74 million people in Germany, and thus almost 90 % of the population, have statutory health insurance. So when it comes to the question of how to bring a new, innovative product to market, medtech start-ups often find a quick answer in the statutory health insurers (SHI) and their reimbursement options, such as the selective contract. However, founders face several hurdles: from successfully contacting an SHI, to negotiating, to marketing the product after the contract is signed. We talked to Robert Leubner and Sarah Williams from BKK Linde and gained valuable insights.
“Basically, we always experience the same thing,” reports Robert Leubner, Head of Marketing at BKK Linde, “Start-ups inspire with high commitment and very good ideas and encounter a health insurance system with narrow legal boundaries and high market entry barriers. This can quickly lead to frustration and misdirection in the process of establishing a company.” While startups that have already succeeded in entering the market have good chances via offers such as the TK-Innovationsportal or the Healthy-Hub, the first contact with health insurance companies is often sobering for early-stage projects. Usually, a friendly rejection follows with the hint to come back with a market-ready concept.
Good preparation is key
In order to increase the chances of successfully contacting a insurance company and thus of discussing the possibilities of a so-called “Vetrag der Besonderen Verordnung” (contract for special care) according to § 140a SGB V – or selective contract for short – extensive preparation is required on the part of the startup. Several aspects should therefore already be thought through to be able to approach a health insurer with a concrete idea about the contract:
- Is it at all possible to offer our product or service within the framework of a selective contract?
- What requirements and objectives must my product fulfil?
- Which health insurance company’s product strategy fits our product in terms of supply, level of innovation, types of therapy and target group?
- How does the health insurance company improve its market position through our product? For example, can new target groups be won or savings achieved?
- What expectations do we have of the health insurance company in return?
- Which other partners, such as doctors, patient associations and management companies, are necessary for our success?
With regard to the latter aspect, Sarah Williams, interface manager services at BKK Linde, explains: “When it comes to contracts for special care, you should think a little “around the corner”. It’s not directly the health insurance company, but rather the service providers that are important for success.” Service providers are, for example, doctors, specialists, hospitals, but also therapists. “Selective contracts are not only intended to promote innovation, but above all to improve and complement the interdisciplinary cooperation of these service providers for the benefit of the patients. Once you have understood the network principle, it is much easier to approach the potential contract participants and to work out the advantages of your own product for them. In the end, you work with a group of doctors, for example, who use the product for treatment and bill the health insurance company.
Once the contract is signed, the marketing action begin
However, this also means that the successful signing of such a contract with a health insurance company is not enough for a product to actually be prescribed by doctors and for a startup to be able to generate sales. If this is not achieved, contracts and their potential remain unused. There are no official figures on this, says Robert Leubner, but one can assume the Pareto principle: 20 % of the contracts are very successful, while the remaining 80 % just run along. To ensure that one’s own contract does not “just run along”, it is worth taking a look at best practice examples. Robert Leubner reports on two successful cooperations of BKK Linde within the framework of § 140a SGB V, TeleClinic and HautkrebsscreeningPLUS, from which he derives valuable tips:
- Relevant service providers should be identified, brought on board and made enthusiastic about the product long before the contract is signed.
- The individual advantages must be worked out for all service providers – in addition to improved patient care, i.e. also with a view to their own economic interests.
- Possible economic success for the health insurance company should be clearly recognizable in the offer for the insurer.
- Marketing agreements with the health insurance company must be contractually recorded – especially the initial communication is crucial for the further course of the cooperation.
Once the hurdle of successful marketing has been overcome, the selective contract is a comparatively quick and easy door opener for cooperation with health insurers. Sarah Williams and Robert Leubner agree: “If implemented well, selective contracts are the speedboat to place one’s product on the SHI market and successfully generate sales.” At the MII, we therefore check whether the selective contract is a suitable entry into the health market for your product and, if so, we go along with you to the successful conclusion of the contract.