A New Care Pathway for Compression Therapy in German Statutory Health Insurance

Client: International manufacturer of medical compression therapy

The situation

Germany's compression therapy market has run the same way for decades: the physician prescribes, the medical supply retailer fits and delivers, the statutory health insurer reimburses. For the manufacturer, that means no direct access to the patient, little control over quality of care, and dependence on a channel that is itself under pressure.

The question

Can a shorter care pathway be built that is legally sound, attractive to health insurers, and worth a physician's time?

Our approach

We developed and tested the model along three dimensions:

• Structure and law: a corporate and contracting model built on §§ 126 ff. of the German Social Code (SGB V), staying clear of the limits set by § 128. No grey zones.

• Payers: discussions with statutory health insurers on contract structures, physician compensation and pilot options.

• Prescribers: qualitative primary research with high-volume prescribers on motivation, practice integration and compensation.

On that basis, we built an economic assessment and an implementation roadmap with defined decision points.

The outcome

Feasibility is confirmed, both legally and on the payer side. None of the high-volume prescribers we interviewed rejected the model. The research also showed what success depends on: how physicians are paid, the manufacturer's role, and the differences between urban and rural practices.

On this basis, the Board decided to move into implementation.

The insight

Physician willingness was never the real question. What mattered was a model that fits everyday practice and holds up under the rules of the system.