00:00:00
Voice-over: 100 days to success. This is the podcast from G_NIUS, the Guichet national de l'innovation et des usages en e-Santé. Around Lionel Reichardt, meet e-Health innovators and key experts to help you succeed in your projects.

00:00:20
Lionel Reichardt: Hello everyone! You're listening to one hundred days to success, the podcast aimed at innovators and entrepreneurs in digital healthcare, but also anyone curious about this field. This podcast is produced by G_NIUS, the Guichet national de l'innovation et des usages en e-Santé. In this episode, we'll be talking about the collaboration between an innovative healthcare start-up and the world of insurance. To this end, we welcome Franck Baudino, doctor, founder and CEO of H4D, a company specialized in telemedicine. We also welcome Stéphane Pénet, Deputy General Delegate of FFA, the French Insurance Federation.

00:01:00
Lionel Reichardt: Franck Baudino good morning. Thank you for agreeing to share your experience with us. First of all, can you tell us about your training and background?

00:01:07
Franck Baudino: As you said, I'm a doctor by training, and in parallel with my medical training, I studied at Sciences Po and then specialized in international relations. I was lucky enough to work with teams, notably Kofi Annan's, in emerging countries, and it was there that my desire to find solutions to promote access to healthcare for all was born, whether in emerging countries or in developed countries like France or Australia or Canada where I was able to practice.

00:01:34
Lionel Reichardt: You founded your company H4D in 2008. What is its ambition?

00:01:39
Franck Baudino: I created H4D in 2008 to respond to a very specific mission, which is to promote access to healthcare in a professional manner. That's why H4D's particularity is to have invented and developed Consult Stations, which are the first connected medical practices, since I, as a doctor, wanted to be able to provide quality care for all patients, wherever they are and whenever they want. So around this Consult Station, you'll find a range of services. Access to a general practitioner or specialist, so the patient enters the telemedicine booth. There's a whole range of measuring instruments and sensors that enable a remote doctor to guide the patient through a complete clinical examination. Our basic mission is to promote the care, follow-up and prevention of patients, wherever they may be.

00:02:32
Lionel Reichardt: Insurers are present in your company, on the one hand as customers to distribute, promote, see use your solutions, and on the other hand, as investors to ensure H4D's development. Was it so obvious from the outset to work with the insurance industry, and why?

00:02:47
Franck Baudino: So, from the start, maybe not, but afterwards, it became obvious as telemedicine evolved. But when we put ourselves back a few years, we formed H4D in 2008, we had to find an economic model to be able to both install this kind of device, whether in medical deserts or in companies. Today, we're also developing them in homes for the elderly, and even in hospitals. But initially, the first market to respond was the corporate sector. At the time, telemedicine was not reimbursed by the French health insurance system. So, naturally, we turned to insurers, who responded. Not immediately, but gradually, as we proved to them the benefits of this type of device.

00:03:36
Lionel Reichardt: How did you approach the world of insurance? To understand its expectations, needs and culture?

00:03:43
Franck Baudino: We went pretty straight to it. Obviously, beforehand, we had done an opportunity analysis to go and contact the insurers. And then, very quickly, we realized, particularly within the company, that there was a lot of interest in proposing an adapted healthcare offer, whether it be primary care, general medicine or specialty medicine, or occupational health, but also prevention programs. We contacted a number of insurance companies, telling them of the benefits they could bring to their relationship with their client partners - the companies we wanted to equip - but also for themselves, in terms of anticipating the occurrence of problems. After a year and a half and two years, the first insurers came on board and agreed to cover the cost of medical consultations at the French Social Security rate from the first euro. So, at first, we had one or two insurers like AXA and Allianz, then others joined the race, obviously CNP and Aviva. In the end, we succeeded in signing contracts with virtually every insurer in France and Europe.

00:04:53
Lionel Reichardt: Insurers, reinsurers, mutuals, brokers, who do we work with and how do we come to understand who is who, and who does what?

00:05:01
Franck Baudino: Already, we train. You get information and then you surround yourself with competent people. That's what we did at H4D, in other words, we took on people who knew this environment inside out. After that, the stakes are not the same for insurers, reinsurers or brokers. Depending on the situation, depending on the company, it's one or the other who will intervene, but always with the same desire to provide a quality service for patients. We also need to imagine what the insurer's, broker's or reinsurer's business is, so that they too can benefit. The patient is always at the heart of the system, at the heart of care. But there are obviously economic factors involved, and returns on investment that need to be considered and calculated. And it's true that the solution proposed by H4D, the telemedicine booth, made it possible not only to carry out a medical consultation, but also to offer prevention and screening programs, which was of interest to absolutely everyone in the value chain.

00:06:07
Lionel Reichardt: What are the best ways to approach these insurers? Responding to calls for tender? Participate in hackathons or conferences? Or approach them directly?

00:06:16
Franck Baudino: In our experience, given that we were opening up a market that didn't exist, we relied on absolutely everything you've just said. We obviously went door-to-door. We also used trade shows where we met insurers. We had them test our system. We took part in various hackathons. I ran several myself, which enabled us to make the most of what was available on the market. After that, it's really a question of trust, as H4D is still the only professional device in Europe. We had this device from the outset, which appealed both to the corporate world, above all to patients, and then, of course, to insurers, because they saw that they were working with healthcare professionals. The first thing is trust. Knowing that what we offer is qualitative, that we take care of both the patient and, of course, the doctor and the care pathway that goes with it. As a result, we won our first contracts three or four years ago. After that, there was a snowball effect from the moment we had our first insurer, and the others followed.

00:07:32
Lionel Reichardt: What were the business models to develop? Did you organize pilots or free trials? Is this how you get your foot in the door, approach new players?

