The Digitalization of the Statutory Health Insurance Companies

A look behind the scenes

Has digitalization now also reached the statutory health insurance companies in Germany? Our expert for statutory health insurance, Lutz Schedlbauer, Managing Consultant at valantic, has experienced the development of digitalization at health insurance companies first-hand. Here, he gives us a look at what he does everyday.

Lutz, how long have you been with valantic and what exactly are your tasks as Managing Consultant?

I have been with valantic (formerly novem business applications) since 2005; that is, for more than 17 years. In this time, my focus has been primarily on the field of statutory health insurance. Among other things, I support AOK Niedersachsen, AOK Nordost, the Techniker Krankenkasse, and the Innungskrankenkasse (IKK – Die Innovationskasse). As Managing Consultant, I have been managing one of our valantic units for the past ten years. A large part of my working life consists of meetings, workshops, and project planning. Together with my team, we implement business intelligence/analytics solutions for our customers; we also build data warehouse structures and help customers develop and implement digitalization strategies.

That’s a long time. That also means that you have experienced the development of the statutory health insurance companies “up close and personal.” Are digitalization, business analytics, and Big Data inevitable trends in the healthcare sector?

Clearly the answer is yes! The disruptive effects have also reached the statutory health insurance companies. The variety and number of digital offerings for patients and insured parties are increasing rapidly. In addition, digitalization projects are a means of distinguishing one’s own company from the competition. However, most communication with insured parties still takes place by post. Today, policyholders expect to be able to do their insurance business digitally as much as possible. In the case of health insurance companies in particular, huge amounts of data are generated every day from various areas; data that must be combined, cleaned up, and evaluated. This requires excellent data processing on the one hand and business intelligence and analytics solutions that deliver important insights based on existing data on the other. Due to the constantly changing laws, which include, for example, the introduction and adaptation of the health fund, and increased cost pressure, e.g. due to the pandemic and the changing age structure, health insurance companies must react flexibly and constantly recognize potential savings.

According to your experience, how “digital” are the statutory health insurance companies in 2022?

A great deal has happened in recent years. Many processes are now being digitalized. Smart AI-driven solutions have also been established successfully. These include, for example, the completely automated processing of electronic mail, chatbots and voicebots (conversational AI) for customer service, the electronic health record, various apps for insured parties, telemedicine, video consultations, and that’s only a small selection of the digital possibilities. However, my project experience shows that internal processes, the technical infrastructure, and especially the training of employees will still have to be optimized in the next few years.

What do statutory health insurance companies have to consider when developing a digitalization strategy?

Digitalized processes must be monitored and evaluated constantly in order to quickly identify and respond to weak points, errors, and changing personnel requirements (e.g. completely automatic processing of electronic mail). All processes must be scrutinized. But as I’ve already said: The most important thing is to train and develop employees in order to prepare them for the constantly changing processes and requirements.

Where do you currently see the greatest opportunities and risks in this industry?

I see a great opportunity for modern health insurance companies with innovative insurance offerings to position themselves well on the market. Not only do such companies attract more people to insure, but they are also interesting for new employees.

Statutory health insurance companies that do not adapt quickly enough will lose out and will be taken over by larger or more innovative insurance companies. The will to change must be there. This is a clear risk – but at the same time, a great opportunity.

What business analytics projects have you implemented in the past few years at statutory insurance companies?

In our projects, we work primarily with business analytics and data warehouse solutions from our Gold partners IBM, SAP, Microsoft and MicroStrategy. The biggest and most exciting projects were, for example, the conversion of a company-wide reporting system from IBM Cognos to SAP BO. Here, we modified or developed anew more than 3,000 reports on more than 30 specialist topics, and we trained and coached over 100 users. Another exciting project was the development of a company-wide reporting system including the construction of a data warehouse. I remain with many of the projects for several years because the health insurance companies are always posing new requirements, requirements that my team and I must implement and support.