CarePay

Practical example and current challenges

• Doctor or hospital bills list different services. These bills are then often paid individually and only then submitted to the insurance companies. There is then a selection of services that are covered by the insurance company and others where it does not happen in whole or in part. The process sometimes takes a long time. Data that is needed to fulfil the relevant activity such as paying an insurance claim is sent in a one-way communication system, leaving many valuable data points such as outpatient care data or patient feedback hidden away in data silos. Another problem is that the individual patient and healthy member only plays a passive role in the process and has little control over his own data.
• Healthcare financing could function much more transparently and smoothly through appropriate data links and two-way communication systems between all stakeholders. However, the EU's statutory health system is currently in a silo-like state. The data is organized in a completely vertical system in accordance with the applicable law. Data exchange between the various players is very complicated. Cost bearers, decision-makers and beneficiaries have to coordinate with each other in order to obtain the access to customer data necessary for the approval of claims.
• One option to improve the exchange of data and the billing and regulation of services received is a public-private platform or “national care bank” where data and payments can be exchanged efficiently and securely. The platform connects insurers, clinics/hospitals, third parties and participants. Each participant is connected to the platform through a mobile healthcare wallet, providing mobile access to healthcare financing and full control over collected data. Previous data silos, including outpatient care data, are connected to related data lakes governed by the rule of law. Every stakeholder can directly interact with the individual in a two-way communication system; resulting transparencies on population health and financing are greatly beneficial to public health interests, while the individual’s data is protected.
• Additionally, two-way communication systems and related data lakes are critical elements to successfully address epidemics as the current coronavirus is highlighting.
• Such a platform has already been successfully launched in Africa on top of mobile money with backing from the Dutch government. In Kenya it was launched in 2016 with more than 4 million participants, 3,100 clinics/hospitals and 185 public and private health insurance programs. In addition, this platform was launched in Nigeria in 2019. The platform is applicable in Europe, as healthcare financing follows the same core process steps globally.
• The potential of mobile healthcare wallets is transformative and initial discussions have been started in the Netherlands and Europe.

What added value does the "GAIA-X project" offer?

• Europe is leading the world in social infrastructure and universal health coverage. Roughly 1/3 of the economy is pre-paid and pre-contracted for this purpose. GAIA-X creates an environment to jointly collaborate to bring this infrastructure into the future. Our European strength becomes an engine for data, algorithms and AI-powered world-class services, and will form a platform able to compete with data-driven companies from the US and China. This can be done in a model where exchange of data is under the rule of law and the returns are in the interest of society, instead of being distributed to private shareholders.
• Health financing processes can be standardized and the related data flows from healthy and sick individuals, clinics and insurers come together in a “national care bank”. The exchange of data flows takes place under the rule of law in the public interest. Algorithms can be shared, and AI-powered solutions can be developed together. If we move Europe’s health financing standards onto a mobile platform, it can have the same impact as GDPR had across the world.
• GAIA-X creates transparency in the cloud market and enables the "hosting" of platforms while maintaining the statutory requirements for data sovereignty in the healthcare sector.
• GAIA-X serves as a basis for a platform that obtains its data from various sources and benefits directly from the open digital ecosystem. A core benefit is the assurance that data is transferred in compliance with defined standards which in turn leads to increased acceptance in the market.
• GAIA-X creates an environment to jointly develop standardized interfaces for social infrastructure. This facilitates the collaboration of fiduciary limited payers, such as insurers, in different geographical locations and guarantees security in data exchanges.
• GAIA-X's guiding principle of modularity and interoperability also makes it possible to reduce dependency on individual cloud providers and to host the platform's various functionalities with different providers.

Use Case Team

• Jan-Willem Scheijgrond – Royal Philips
• Onno Schellekens – CarePay International