HNU Healthcare Management Insights #26

What role does innovation management currently play in SHI and what goals are being pursued?

We see innovations as new approaches to solving existing problems, or more succinctly: Innovations are problem solvers. Unfortunately, healthcare in the SHI system is struggling with multiple problems, as can be seen from the daily media coverage: Hospital closures, drug supply shortages, long waiting times to see a doctor, rising health insurance premiums and an increasing prevalence of chronic diseases are just a few prominent examples. Healthcare innovations - i.e. innovations that aim to further develop healthcare provision - can help to solve such problems. In this respect, innovation management - understood as the systematic identification, testing and scaling of promising innovations - is playing an increasingly important role in SHI. With the help of innovation management, we health insurance funds always pursue the goal of improving the quality of healthcare while at the same time making it more cost-effective. In this way, we want to ensure the future viability of our health insurance fund within the SHI system, but also the future viability of the SHI system as a whole.

What are the components of innovation management in SHI?

The main components of innovation management are the identification, testing and scaling of promising healthcare innovations. The operational implementation of these components takes place through a colorful bouquet of activities:

The identification of suitable innovations includes research and analysis work, participation in relevant events as well as communication and networking with other players from the innovation management environment - for example with start-ups, universities, companies from the pharmaceutical, biotechnology and medical technology sectors, future-oriented providers or other health insurance companies. After all, we first have to become aware of promising healthcare innovations.

As soon as we have identified an innovation whose provider has been able to plausibly demonstrate to us that its use will improve the quality of care for our policyholders and at the same time make it more cost-effective, we enter the trial phase. This is generally based on a special agreement with the provider of the innovation and any participating providers (e.g. doctors or clinics) - the so-called selective contract. As part of the selective contract, we agree to provide financing over and above the regular care and thus bring the innovation into the SHI system. We also use available diagnostic and billing data or survey our policyholders to evaluate whether the goal we are pursuing is actually being achieved.

If the innovation performs well, we support its dissemination in the SHI system by linking up with partners from our network and proactively participating in joint press and public relations work.

With our Healthy Hub, we have systematized innovation management in a joint venture between BIG direkt gesund, IKK Südwest, mhplus Krankenkasse and SBK Siemens-Betriebskrankenkasse. In a way, the Healthy Hub is the statutory health insurance equivalent of the VOX format “Die Höhle der Löwen” - with one major difference: we do not buy shares in companies, but finance healthcare innovations for our policyholders via selective contracts.

In your book “Innovating Healthcare - Wie Start-ups gemeinsam mit Krankenkassen im Gesundheitsmarkt durchstarten” (published by medhochzwei Verlag), you develop a Health Innovation Canvas. How can this structured approach be used for innovation management?

Our Health Innovation Canvas is based on the probably better-known Business Model Canvas. This is a framework for structured business model development that has enjoyed great popularity since its introduction. However, the Business Model Canvas is a general tool that does not take into account the specifics of the SHI market or the interests of the relevant stakeholders, especially the health insurance companies. This is where our more specific Health Innovation Canvas comes in, which we have developed specifically for the preparation of project partnerships between healthcare innovators and statutory health insurance companies. At its core is the benefit of healthcare. A business model can only be sustainably successful in the healthcare sector if it creates tangible added value or a win-win situation for all parties involved - usually patients, doctors and health insurance companies. The Health Innovation Canvas also looks at which stakeholders work together in what way to provide healthcare innovations and how this solves which healthcare problem. Key performance indicators (KPIs) are also defined, the regulatory framework of SGB V & Co. is considered, the costs of the healthcare innovation offered for the health insurance company are worked out and how these costs can be overcompensated by savings effects (e.g. through avoided secondary illnesses or complications as a result of innovation-related optimized care). Good to know: Realized savings effects with a simultaneous increase in quality are the central KPI by which a care manager employed by a health insurance company must be measured - the equivalent of the sales figures of a sales employee, so to speak.

What role do statutory health insurance companies currently play in start-up ecosystems?

Start-ups are bringing a breath of fresh air to the healthcare sector with innovative business models and providing important impetus for necessary further development processes. The approaches are diverse: AI-based diagnostic systems, digitalized therapies or coaching for chronically ill patients are just a few examples of the many different business models based on healthcare innovations. Ultimately, every business model must lead to sustainable sales in the target market or be financially viable. In the SHI market, this is where health insurance companies come into play and, at the latest when there is no regular market access process on the system side, such as the AMNOG procedure for new drugs, cooperation with a health insurance company to finance one's own business model is often essential. In such circumstances, a selective contract can be a relevant or even the only market entry option. With our Healthy Hub and the underlying promise “We'll get you into the SHI system”, we have been operating a format since 2018 that has established itself in the start-up ecosystem and is fortunately very popular there.

Should statutory health insurance companies expand their innovation management activities in the future?

Every company that wants its business model to be successful in the long term should focus on innovation management. The product life cycle, a well-known concept from management theory, illustrates this very clearly. After its launch, every product goes through various phases with varying contributions to the company's success. Ultimately, sooner or later, every product reaches the degeneration phase. If we look at a company's business model as the sum of the products it offers, it quickly becomes clear how important it is to systematically deal with innovations. If a company cannot react successfully to constantly new challenges in a changing business environment or ideally even anticipate them with innovative approaches, the business model will not be sustainable in the long term. This also applies to health insurance companies, which have to compete by offering the lowest possible additional contribution, a high quality of service and, of course, an innovative portfolio of care services. In this respect and also in view of the problems to be solved, we answer the question with a clear “yes”: health insurance companies should definitely expand their activities in the area of innovation management!

Thank you very much for the interview!