Insurers, patients and health data

From lack of access to data, to being the last link in the chain, through fierce competition, there are many pitfalls for insurers in the healthcare environment.

Published on February 24, 2022 at 09:11 am

These players, in association with the social security system, play a central role in patients' lives. In the digital age, they are more than ever determined on offering personalized support tailored to individual needs, as is already the case in many other sectors. The problem is that there's a big gap between will and reality. Once again, the lack of interoperability.

To discuss this hot topic, we interviewed Yanick Philippon, Director of Group Insurance at Generali France.

Care pathways: organization and players

Strictly speaking, there is no such thing as a universal care pathway between patient and insurer. However, we can build on what currently exists via the Generali France customer area and its corollary, the mobile application. Today, the patient interacts with his or her complementary health insurance provider prior to treatment, for example to submit a quote, a request for reimbursement or to seek a second medical opinion before undergoing treatment or an operation. Then, once the treatment has been carried out, the patient receives the reimbursements to which he or she is entitled as a policyholder.

Between these two phases, however, the insurer has no information about the patient's care path. This is the prerogative of the Caisse Primaire d'Assurance Maladie (local sickness insurance fund, "CPAM"). This information is then transmitted to the Dossier Médical Partagé (shared medical file, "DMP"), a digital health record that stores and secures the patient's health information: treatments received over the last 12 months, medical history (pathologies, allergies), test results, hospitalization reports, etc. The only people who have access to this data are the attending physician and all healthcare professionals (except occupational medicine), including hospitals.

Since January 2022, existing DMPs have been migrated to a new platform called "Mon Espace Santé" (My Health Space), where new files will also be created. Until March 2022, all Social Security subscribers will be notified and will be able (if they so wish) to refuse the activation or creation of their space.

"Mon Espace Santé" has two main functions. First, to become one's own medical file. This will enable you to store medical documents added by you or your healthcare professionals. It will also allow you to add documents and information that predate the creation of this space, in order to retrace your medical history. In short, the paper health record we've treasured for years is going digital.

The second feature is instant messaging. As patients, we can exchange or receive information or documents from our healthcare professionals.

Reassurance and trust for better support

The constraints faced by players such as Generali, through its complementary healthcare offering, are not a new issue. Patient medical data is completely sealed off from institutional players. As the CPAM states on its public information website: "Neither the occupational health service, nor mutual insurance companies, nor banks, nor your employer can access your Dossier Médical Partagé (shared medical file). Finally, any access to your DMP by an unauthorized healthcare professional would constitute an offence punishable by imprisonment and a fine".

This is a constraint considering these players could better support their policyholders if they had access to some of this information. Knowing a patient's pathology, for example, makes it easier to provide specific advice on pricing without compromising the quality of care and treatment.

For some treatments, variations in the fees charged can be of a magnitude that is not always justified. The same applies to prescription drugs. Wider access would make it possible to offer more precise, better-adapted health cover for the patient.

Since January 1, 2022, with the opening of "Mon Espace Santé" (My Health Space), every person affiliated to the general Social Security scheme has been able to grant or restrict access to their DMP. However, this only applies to healthcare professionals. For example, a chiropodist will not be able to access your hospital reports.

Another obstacle is the patient's reluctance to share his health data with his insurer. While this is absolutely not the case on the part of the insurer, there is nevertheless a fear of being selected and somehow penalized by more expensive rates, or even of being cancelled or refused complementary health cover. There is undoubtedly also confusion with the loan insurance process, where each person must fill in a health questionnaire on their honour, and may have to undergo some medical tests.

Clearly, we must continue to reassure patients that there is no intention to discriminate.

Likewise, there is an ongoing need for in-depth educational work to show the real added value for the patient of sharing certain data. In the case of the second medical opinion to which a patient is entitled through his or her complementary health insurance, having more data would enable a more refined diagnosis or medical advice to be given for the benefit of the patient. The more data is available to understand the patient's care pathway, the more efficient the services offered will be.

Even more so, it's the ease with which data can be made available and used that is essential if patients are to benefit from the best possible prevention, the best possible care pathways when medical intervention is required, and the best possible post-intervention follow-up. In this respect, a digital health innovation ecosystem such as Future4care represents a tremendous opportunity to accelerate the development and marketing of e-health solutions based precisely on data, to the benefit of all, in particular patients and healthcare professionals.

The divide between players has a direct impact on patients

There is no denying that strong reluctance exists and persists at various levels of the value chain. For healthcare professionals, extending access to health data is very often seen as a form of increased control over their medical acts by non-legitimate third parties, or even a stronger possibility of questioning and contesting their diagnoses. Here, also, there is a need for explanation and dialogue in order to gradually overcome resistance and apprehension, and move towards mutual cooperation in the service and benefit of the patient.

