Reimbursement process for digital health solutions is a complex journey. Which steps are perceived as most challenging?

Monetization through reimbursement is complicated and a long journey with multiple steps. There are two most challenging milestones on the way to reimbursement, while one distribution channel is selected as the best option.

Reimbursement for digital health solutions is a multi-step journey that can be lengthy, time-consuming, and resource intensive. The process typically begins with a thorough requirement assessment, where the digital health solution needs to align with specific criteria set by the regulators.

The next steps involve meeting data security and interoperability demands, providing clinical evidence, and showcasing socio-economic benefits. Negotiating pricing and contracting with healthcare providers and/or insurance companies is another critical aspect of the reimbursement process, followed by managing the adoption by the end users.

In order to understand the opinion of digital health decision makers on reimbursement landscape, the most challenging steps in reimbursement process, the monetization approaches and more, R2G conducted a global survey on How to make money in digital health? The detailed results are published in the whitepaper Monetizing Digital Health Solutions – 2023. According to a majority of the survey participants (78%) ensuring HCP adoption is the most challenging step followed by providing clinical evidence (59%). Demonstrating socio-economic benefits and ensuring patient adoption are also difficult steps as indicated by digital health industry stakeholders.

According to one of the largest German insurers Techniker Krankenkasse (TK), the prescription rate of DiGA among physicians stood at a mere 4% as of early 2022[1]. In other countries like the USA or Scandinavian countries, telehealth or RPM adoption may be higher, but it remains below 10 percent in most countries[2].

In addition, Digital Health Applications (DiGA) requirements have become more stringent, leading to a significant number of rejections and deletions. Among the six provisionally listed apps, four were deleted due to the inability to demonstrate positive clinical outcomes. As a result, regulators should focus on simplifying the application process to encourage more digital health companies to apply and provide guidance on generating clinical evidence.

On the contrary, health care providers are preferred as the best distribution channel for digital health solutions according to the majority of the stakeholders (73%). Hospitals are a key target for remote patient monitoring applications, especially in chronic disease management like cardiovascular diseases, diabetes, oncology etc.

Prominent hospital groups like Charite and Vivantes in Germany have already deployed several RPM projects for cardiovascular diseases and hypertension. They also collaborate with providers like Samedi, Clickdoc, Patientus, and Minddistrict to offer telehealth, appointment scheduling, and mental health solutions.

Similarly, renowned health systems and hospitals like the Veteran Health Administration and Cleveland Clinic in the USA are integrating third-party digital health solutions like CBT-I coach, Insomnia coach, and more into their healthcare offerings. Even though providers are picking up, the overall HCP adoption towards digital health solutions is rather low. As a results, companies may need to explore other distribution partnerships to reach doctors more easily. See also R2G’s global study on digital health partnerships and its success factors.

Although healthcare providers (HCPs) are ranked as the top distribution channel for digital health solutions, their adoption of these solutions remains low, presenting a significant challenge in the reimbursement process as indicated by the digital health decision makers. To overcome this challenge, new approaches are needed to encourage HCPs to prescribe and integrate digital health solutions into their practice. Solution providers should prioritize strategies that emphasize HCP onboarding and ongoing support to drive better adoption rates.

Download your free copy of the whitepaper to gain valuable insights and stakeholder perspectives on effective monetization strategies, successful business models, barriers in monetizing digital health solutions and much more!

R2G has been constantly monitoring the global digital health industry since 2010. We provide strategic advice for how to build and grow a successful digital health business within all therapeutic areas, business models and regions. We are happy to talk and share our experience!
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[1] TK report (2022)

[2] R2G telehealth study 2022