Healthcare quality and affordability

Taking a holistic view of costs, quality and services allows the healthcare system to be developed sustainably, and in a way that makes sense, to serve the general public. Better quality care, starting with prevention, has a positive impact on public health and makes a lasting contribution to keeping costs down. Our commitment is not aimed at getting rid of certain services but at keeping services affordable. This means that they need to be used as part of a conscious and controlled approach. We advocate for quality playing a role in how medical services are paid for in the future.

Healthcare research has an impact on quality and costs

One of the ways to optimise the quality of care is transparency. This is why Helsana has been operating its own scientific centre for more than ten years now, researching the efficiency and quality of medical care. We use data on insured persons that has been rendered anonymous to examine the links between therapy results and the resources deployed, allowing us to draw conclusions about their effectiveness and efficiency. The insights gained as a result of this process serve as impetus for the further development of the healthcare system, particularly for decision-makers in politics and medicine.

16 scientific healthcare studies bear testimony to our commitment to healthcare research in the 2023 reporting year.

Improved medical care thanks to quality indicators

One of the studies from 2023, for example, looked at the treatment of patients suffering from diabetes. The study revealed that the probability of our insured persons with diabetes being treated in line with the medical guidelines increases if quality indicators related to remuneration are implemented in the contracts concluded with networks of doctors.

Helsana Services Contracting implemented selected remuneration-related quality indicators in all contracts with networks of doctors back in 2018. They are based on the 33 evidence-based quality indicators developed by Helsana Public Health Sciences based on our billing data and recommendations from professional medical associations. The quality indicators can be used to measure aspects of the quality of care, particularly in primary medical care.

Patients treated as part of an integrated care model where quality indicators have been implemented receive higher-quality and more cost-effective treatment than patients who are not part of this sort of model. We create transparency for doctors regarding the quality of the treatment they provide and in the area of pharmacotherapy safety. This helps them to improve how they treat their patients. Almost 40% of our insured persons have already opted for a model with a contractually integrated network of doctors.

Cutting costs through digital transformation

Helsana uses digital technologies to make its activities more secure, transparent and flexible, and to enable it to be more responsible in terms of handling customer funds and the environment. The number of documents that Helsana has to process, such as medical or hospital bills, is constantly on the rise – even when the number of customers remains the same. By continuously optimising and digitalising our processing steps, we can cut administrative costs – despite a constant increase in the volume of documents. Automatic processing also reduces the error rate in processing, enhancing processing quality. Thanks to our focus on automated document processing, we have been able to continuously increase the proportion of documents delivered electronically by service providers in relation to the total volume of documents in recent years (see section “Resource consumption”). What is more, any hard-copy documents received are scanned so that they can be processed automatically later on down the line. In 2023, this led to a document automation rate of 89.2%, meaning that 89.2% of all documents submitted to Helsana digitally or as hard copies are then verified by the system automatically, ensuring that they are processed efficiently. Only 10.8% of all documents require manual processing by employees during the verification process.

Support for a healthy life

One of Helsana’s key interests is the health of its insured persons: we want them to stay healthy and enjoy a high quality of life. This is why we don’t focus exclusively on paying out the costs associated with illness, but also specifically promote measures to stay healthy by supporting and rewarding health-conscious behaviour.

• Our health consultation helpline provides our supplementary insurance policyholders with helpful information and specific recommendations for action. Just under 16,000 insured persons took advantage of this service in the reporting year.
• Our Helsana+ app rewards customers for maintaining a healthy lifestyle and preventing illness. Insured persons who have installed the full version of the app can collect Plus points worth over CHF 300 a year and redeem them in various ways: as cash, vouchers from selected partners or as donations for our social engagements (Swiss Red Cross and Theodora Foundation; see section “Community involvement”). Since the beginning of 2023, customers have been able to connect their personal fitness trackers to the app. Their physical activities are synchronised automatically and the Plus points collected are credited directly.
• The Helsana Coach app helps our customers to achieve their personal health goals and offers tips and programmes on exercise, nutrition and mindfulness. The app also features weekly fitness and cooking lessons, recipe ideas, background information and answers to health-related questions. The Coach app can also be linked with the Helsana+ app so that any Coach sessions completed are converted into rewards in the form of Helsana+ Plus points.
• More than 360 Helsana trails, signposted circuits for open-air exercise and sport, can be found at over 120 locations throughout Switzerland. They are regularly maintained by local trail managers and are available to the public free of charge and throughout the year.
• We support insured persons who have fallen ill or been involved in an accident with our Case Management service. The individuals affected receive targeted and coordinated support and comprehensive advice in their complex life situation. This allows us to help them make a return to working life as quickly as possible.
• Helsana also promotes general health literacy, for example, with its “Ratgeber” publication. Each “Ratgeber” guide addresses a specific health topic, such as weight, and provides background knowledge and tips that have been given the green light by experts in the field.