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people across Germany
AOK, the market leader in Statutory Health Insurance (SHI) in Germany, has guaranteed quality medical care for policy holders for over 130 years. With help from SAP, AOK Systems – the IT division of AOK – created a cross-industry solution designed to cover all the core and support processes typical of a statutory health insurance company. This solution enables SHI companies to optimize spending, comply with all government mandated regulations, and help more patients gain access to special treatment programs and preventative care.
Service, Finance, Information Technology
SAP for Insurance, SAP Business Warehouse, SAP Business Suite, SAP HANA, SAP Customer Relationship Management
Health insurance is compulsory for everyone living in Germany. Based on their income, many people are required to obtain statutory health insurance (SHI) which is available through self-governed health insurance providers. The cost of SHI is shared between both employers and employees. The current rate represents 15.5% of a person’s gross wages (7.3% is contributed by the employer and 8.2% is contributed by the employee).
Citizens who earn over 55,000 euro annually may choose to opt out of public insurance and instead pay for private health insurance. However, only about 14% of Germany’s policy holders are privately insured.
The SHI system has proved a successful model in Germany for almost 130 years. And today, AOK is the largest SHI in the country, representing 35% of market share. With an electronic patient’s card, every AOK member has access to all the services their health insurance fund provides. The "benefits in kind" principle guarantees that people with health insurance never have to pay for doctors’ services themselves. Patients are free to choose their own doctor and how frequently they need to see that doctor.
Insuring the majority of Germany through SHI
AOK doesn’t only offer health insurance coverage. The company also works hard to continuously improve services and provide beneficiaries with more effective healthcare. For instance, AOK offers developed structured treatment programs for people with chronic diseases. Beneficiaries who become part of AOK’s disease management programs are offered scientific monitoring and an integrated quality management system to prevent unnecessary deterioration of health conditions and to help ensure constant improvement of treatments.
In addition, AOK maintains an integrated-care model of healthcare that better coordinates fragmented levels of care in doctors’ offices, hospitals, nursing homes, and rehabilitation centers. This prevents duplicated patient services, improves health outcomes, and helps to reduce expenditure. The result? More affordable healthcare for AOK beneficiaries.
All SHI providers in Germany are dedicated to preserving the health of policy holders by providing the best treatment possible. But with premiums mandated by law, competition among insurance providers is fierce.
And competition is only one of the challenges that SHI companies face. The changing demographic in Germany is leading to rising medical costs, so cutting internal costs is incredibly important. Further, each change in government policy requires an update in the company’s IT systems.
Implementing IT solutions that can handle the volume
In addition to helping control costs, AOK required an IT solution that could handle very large amounts of data. Collectively, 11 independent regional AOKs manage 6 million cases of clinical treatment, 370 million cases of medical treatment, and 400 million drug prescriptions annually.
Motivated to fix the complexity associated with SHI challenges and to combat their own internal data management issues, AOK Systems, the IT division of AOK, teamed with SAP to create a cross-industry solution. The result, oscare®, is a technical platform that’s available to all SHI companies to license, not just AOK, and is purposed to cover and support all processes of SHI.
Currently oscare® runs SAP Business Warehouse powered by SAP HANA, but in their SAP HANA roadmap, AOK Systems outlines their plan to move their other SAP components onto the SAP HANA platform, such as the SAP ERP application and the SAP Customer Relationship Management application.
All core and support processes
- Udo Patzelt, Head of Product Management at AOK Systems
Solving performance problems and generating new business ideas
The difference SAP HANA is making
With SAP BW powered by SAP HANA running on the backend, oscare® is able to analyze and process the huge amounts of data running through AOK on a daily basis. AOK now has operational analytics to optimize processes. In addition, AOK now is able to better design disease prevention programs that protect and improve the health of insurance holders.
One perfect example of improved analytic capabilities…
AOK can point to some very specific examples of improvements in both their operational efficiency and patient programs. For example, they can now more effectively review and approve thousands of prescriptions associated with home nursing services. Millions of data points are analyzed, and AOK personnel receive color-coded alerts when possible anomalies are found. This helps them identify cases that might require further investigation.
Patient care programs have benefited too. Evaluating diabetic foot syndrome can be a complicated and time-consuming process. With their new systems in place, AOK has reduced the evaluation processing time for this condition from 150 hours (about 6 full days) to 15 minutes. This rapid analysis of the data makes it easier for AOK to design optimized care programs and to get help out faster to the patients who need it.
– Udo Patzelt, Head of Product Management at AOK Systems
Benefits of SAP HANA
oscare® is alleviating some of the main challenges that exist within SHI. The solution is completely customizable so that each SHI company that has licensed the solution is able to innovate on their own terms and differentiate themselves from competition. In addition, the solution is continuously updated to align with all German laws as they evolve over time.
SHI companies are better managing costs and claim expenses by improving the services offered to customers.
AOK plans to migrate their entire oscare landscape to the SAP HANA platform, and they will further enhance their system with additional functionality. These enhancements should help AOK continue their mission of enabling millions of German citizens to receive quality heath care.
Planning for the future