By Karsten Neumann and Nils Breuer

Debate over how best to curb rising costs in the German healthcare system has been ongoing for years. In this context, calls for increased patient management have become louder in recent times – both from health insurance companies and from doctors' representatives and policymakers.

With patient management, people receive the correct treatment even more often and urgent cases are appropriately prioritized, both of which help to reduce healthcare costs while at the same time enabling the provision of better medical care. And, as an international comparison shows, coordinated care is one of the central principles of the system in many parts of the world where medical care is considered exemplary, including Australia and Scandinavia.

The positive effects are thus well documented. What is unclear are the concrete savings that could be achieved through increased patient management. In a recent study, Roland Berger healthcare experts examined the potential savings from patient management in Germany, looking at which areas are likely to yield the greatest effects and where health insurers and policymakers could already be taking action.

Potential savings exceed six percent of annual healthcare costs

Some EUR 312 billion is spent on medical care in Germany every year. The study found that EUR 26 billion, or eight percent of the total, could be saved through better coordinated care. After the necessary investments in digital tools and IT infrastructure, the net saving would still total more than EUR 20 billion.

The experts' calculations took in all relevant sectors. In the outpatient sector, the savings from avoiding some initial consultations and reducing the number of follow-up consultations – including by making targeted use of telemedicine services – amount to EUR 1.2 billion. The study authors predict that the biggest lever will lie in avoiding hospital stays, which can partly be achieved by systematically converting inpatient services to outpatient services. Coupled with avoiding medically unnecessary treatments, the resulting savings potential amounts to EUR 10.3 billion. And, with a contribution of EUR 2.6 billion, improved drug management – for example, to avoid interactions – could also be a significant factor in preventing costs from rising further.

The authors also analyzed the potential of patient management in the indications considered the most important. The indications they examined include common conditions such as back pain, mental illness, stroke, osteoarthritis, cancer and COPD. Their calculations revealed total savings potential of EUR 14 billion in these indications. Together with the sector-specific savings, this results in total savings of at least nine percent of the EUR 312 billion in payments made by statutory health insurers in 2024.

Health insurance representatives see similar potential

To validate their calculations, the study authors also polled the opinions of healthcare experts from the biggest statutory and private health insurance companies. This survey revealed a high degree of agreement with the study's key findings. The health insurance representatives, too, predict that avoiding unnecessary hospital stays will be the biggest lever for reducing expenditure. They see three approaches as being the most effective: shifting to outpatient care for suitable cases, reducing the overuse of medical services (e.g. for certain operations) and seeking second opinions.

A survey conducted among a random sample of registered physicians revealed that they, too, are open to increased patient management. According to them, complex pathologies, unclear symptoms and cases requiring treatment from several medical disciplines are the most suitable starting points for increased patient management.

Recommendations for rapid implementation

The survey of experts also showed that a number of prerequisites first need to be met before the potential outlined above can be realized. These include the introduction of mandatory gatekeeping by primary care physicians, automated referral for a second opinion (e.g. from a doctor operating within Germany's private health insurance system) and the establishment of indication-specific care pathways as binding patient management instruments.

The study concludes with five recommendations designed to enable the rapid implementation of increased patient management in Germany. First, in order to be able to define goals and address the most important issues, policymakers must create a systematic overview of the various levers that are available and the measures that need to be taken to apply them. The next step is then to create, among other things, a suitable legal framework and specifications for a standardized triage system. The authors also call for stronger interdisciplinary structures and greater digitalization, for example to enable digital booking platforms or digital triage.

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