Aligning Strategies: How Digital Health Technologies Are Used by a

Swiss Insurance Company to Foster a Sustainable Healthcare

Landscape

Alina Liebich

, Livia Jacob

and Tobias Kowatsch

1,3,4 b

School of Medicine, University of St. Gallen, Switzerland

SWICA Krankenversicherung AG, Switzerland

CDHI Department of Management, Technology, and Economics, ETH Zurich, Switzerland

Institute for Implementation Science in Health Care, University of Zurich, Switzerland

Keywords: Digital Health Technology, Disease Prevention, Integrated Care, Health Insurance.

Abstract: Escalating healthcare costs, as well as an outdated traditional healthcare landscape, are placing considerable

strain on European healthcare systems, pushing society to re-evaluate current business models. Sustainable

solutions require stakeholders to collaborate and innovate. For this Position Paper, we interviewed a

representative of SWICA, one of Switzerland’s largest health insurance companies, to gain insight into their

perspective and expectations regarding the upcoming challenges. The results show that SWICA has developed

a portfolio of multiple digital health technologies to promote an integrated and preventive care approach in

collaboration with new partners in the healthcare system.

1 INTRODUCTION

Recent trends demonstrate an increasing burden of

morbidity (Collaborator, 2020), primarily driven by

an aging population and the rising prevalence of non-

communicable diseases (NCDs), such as

cardiovascular disease, diabetes, and cancer

(Garmany, Yamada, & Terzic, 2021). The associated

escalating healthcare costs, with NCDs accounting

for 80% of these expenses (Wieser et al., 2014), are

placing considerable strain on European healthcare

systems, pushing society to re-evaluate the traditional

healthcare landscape. Several factors, as summarized

in Table 1, have been identified that require

innovative solutions that are sustainable for society

(BAG, 2023; Statistics, 2023).

1.1 A National Strategy Is Required

The Swiss Ministry of Health has developed a

"Health2030" strategy to address these challenges to

alleviate the rising cost and disease burden for the

Swiss population (BAG, 2023). The specific goals

https://orcid.org/0009-0004-2475-2060

https://orcid.org/0000-0001-5939-4145

Table 1: Challenges the Swiss healthcare system is facing

(BAG, 2023; Statistics, 2023).

• Inefficient traditional care models, e.g.,

communication between specialists and

community care or data exchange

• "One-size-fits-all" medicine

• Increasing workloads

• Shortage of qualified healthcare professionals

• Untransparent cost structures

• Socioeconomic and geographical disparities

regarding healthcare access and outcomes

• Unmet patient expectations for affordability,

accessibility, and reduced waiting times

• Passive patient participation

• Slowed digitalization of the healthcare sector

compared to other industries

• Higher focus on acute care compared to chronic

care

894

Liebich, A., Jacob, L. and Kowatsch, T.

Aligning Strategies: How Digital Health Technologies Are Used by a Swiss Insurance Company to Foster a Sustainable Healthcare Landscape.

DOI: 10.5220/0012402400003657

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 17th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2024) - Volume 2, pages 894-899

ISBN: 978-989-758-688-0; ISSN: 2184-4305

include improved health literacy, promotion of

healthy aging initiatives, and increased treatment

quality while guaranteeing the affordability of

healthcare. Traditional models have yet to keep pace

with increased workload (Hickmann, Richter, &

Schlieter, 2022). Therefore, emerging scalable

business models are required to achieve these goals.

The proposed national strategy focuses on preventing

NCDs and implementing digital health technologies

(DHT) (Alliance, 2023), including telemedicine,

mobile health apps, wearable devices, electronic

health records, and artificial intelligence. These

technologies hold the potential to reshape the whole

patient journey from the prevention and diagnosis of

disease, assisted decision support, and personalized

therapy to more efficient disease monitoring and

management (Mumtaz et al., 2023). For the

sustainable implementation of the national strategy,

close collaboration and tight coordination of various

stakeholders, including healthcare insurance

providers, is essential to build the necessary

infrastructure and use resources efficiently (Essén et

al., 2022). For this Position Paper, we partnered with

a representative of SWICA, one of Switzerland’s

largest health insurance companies, to gain insight

into their perspective and expectations regarding the

upcoming challenges.

