Reimbursement for digital health solutions

Consultancy firm McKinsey has conducted a survey among 213 European physicians. This survey suggests that 55 to 58 percent of them believe that telemedicine will play a significantly greater role in the future. Thousands of digital health solutions are currently on the market. Thousands more are being developed, mostly by start-ups and tech companies entering the sector for the first time rather than traditional healthcare companies.

This article elaborates on the reimbursement and product quality challenges addressed in the eMEN project. Below some excerpts of this interesting article:

“Despite high market expectations, many digital health solutions might not be eligible for reimbursement. Companies should therefore develop strategies for generating and publishing robust data. Such strategies will require a deep understanding of each market’s reimbursement requirements, of the methodologies payers use to evaluate solutions (such as cost-effectiveness analyses), and of the most important concerns for each market.”

“The “fail fast and break things” approach often favored by tech start-ups in other sectors is unlikely to work in healthcare, since the users of solutions will probably be patients, whose safety is paramount, and physicians. A slower, more deliberate route to market and reimbursement is more likely to succeed. Companies should take the time needed to understand fully each country’s digital health environment and to build the high-quality medical and economic evidence that public payers require.”

“Solution providers can craft a compelling value proposition if they thoroughly understand the healthcare system of the countries they are targeting. Healthcare systems can be extraordinarily complicated. Companies must therefore invest time to learn about the relevant reimbursement pathways and which stakeholders (apart from patients) have the most to gain from adopting their solutions.”

“Reimbursement pathways for digital health solutions are evolving at different speeds in different European markets. Germany, Sweden, and the United Kingdom are relatively mature markets where governments are promoting the digitization of care and have standardized reimbursement pathways. Elsewhere, pathways are either not yet established or far from clear. Spain, for example, has many highly autonomous regional payers, so the pathways and evidence requirements vary. It is thus a hard market to tackle.”

“Knowing the market means not only understanding the funding options but also uncovering which stakeholders will have incentives to adopt a solution. Even if its medical benefits have been proved and a strong case made for its economic advantages to the overall health system, certain stakeholders will probably have more to gain than others. These will be the ones to target.”

“Stringent criteria determine which traditional products and services public healthcare systems reimburse. Payers generally want to see high-quality medical data that prove a solution’s efficacy before they will even consider reimbursement.”

“Companies must therefore invest time to learn about the relevant reimbursement pathways and which stakeholders (apart from patients) have the most to gain from adopting their solutions.”

“Path to reimbursement:

  1. The first step is the trial phase, in which a solution is piloted in a small patient pool to refine the technology and collect initial data proving efficacy.
  2. The second phase, early adopters are enlisted with a view to collecting sufficient efficacy and safety data to qualify the solution for certification as a medical product
  3. Third step is to seek reimbursement. In Europe, public payers reimburse medical products and services in two main ways: a centralized approval process in which the full costs of qualifying treatments are reimbursed on a countrywide basis, or a decentralized one, in which payers or local healthcare authorities sign individual contracts with solution providers. 

Digital health solutions are indisputably disrupting the sector, but not as quickly as their developers might like. While the current COVID-19 pandemic might speed up the development and adoption of some digital health solutions (such as remote monitoring or telemedicine), cutting corners in pursuit of a faster route to market could lead to a dead end. Sure and steady will probably win the day.”

You will find a link to the full article below.

The European path to reimbursement for digital health solutions

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