L’Etat lui-même n’est pas toujours exempt de certaines frictions. Le rapport du Haut Conseil pour l’avenir de l’assurance The State itself is not always exempt from certain frictions. The report by the Haut Conseil pour l'avenir de l'assurance maladie (HCAAM) on the "Grande Sécu" project (commissioned by the French Ministry of Health) is a prime example. At the moment, four scenarios for linking basic compulsory health cover to supplementary health cover are being studied. From the most radical to the most "balanced", these 4 hypotheses would de facto lead to the nationalization of health coverage and the marginalization of supplementary health insurance.

If this project were to see the light of day, it would undoubtedly create a profoundly unfair system, creating a divide between those who can afford to pay more without public support and gain rapid access to the best professionals, and those who cannot.

Such a scenario does not correspond to the expectations of healthcare professionals, and above all to the expectations of the French in general, who are deeply attached to a certain freedom of activity and choice.

There are still things that can be done to improve health coverage for the population, in particular the most vulnerable, but this "Grande Sécu" scenario is clearly not the right decision to take. Common sense must prevail on this issue.

Digital health care, the key asset

The subject of the "Grande Sécu" is divisive, while the benefits of digital technology are increasingly unifying the thinking of our ecosystem. In fact, it's difficult to be totally exhaustive about the qualities of digital technology, given the number of positive contributions it can make to a patient's healthcare pathway at any given stage. Connected devices, for example, are a formidable lever for optimized, personalized daily monitoring of various chronic diseases such as cardiac arrhythmia, asthma and diabetes, as well as for post-operative monitoring on an outpatient basis and/or at home, rather than in hospital for longer periods.

Prevention is another fundamental area where immense progress can be made thanks to digital technology, for a better understanding of the patient's lifestyle and environment.

For healthcare professionals (as well as for governments and insurers), predictive medicine also opens up a vast field of opportunities, such as better anticipating and curbing the onset of certain pandemics or more familiar epidemics like influenza, gastroenteritis and seasonal allergies. With the launch of messenger RNA vaccines against Covid-19, for example, the world has become aware of the fantastic progress made by digital RNA sequencing and synthesis technologies. This technology also opens up great prospects for information storage, with capacities never achieved before .

The challenge of telemedicine

It's impossible to talk about digital technology without mentioning the long-standing subject of telemedicine. To be functional, telemedicine requires sufficiently powerful infrastructures and telecommunications networks. 20 years ago, access to fiber optics and mobile broadband was still in its infancy in terms of deployment across France.

Today, fiber and 5G have a much higher coverage rate, although there are still white zones where patients and healthcare professionals cannot use telemedicine. As a result, the use of telemedicine will be facilitated and amplified.

Furthermore, beyond the question of infrastructure, we need to encourage the use of remote healthcare services as soon as possible. In this respect, a very interesting step forward was taken on January 27. The French National Authority for Health (HAS) published four guidelines to help healthcare professionals make the most of remote medical monitoring. These guides define the conditions for prescribing telemonitoring, the minimum technical specifications required for digital medical devices and collection accessories, the conditions of distribution and use, the professionals involved, the professional qualifications required, the organization of telemonitoring, the minimum provisions necessary to ensure quality of care, and the follow-up and use of telemonitoring.

By July 1, reimbursement for remote medical monitoring will be generalized for several pathologies (diabetes, renal failure, heart failure and chronic respiratory disease). In the near future, patients with implantable cardiac prostheses will also be covered. For healthcare professionals, this means they can remotely interpret data for their patient's medical follow-up, and even adapt their treatment. This remote monitoring can detect a worsening in a patient's state of health, enabling them to intervene more rapidly. These devices are real assets in demonstrating the immense benefits of digital technology in healthcare.

Future4care, catalyst and gas pedal of progress in digital healthcare

Future4care has a fundamental role to play in this digital health ecosystem. This is what led Generali to become one of the four founding partners (alongside Sanofi, Orange and Capgemini) of this innovative and powerful initiative, which will help to model the healthcare of the future and find new technological solutions and innovative services for patients. The insurance industry works statistically with a large volume of anonymized data and a history spanning several decades, which can be made available to startups to fuel their search for solutions.

In the teeming world of startups, Future4care acts as a veritable catalyst, identifying the most relevant and promising digital healthcare projects, supporting them to accelerate their development and bring them to market for the benefit of healthcare professionals and patients alike.

Secondly, Future4care is a physical and virtual forum for exchange and technology watch, which will forge closer links between major players such as the four founders involved in digital health, start-ups who will be able to test, make reliable and launch concrete, innovative solutions, and players from the medical world, universities and patient associations. The idea is really to build more bridges between these communities, all of whom are ultimately working towards the same ultimate goal: better prevention to better protect everyone's health, and better care to better restore quality of life.