1.2 Accepting the Challenge

SWICA counts 1.6 million insured individuals and

serves 30,000 business clients, making it one of

Switzerland's leading health insurance companies

(SWICA, 2023b). Established in 1992, it follows the

paradigm of delivering medical care to help its

customers stay healthy, get healthy, and live well with

a disability (SWICA, 2023a). The Company's

primary objective lies in the satisfaction of its

customers, which the Company demonstrated again

in 2023 by ranking first regarding best customer

satisfaction compared to other Swiss health insurers

(SWICA, 2023d). SWICA's primary concern is the

expected demographic change of an aging population.

The Company aims to address the cost implications

of this change with various offerings for its insured

members, ranging from disease prevention and

healthy aging initiatives to extended integrated care

solutions. Most of these offerings are part of

SWICA's digital transformation, which began gaining

traction in 2008 with the launch of the sante24 health

advice telemedicine helpline.

2 METHODS

An initial search about SWICA's history, current

goals, and initiatives was performed using annual

company reports. Afterward, we conducted a semi-

structured online interview with a Senior Digital

Health Specialist at SWICA using Zoom. The

Interview took place on the 5th of October and was

guided by the topics suggested in the Scale-IT-up

2024 workshop (BIOSTEC, 2023). The workshop

explores emerging business models in preventive care

using DHTs. The following section summarizes the

qualitative results obtained in the interview. Further,

we analyzed the new business models around

SWICA’s preventive care efforts using Gassmann’s

Business Model Navigator framework (Gassmann,

2020). A conclusion, including an outlook, follows

the discussion.

3 SWICA’S APPROACH TO

BECOME A SUSTAINABLE

HEALTH INSURANCE

COMPANY

Sustainability can be defined as a governing principle

shaping the activity of a system to preserve resources

(Rashdan & Csepy, 2022). The sustainability of the

Swiss healthcare system is next to environmental and

financial ambitions, one of the four declared

sustainability focus areas of SWICA. Specific goals

include maintaining the health of its members and

improving the quality and efficiency of the healthcare

system (SWICA, 2023c). These goals triggered the

company to redefine its responsibilities as a

healthcare insurer. SWICA`s role has since shifted

from being a traditional health insurer to becoming a

holistic health care organization that plays an active

role in various parts of the lives of its members. The

focus is on offering products and services that have

an additive effect on existing models, as SWICA

wants to avoid direct interference with the work of

traditional healthcare providers. The company aims to

offer solutions characterized by easy accessibility,

scalability, and personal customization. SWICA thus

focused on creating new business models around

DHTs. DHTs allow the incorporation of those three

characteristics. SWICA’s DHT spectrum ranges from

disease prevention to diagnosis and management and

can be structured into two main categories (Figure 1):

(1) DHTs for integrated care and (2) DHTs for

preventive care.

Aligning Strategies: How Digital Health Technologies Are Used by a Swiss Insurance Company to Foster a Sustainable Healthcare

Landscape

895

Figure 1: SWICA’s approach towards becoming a

sustainable health insurance company.

3.1 Integrated Care at the Front

Establishing an integrated healthcare system aims to

promote connections and coordination across

different levels and sites of care within and beyond

the health sector according to the patient’s needs

(Goodwin, 2016). One objective is to support

individuals with chronic or multiple illnesses in

managing their health while identifying and

preventing overuse or gaps in the patient journey.

These advancements are essential to increase

efficiency, reduce costs, and improve the quality of

care. Part of integrated care are Disease-management

programs (DMPs) that primarily cater to chronically

ill patients and patients with multiple diseases. The

goal is to support and integrate them actively in their

patient journey. A recent intervention study of

SWICA demonstrated the positive effects on

treatment quality and hospitalization rates through

intensified DMPs (Carlander, 2021).

3.2 Scale-up Prevention

SWICA offers traditional in-person as well as new

digital prevention solutions. Some target the

prevention of specific diseases, while other, more

general solutions encourage a healthy lifestyle.

General prevention covers well-being, exercise, and

nutrition programs, while specific options include

disease counseling and education. Further, SWICA

subsidizes several external prevention programs

organized by third parties. Some of these prevention

initiatives align with their broader mission to promote

healthy aging. SWICA’s "Demographic

Development and Aging" strategy focuses on the

demographic changes associated with an aging

population. SWICA has actively created new

products and business models to alleviate age-related

health challenges as part of this strategy. The target

population for individual projects, such as "Health

Promotion Golden Age," comprises insured

individuals aged 60 and above. SWICAs own

offerings in that domain include mainly the use of

DHTs. However, they also cooperate with partners,

such as the University Hospital of Zurich or Spitex, a

local care provider, to offer in-person support.

