Reimbursement may not be the primary barrier for digital health!?
04 Mar 2022

What can we learn from the critique of the insurance companies regarding the German DiGA experience?

I am the first to recognize that there is a significant gap in most healthcare system regarding the process to evaluate and reimburse digital health. We tried to address some of this in our paper “Do we need a decision framework for integrated digital health to ensure sustainable healthcare?”. More recently, the need for ways to leverage Real world Data sources as part of the evaluation of Digital health solutions in the paper “Advancing digital health applications: priorities for innovation in real-world evidence generation”.

Earlier this week, the GKV Spitzenverband (The National Association of Statutory Health Insurance Funds) issued a report where they reviewed the initial experience with the DiGA process in Germany.

A few highlights from the report:

  • The insurance companies were expecting to see Digital Health solutions with better value.
  • During the period of September 2020 to September 2021:
    • 50 000 DiGAs prescribed
    • Cost of 13 Million EURO
    • Price range from 119-743 € per 90 days.
    • Only 5 out 20 products have been permanently added to the DiGA list.
    • 15 products have not yet demonstrated a meaningful benefit but are still reimbursed during the process to develop evidence.

In summary the insurance companies were expecting better ability of the digital health solutions to improve outcomes for the patients. Even though the initial utilization is rather low, they are approved for indications that have very high prevalence which may lead to a significant cost for solutions that are not yet proven. This combination is a concern for the insurance companies.

The German DiGA pathway has made a very important step in establishing a national route for reimbursement. I believe there is a need to further refine the outcomes that are considered valuable as well as the methods to evaluate the performance of the products to ensure a cost-effective utility in society.

Most importantly, we need digital health solutions that can provide a real value to the healthcare system demonstrated in relevant clinical trials.

Before we have this, the issue of reimbursement is not the primary problem..