Health special: BITMARCK revs up the digital engine of SHIs with data and AI

How can health insurers reduce costs, provide better care for policyholders, and at the same time meet the latest legal requirements for digitization? BITMARCK assists them in solving these issues with the help of data and AI and benefits itself from an integrated data strategy developed in cooperation with Comma Soft.

“Data are the future of statutory health insurance. They hold enormous potential for efficiency, can increase the satisfaction of policyholders and improve overall healthcare,” says Peter Flemming, Business Manager Data Science at BITMARCK. According to the Association of Statutory Health Insurance Funds (Verband der Ersatzkassen), 88% of all Germans are insured through statutory health insurance funds (SHIs). What most people don’t realize is that for more than 80% of these health insurance companies, the managed service provider BITMARCK ensures that the digital processes run in the background. The company’s consulting services, and software solutions have been supporting health insurers since 1994 in areas such as data exchange with pharmacies, hospitals, and doctors, as well as in digitizing the associated processes. For one thing, this is essential for the provision of services and billing. Furthermore, the data hold a veritable treasure trove of information that SHI organizations can use to address numerous current challenges.

Using data to counter the pressure of digitization

“SHIs work with a complex and interconnected data landscape. It feeds on billing data, process data, policyholder data, etc. from a wide variety of sources and processes. BITMARCK provides both modern centralized and decentralized systems to handle these substantial amounts of data. This is the basis on which we are tackling the latest challenges together with the SHIs,” explains Peter Flemming. One reason why the challenges arise is the change in expectations on the part of policyholders. They are used to shopping online and tracking the status of orders in real time via an app. They have come to expect the same from insurance companies. If the quality of service is not up to scratch, policyholders can simply switch to another insurer with a few clicks. “Health insurance companies have many more digital touch points with policyholders these days, in addition to direct contact with customers. Expectations and demands for convenience have risen. In order to do justice to this, SHIs are dependent on efficient evaluation and use of customer data,” explains Peter Flemming. “On the other hand, politics provides a framework for future action: electronic patient files, e-prescriptions – all of this creates additional pressure for digitization. Lastly, SHIs also want to achieve their strategic growth targets in order to survive in the market. We are helping SHIs meet these challenges through efficient use of data.”

A guide on the journey to becoming a data-driven SHI

If SHIs increasingly digitize processes, data will be relevant in two respects: they will support the digital processes and, at the same time, new data can be generated from them. “Data Science is therefore the next logical step in my view. As a result of the increasing digitization of their processes, the SHIs are receiving even more data, which are analyzed by means of data science and used in processes. The processes themselves can in turn be made smarter and improved through data and AI,” says Peter Flemming. BITMARCK plays a decisive role in this. Peter Flemming’s data science team develops innovative solutions for various use cases and implements them at SHIs, for instance in the context of fraud detection. “The challenge here is that we have a very wide-ranging customer base. Each SHI will have different amounts of data of varying quality, depending on the size of the company. Our solutions should meet individual requirements and conditions, but at the same time be sufficiently standardized so that as many SHIs as possible can use them and, for example, compensate for a smaller data pool,” says Peter Flemming. BITMARCK achieves this firstly through a close dialogue with the health insurers, and secondly through a consistent strategic approach. “When it came to finding our strategic direction, we brought Comma Soft on board to help us,” Peter Flemming tells us, elaborating: “We worked with a bottom-up principle for a long time, first developing solutions individually and then rolling them out further. What we lacked was a holistic view from above.”

Integrated data strategy as the basis for further AI cases

Working together with Comma Soft, BITMARCK was able to produce useful and expedient concepts for the standardization of data management as well as other important topics such as data governance, data culture and digital ethics. The standardization of the data science-related IT infrastructure and development environment, which had already been started by BITMARCK, was integrated into this holistic view at the same time. “We now have a coherent master plan for our data science strategy and a strategically aligned roadmap for our use cases – both internally and in collaboration with SHIs. In my view, the wealth of experience that Comma Soft brings with it from other projects and the agile, transparent approach to our collaboration are particularly helpful,” says Peter Flemming. Next, he and his team and Comma Soft plan to increase their focus on the use of AI: “There are still many opportunities here for us to make improvements through smart data use, from using historical policyholder data to provide prevention and personalized treatments, to helping providers with patient histories, to improving real-time communications. With the BITMARCK Health Cockpit, for example, we already support the new communication channels that are currently emerging within the SHI telematics infrastructure. All of this can be used to improve policyholder satisfaction and the quality of care if we continue in this direction. We’ve already got the ball rolling in this respect: with data and artificial intelligence.”

Would you like to learn more about how BITMARCK is expanding and implementing its data strategy? Our colleague Dr. Markus Knappitsch will gladly provide you with insights and suggestions for your projects. Feel free to get in touch with him.

Peter Flemming is Business Manager Data Science at BITMARCK, where he drives agile transformation and strategic alignment in the field of Data Science. As a managed service provider, BITMARCK supports more than 80% of the German statutory health insurance funds (SHIs) with customized software solutions in the digitization of all business areas and business processes as well as operating the IT infrastructure required for this. There is a particular focus on developing innovative AI and data-based solutions in BITMARCK’s Data.Science.Factory, through which the SHIs can offer their policyholders even better coverage.