Health apps on prescription – could this be a model for Switzerland?

The first digital health application was included in the catalogue of services provided by statutory health insurance funds in 2020. This meant that Germany led the way internationally with regard to the reimbursement of DiGA. Since then, the German DiGA register has been expanded continuously and now includes 64 DiGA (as at July 2024). The range of applications covers everything from physiotherapy to psychotherapy and oncology. The most frequently used app (as at September 2023) is zanadio, which helps patients to lose weight and keep it off by making changes to their exercise and eating habits.
Read on for a summary of the lessons learned in Germany and my takeaways on the challenges of integrating DiGA into treatment processes:

Cautiously positive interim conclusions from Germany
The interim conclusion after the first four years is cautiously positive: the “Digital Health” specialist group set up by the Gesellschaft für Informatik e.V. (German Information Technology Society) refers to DIGA as a “niche product” but also as having “proven benefits for the health care system”. The number of prescriptions has been rising steadily since 2020, even if this is significantly below initial expectations. As at September 2023, DiGA had been accessed approximately 374,000 times.
Statutory health insurance holders can obtain DiGA in two ways: medical professionals can prescribe a DiGA for their patients or patients can apply directly to their health insurance provider. The fact that the vast majority of DiGA (89%) are prescribed by doctors underscores, in my view, the important role played by the medical profession in the further dissemination of DiGA.
The data also refute the myth that it is only younger patients who use health apps: DiGA are used most frequently in the 50-60 age group, however, they are also used in the 60-70 age group.
A major talking point when it comes to DiGA is the cost-benefit ratio. A look at the services covered reveals that in the period from September 2020 to September 2023, EUR 113 million was paid by statutory health insurance funds. Germany’s GKV-Spitzenverband, the umbrella organisation representing statutory health and nursing care insurance funds, is critical of the fact that the insurance funds are obliged to cover DiGA costs that have not yet demonstrated their effectiveness, while the companies producing them are free to set any price they like during the first year. This is something that would certainly need to be examined more closely in Switzerland.

The challenge of integrating DiGA into health care processes
Every new path presents obstacles and other challenges. In the case of DiGA, it is their “integration into health care processes” that is proving to be both a central and complex issue. According to GKV-Spitzenverband, “DiGA are rarely integrated into existing healthcare pathways”.
One reason for this is the limited interoperability of DiGA with other systems such as medical practice information systems. While some DiGA providers do facilitate the export of data from the app as a PDF, it is still a long way from guaranteeing that this information is available to the patient’s treatment team in a clear and comprehensible form. In addition, DiGA frequently lack indication-independent functionalities that play an important role in their integration into the treatment process, such as options to manage medication lists, order medication, exchange information easily with the medical team or record patient-reported outcomes. These missing links mean that DiGA are still largely viewed as isolated rather than integrated therapies.
Another factor is that the medical profession does not fully accept them. Both the lack of clinical evidence for provisionally approved DiGA and reservations surrounding digital solutions are likely to pose obstacles to their prescription. The question of remuneration should not be overlooked either. Doctors need to familiarise themselves with the relevant DiGA in order to be able to explain them to patients and provide support if necessary. The remuneration paid for an initial prescription represents only a very small financial incentive.

Conclusion for Switzerland
France and many other countries are currently looking to Germany for inspiration when it comes to the remuneration of DiGA. In Switzerland, the Allianz Digitale Transformation im Gesundheitswesen (Alliance for Digital Transformation in the Health Care Sector) argues that current tariff systems are suitable only to a limited extent to provide “adequate remuneration for the broad range of new digital health care applications”. The vast majority of digital applications cannot be reflected in current tariff systems, would have to be represented using different tariffs, and the process would take too long to keep up with the pace of innovation.
If we really want to promote the use of digital innovations for treating medical conditions in Switzerland, it is high time we created the pricing structures to make this happen. To maximise their potential, the integration of DiGA into health care processes should be considered from the very beginning and doctors should be included in the process.