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The digital transformation in providing medical devices

Process potentials for the private health insurance sector

The need for medical devices in Germany is steadily increasing

The need for medical devices (bandages, walking aids, wheelchairs, hospital beds and so on) in Germany is increasing. This is clearly substantiated by statistics from the German Association of Private Health Insurance (Verband der Privaten Krankenversicherung, PKV-Verband [PKV]). In the PKV’s statistical report from 2019, there was already a recognisable growth of 7.35 per cent per policyholder compared to the previous year, whereby the insurance benefits grew by only four per cent overall. Looking at the demographic development in Germany, an additional noticeable increase can be expected with the baby boomer generation. The percentage of medical devices in outpatient services is already 8.18 per cent of the total costs.

Breakdown of outpatient services in the private health insurance sector – from the 2019 statistical report

Breakdown of outpatient services in the private health insurance sector – from the 2019 statistical report

For the insurers, this continuous increase means that they either need more staff for processing the applications for medical devices or they have to design their processes to be more efficient.

The medical device provision process in the private health insurance sector

In contrast to SHI, in private health insurance, making reimbursements for medical devices depends on the policy and the type of medical device. Smaller medical devices, such as bandages, do not require a cost estimate, but are instead reimbursed by the private health insurer as part of the usual settlement procedure if they are included in the policy. For larger medical devices, either reimbursements are made as lump sums from the catalogue or policy-dependent reimbursements are granted. These usually have to be applied for in advance. Depending on the diagnosis, special equipment/models are then also approved. After being approved, reimbursement is made the same way as it is for smaller medical devices. The policyholders obtain the medical device from the medical supply store, pay for it and submit the receipt to the private health insurer. All in all, it is a laborious, manual process that takes time.


The announcement of electronic care (eVO)

The German electronic prescription (elektronische Verordnung, eVO) for medical devices is to be considered analogous to the German ‘E-Rezept’ (e-prescription). Policyholders receive a code instead of a paper prescription and can use it to start the digital process. The rollout starts on 1 July 2024, then, as of 1 July 2026, the electronic prescription will be obligatory for medical device providers. The basis for the eVO is the German Digital Healthcare and Nursing Care Modernisation Act (Digitale-Versorgungs-und-Pflege-Modernisierungs-Gesetz, DVPMG) from May 2021. An end-to-end digital process must be linked to the prescription, otherwise the significance of it will be lost. In light of the increasing demand for medical devices, this is another reason for insurers to change the processes for providing medical devices at an early stage. Insurers now have the opportunity to implement a customer-centric approach that benefits everyone involved.

Three perspectives on the future of the medical device provision process

The future medical device provision process must be viewed from different perspectives. Advantages can be quickly seen from every angle.

Once the eVO has been received, the policyholder can be given a benefit commitment for reimbursements in line with their policy – in the best case, electronically. Ideally, this commitment will include information on the medical supply store that has the required medical device in stock. This information is transmitted electronically – in the simplest case, as a push notification on the policyholder’s mobile device.

The policyholder sends the eVO to the private health insurer and immediately receives a link to their app, which supports the medical device provision process. If the policyholder already has the private health insurer’s app, the ‘provision of medical devices’ function is activated for them. After just a short amount time, they receive a reimbursement confirmation from their private health insurer via the new function, which includes information about the medical supply store, models, possible cost coverages and deductibles. The policyholders initiate a cost estimate from a medical supply store for the model of their choice with a single click in the app and quickly receive confirmation from the private health insurer as well as the medical device delivery.

The policyholder sends a medical device provider (for instance, the medical supply store) a digital request to provide a cost estimate. The request contains all the necessary information. The cost estimate is sent electronically to the private health insurer, which in turn sends its cost coverage statement electronically. The policyholder will be contacted to organise a delivery date, and the delivery will be shipped out –

a faster, more customer-friendly, digital process with benefits for everyone involved. Invoices can be settled either via the usual channel between the policyholder and their private health insurer or directly between the medical device provider and the private health insurer.

adesso and HMM team up to digitalise the medical device provision process

adesso SE and HMM Deutschland GmbH are teaming up to pave the way for the transformation in providing medical devices by providing digital control with seamless involvement on the part of the patients. The basis of this transformation is formed by end-to-end digital processes for policyholders, the digital connection of 95 per cent of all care providers as well as the private health insurers in the ‘health promoters ecosystem’.

HMM logo
‘Since 2005, we as HMM have been creating a network within the medical device provider ecosystem with a focus on the SHI market. Since then, we have managed to connect 95 per cent of all care providers in Germany and use automation to handle medical device application and approval processes to the tune of approximately €2.5 billion per year. It is high time to make the benefits of this completely digital process available to everyone involved in private health insurance – of course taking into account all the specifics involved in private health insurance, such as policy diversity, the particularities of data protection law and so on. We are also interested in seeing every private health insurer become eVO Ready by establishing this digital route.’
Jörg Diepenseifen I CSO and Bu Manager PKV I HMM Deutschland GmbH

adesso is developing the policyholder app for the medical device provision process, including a corresponding back end, and ensuring the integration of the private health insurance systems with the aid of the adesso in|sure health product family. The systems from HMM complement the technical components associated with the medical device provision process.

What we offer

A two-day workshop in which we analyse your company’s current situation. We work with you to develop a medical device provision process for the future and tailor it to meet to your needs. Once we are done, we will happily prepare you an implementation offer.

Get in touch with us

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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