SWICA also has a dedicated “Health in Aging”

section on its website and hosted the 2023 SWICA

Symposium on “Health in Aging,” uniting academics

and industry representatives to explore future

solutions. These efforts highlight the holistic

approach to promoting healthy aging, encouraging

customer self-empowerment and education while

actively supporting health engagement through

innovative product offerings.

3.3 Tightening the Knots with New

Partners

SWICA acknowledges that many aspects are beyond

the company's control or capacity. This includes

aspects such as medical care reimbursement or

technical innovation expertise. SWICA, therefore,

believes in interprofessional collaborations to

develop new business models with various partners in

preventive and integrated care initiatives. The

company depends on new partners to successfully

implement SWICA’s ambitions and positions itself as

a co-creator of new structures. On several projects,

SWICA cooperates with other stakeholders in the

Swiss healthcare industry to use resources efficiently

and ease the way for a common sustainable health

landscape. The development of new DHTs primarily

relies on external innovations and collaborations with

other stakeholders.

4 HALLMARKS OF EMERGING

BUSINESS MODELS- AN

ANALYSIS

A business model reflects the firm's strategy

(Casadesus-Masanell, 2009). SWICA’s ambition is to

make prevention successful and reduce the misuse of

healthcare resources. The company has, therefore,

developed multiple DHTs targeting disease

prevention and extending its integrated care

approach. In the following section, we used

Gassmann’s Business Model Navigator framework to

assess the individual DHTs SWICA chose to

implement its strategy (Gassmann, 2020). His model

consists of four dimensions:

Healthcare

Sustainability

Integrated

Care

Preventive

Care

Scale-IT-up 2024 - Workshop on Emerging Business Models in Digital Health

896

• WHO are the target customers?

• WHAT is offered to them?

• HOW is the value created?

• WHY does it generate value?

4.1 DHTs for Integrated Care

SWICA combines different technologies to promote

integrated care solutions for its customers. Its focus

lies on telecommunication and app-based product

offerings.

4.1.1 Telemedicine Advanced

One of SWICA's first and most used DHTs is the

Sante24 telemedicine service, which was launched in

2008 and works as an independent center, offering

various products concerning disease prevention,

diagnosis, and management. All insured individuals

may call Sante24 24/7 without any cost incurred and

are initially guided by a health coach. The patient will

be directed to a doctor for further consultation if

necessary. Members benefit from medical

consultation and coaching. Through telemedicine, the

barrier to receiving medical expertise is lowered

significantly (Haleem, Javaid, Singh, & Suman,

2021). SWICA expects that by offering the

telemedical service free of charge, healthcare costs in

the traditional system will be saved, and overall costs

for SWICA will be reduced. Sante24 is supported by

other DHTs developed by SWICA, strengthening the

digital integrated care approach.

Another telemedicine tool is the TytoHome

device. Initially an Israeli startup, it enables

customers to conduct home-based examinations and

share the results with santé24 autonomously. The

target audience includes families with young

children, but all insured members can order a

TytoHome device for a fee. Members no longer need

to go physically to a doctor, as this DHT integrates

them actively in the diagnosis process. The cost

depends on their insurance coverage, while subsequent

usage and telemedical consultations are free.

4.1.2 An App-Based Integrated Care Model

Through SWICA’s Benecura app, the patient may do

a digital symptom check-up, for example, on their

phone, and share the results with their Sante24 coach,

making the anamnesis process for the doctor and

patient more efficient. The app is a triage tool to

assess urgency, prepare the patient, and recommend

the next steps. Further, it allows the user to save and

share all his medical records in a digital format, with

the required data security structure integrated. The tool

increases efficiency and simultaneously enhances

patient autonomy. Benecura is free for insured

members, and approximately 50,000 of them have used

it so far. The project is funded through SWICA's IT

budget. The whole project aims to increase financial

efficiency in the long run and increase customer

satisfaction for the company. SWICA is also working

on versions specifically tailored to chronically ill

patients, such as COPD patients. In these cases, the

questionnaires are intended for ongoing disease

monitoring, allowing doctors to detect therapy-relevant

changes early to support their DMPs. In the future, the

Benecura app will integrate the five most critical

chronic diseases to improve disease monitoring.

4.2 DHTs for Disease Prevention

SWICA has developed its products as summarized in

Table 2, that encourage a generally healthy lifestyle.

