems, and inefficient core processes. For example, we propose the electronic patient record (ePA) as an active management platform. So far, however, the ePA has primarily served as a digital document repository. That is not enough. We therefore call for the further development of the ePA into an active care platform that is managed according to the BPA principle (accompany, personalize, activate):

• Accompany (continuous database): Continuous recording of vital data and behavior patterns via digital assistance systems in order to detect changes at an early stage.
• Personalization (demand control): Intelligent classification into risk profiles and tailored assignment of measures (prevention, coaching, DMP) based on the data.
• Activation (timely intervention): Triggering of specific steps (doctor's visit, telemedicine) exactly when interventions are most effective.
• The benefit: Instead of reacting to expensive complications, we take preventive action. This reduces hospital stays, avoids unnecessary treatments, and demonstrably improves the quality of life of chronically ill patients (as studies such as TeLIPro show).

The core issue: From five percent administration to 95 percent care

The German healthcare system spends over €6,000 per capita annually – yet its results lag behind in international comparisons. Investments in digitalization are mostly limited to the five percent administrative costs. However, the overwhelming potential lies in the 95 percent care costs.

Our white paper shows that the key is to create integrated digital solutions that bring together care, technology, and user-centricity. We understand health insurance companies from the inside out – from back-end systems to insured person apps. This experience enables us to bridge the gap between strategy and secure, regulatory-compliant implementation that is accepted by users.

The digitalization of healthcare management is not an option, but a necessity. We invite you to rethink the logic of healthcare and make consistent use of technological levers.