The AOK Baden-Württemberg, a regional German health insurance company with three million members, has signed a direct primary care contract with up to 5,000 doctors in the state of Baden-Württemberg that requires them to digitise.

Doctors can only take part in the contract online, which replaces the traditional collective doctor contracts that have existed in the German system. Media and health policy experts have hailed the new contract as a minor revolution, cutting through the layers of bureaucracy that currently exist.

The German healthcare system is organised in a collective fashion: health insurance companies pay fixed budgets to regional doctor’s associations, the “Kassenärztliche Vereinigungen”. These regional associations then give the money to usually several thousand doctors in the region.

How much money a doctor actually receives out of this budget depends on how many patients he sees, on the kind of diagnostics he performs and on the therapy he prescribes.

The whole system is terribly bureaucratic and heavily criticized by doctors. “We are now leaving all this behind”, said head of AOK Baden Württemberg, Rolf Hoberg. Instead of going the collective way, AOK pays individual doctors directly now. “This should reduce bureaucracy massively”, said Hoberg.

The new contract is not only about paying doctors differently, but also about paying them more: on average, what the doctor gets for an AOK patient is expected to increase 30% from July onwards. AOK will have to refinance the increase in expenses, and this is where IT comes into play.

The contract says doctors have to go online with their primary care practice using a virtual private network with a hardware client, i.e. a router. They also have to install a medication order entry software.

This software is updated every fortnight or so by the AOK. It contains up-to-date information about which pharmaceutical company offers the cheapest medication. When making a prescription, the software will recommend a cheap vendor. The doctor does not necessarily have to follow the recommendation. But a refusal will reduce his payments, at least when it happens with regularity.

Generally the contract is welcomed by the IT industry, as it is the first time that primary care doctors are obliged to go online. What is criticized, though, is that the software will be offered exclusively by the HÄVG Software GmbH, a joint venture of doctors and the IT company ICW.

Software companies like CompuGROUP would like to integrate the software tool into their primary care information systems instead. CompuGROUP, in particular, has gone to court already to check if the contract is in line with competition regulations. The jury is still out.

ICW, in return, denies any monopolistic ambitions: “This will be an open architecture”, said Frank Warda, one of the heads of ICW. But CompuGROUP, Docexpert and the like doubt that all necessary information will be made public early enough to have a fair competition at the start of the project in July.