Additionally, SWICA is benefitting from synergies

with the offerings of Sante24 to support its members

in staying healthy. All members have access to

SWICA’s prevention programs. SWICA hopes to

attract healthy future customers and maintain health

among its insured people, thus saving healthcare costs

in the long run. Benevita is an app that was released

in 2020. It acts as a digital health coach and engages

the participants through exercise, nutrition, and well-

being challenges. Customers may earn points in the

challenges that lead to premium discounts or can be

converted into digital vouchers or donated to

charitable causes.

Table 2: An overview of DHTs aiming to prevent disease

and their delivery mode.

Product Domain Delivery mode

Benevita

• Exercise

• Nutrition

• Well-

ein

• App

Fall

prevention

• Exercise

• Nutrition

• Medical therapy

• Telemedicine

• Video tutorial

• Online self-

assessment

Prevent

sleep

disorders

• Sleep hygiene • Telemedicine

• Online self-

assessment

• Online education

Sport

Classes

• Pilates

• Yoga

• Specific

Exercises

• Youtube Video

Coach

• Nutrition

• Medication

• Exercise etc.

• Telemedicine

Aligning Strategies: How Digital Health Technologies Are Used by a Swiss Insurance Company to Foster a Sustainable Healthcare

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More specific DHTs include a fall prevention

program conducted in collaboration with santé24 and

uses an online assessment on the website to identify

at-risk individuals and provide help through

telephone counseling.

5 THE POTENTIAL OF DHTS TO

ALIGN STRATEGIES WITHIN

THE HEALTHCARE

LANDSCAPE

In their Four Steps to Sustainable Business Model

Innovation Guide, Boston Consulting Group

Managing Director David Young highlights the

importance of listening to external stakeholders

(Young, 2021). SWICA has not only heard the Swiss

Ministry of Health’s call for action but has

internalized the stated goals of improved health

literacy, promotion of healthy aging initiatives, and

increased quality of affordable healthcare in its core

business model. To tackle the challenges stated in

Table 1 successfully, SWICA’s strategy has been to

build up a growing portfolio of DHTs that are, in their

nature, easily accessible and scalable while

simultaneously benefitting from synergies. DHTs

focusing on integrated and preventive care, such as

the Benecura App, Benevita App, and Sante24

Telemedicine service, aim to increase efficiency in

the Swiss healthcare system by reducing workloads

of traditional healthcare models while improving

healthcare accessibility and shifting the focus on

chronic care. Further, most tools require the user's

participation, empowering members to become active

in their health journey. Other health insurance

companies, such as the CSS, are joint in these efforts

and follow a similar approach to align with the

national strategy (CSS, 2023).

SWICA’s DHTs share a common approach to

business model innovation as they overlap in the

WHO and WHY dimensions of Gassmann’s business

model navigator framework (Gassmann, 2020). All

DHTs are directly targeted at members to establish a

personal interaction and are expected to raise a return

on investment through long-term cost savings. The

values created for the members range from increased

patient empowerment to better health and improved

access to medical care if needed.

6 CONCLUSION

Escalating healthcare costs and an outdated

traditional healthcare landscape are placing

considerable strain on European healthcare systems,

pushing society to re-evaluate current business

models. Sustainable solutions require stakeholders to

collaborate and innovate. SWICA has demonstrated

through various initiatives that it views itself as a key

stakeholder in the fight against NCDs and has taken

responsibility to actively co-create part of the solution

within its dimensions through DHTs. In the future,

SWICA aims to design more specific DHTs for

chronically ill patients. However, to achieve a

meaningful contribution towards a sustainable

healthcare system, SWICA should aim to increase the

adoption of these new DHTs by its insured

individuals in the future.

CONFLICTS OF INTEREST

AL and TK are affiliated with the Centre for Digital

Health Interventions (CDHI), a joint initiative of the

Institute for Implementation Science in Health Care,

University of Zurich; the Department of

Management, Technology, and Economics at Swiss

Federal Institute of Technology in Zürich; and the

Institute of Technology Management and School of

Medicine at the University of St Gallen. CDHI is

funded in part by CSS, a Swiss health insurer, MTIP,

a Swiss investor company, and MavieNext, an

Austrian healthcare provider. TK is also a co-founder

of Pathmate Technologies, a university spin-off

company that creates and delivers digital clinical

pathways. However, neither Pathmate Technologies,

CSS, MTIP nor MavieNext was involved in this

research.

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