00:07:40
Franck Baudino: H4D has the distinction of still being the only class 2 medical device on the market today via this telemedicine booth. So, to obtain all the certifications, it had already taken us five, six years of piloting, testing and so on. When we arrived on the market, there was no longer any question of doing a pilot. Companies understood this, insurers understood this, so they played along right from the start. Obviously, they took a risk at the time, but it paid off handsomely, because we believe that quality service doesn't come for free. We're a company too, and there's a whole ecosystem to work with. So we immediately put solutions on the market with a robust business model that paid off.

00:08:31
Lionel Reichardt: As you were saying, you're a doctor, so the medical and scientific validation of your device rightly interests you. You do a lot of evaluation and data analysis, and we know that insurers are also very fond of data. What do insurance companies and digital health companies have in common? How do you move forward, hand in hand?

00:08:50
Franck Baudino: You're touching on an extremely sensitive subject, that of data, health data in particular, which is the exclusive property of the patient, the user. In other words, neither the insurer nor we have access to it. Data is encrypted, secured and stored in approved databases. We work with a healthcare host, Orange, which has all the necessary approvals. So, our main aim is to offer a service for companies and, of course, for company employees. And then, little by little, this service was extended to employees, but also to the doctors who work with us, hand in hand. By using our Consult Station system, doctors, particularly occupational physicians, save time, and can work with the company's human resources to develop prevention and screening programs. I was going to say that the common denominator remains the salaried patient, and always finding quality services for the patient.

00:09:56
Lionel Reichardt: To conclude, Franck Baudino, what advice would you give to a digital health innovator who would like to collaborate with the insurance world?

00:10:04
Franck Baudino: Getting to know your device already, getting to know the added value you bring to this ecosystem. I'd say that today, the world of telemedicine is much more open. It's been democratized, which wasn't the case three or four years ago. So it's easier to talk about telemedicine. It's easier to talk about digital health. On the other hand, there's a lot more competition, so we need to be perfectly aware of the added value of our solution, and the benefits it can bring to the various players. Then, of course, you need to be in a position of trust, have extremely regular relationships and do quality work.

00:10:49
Lionel Reichardt: Franck Baudino, thank you for this information.

00:10:56
Lionel Reichardt: Are you wondering how to work with the insurance world? Elements of an answer with Stéphane Pénet, deputy delegate general of FFA, the French Insurance Federation. Hello, Stéphane Pénet, and thank you for accepting our invitation. First of all, could you tell us a little about your background and training?

00:11:14
Stéphane Pénet: I'm Stéphane Pénet, an HEC graduate. I entered the world of insurance straight from my studies. I worked at Allianz for five years, at AXA for fifteen years, and now, for the past twelve years, I've been at the Fédération Française de l'Assurance, where I'm in charge of all insurance businesses, whether it's property and liability insurance, life insurance or health insurance.

00:11:40
Lionel Reichardt: What can you tell us about health insurance? What are the key issues?

00:11:43
Stéphane Pénet: So, you have to understand that health insurance is a very special business, since we are a business that is complementary to compulsory health insurance. Today, there are, let's say, some thirty or forty complementary health insurers of all sizes, who are very competitive with each other, but who operate in a market that is complementary to compulsory health insurance. This implies two things that are important in the way these insurers approach the market. The first is that the compulsory health insurance scheme has provided a relatively well-defined framework for the supplementary health insurance offer, since, as we are effectively behind the Social Security system, the offer of cover itself is relatively well-defined and relatively well-defined, notably through a concept known as "contrats responsables" (responsible contracts). In other words, the French health insurance system has told complementary health insurers that if they want their contracts to benefit from favorable tax treatment, they must meet a certain number of criteria. What does this mean? It means that the range of cover offered is relatively homogeneous from one insurer to another, and that insurers are now trying to differentiate themselves essentially on the basis of service. Today, there are two categories of offer: group contracts, taken out by companies on behalf of their employees. All companies are now required to offer supplementary health insurance to their employees, and this is the first type of offer. For people who are not employees, i.e. the self-employed, pensioners and students, there are individual insurance contracts taken out on a person-by-person basis. But in both cases, we are dealing with fairly homogeneous offers, and insurers are trying to differentiate themselves above all on the basis of services. Services such as prevention, care assistance, medical guidance, care pathways - in short, a whole range of services that make all the difference today, from one insurer to another. This is one of the first characteristics of the health insurance market. The second characteristic is that this is a market in which management costs are fairly high. In other words, we are obliged to deal with all the expenses of each policyholder, in collaboration with the compulsory health insurance scheme, since in many cases the insurer pays part of the expense after the Social Security system has paid it. So there's a management aspect that's also very important, and insurers are also seeking to make very substantial efforts to ensure that this management is as inexpensive as possible, to have productivity efforts that make the difference on the selling price.

00:14:45
Lionel Reichardt: The insurance world is being turned upside down by the development of Assurtech. Is HealthTech also of interest to health insurers?

00:14:52
Stéphane Pénet: Enormously, and today, I'd say that this is perhaps one of the areas in insurance where insurers are most attentive to everything that technology, everything that innovation can bring, particularly in the two areas I've just mentioned. In terms of services, insurers have clearly understood that technology will enable them to personalize services for each and every one of their policyholders. As you know, the insurance industry has always sought to multiply positive contacts with its customers. In other words, a customer or policyholder whose only relationship with the insurer is to pay a premium every year is a very vulnerable policyholder. Insurers therefore seek to multiply positive contacts, particularly through services. As I said earlier, healthcare is an area where services can be very numerous. I mentioned, for example, offering telemedicine to their policyholders, offering individualized prevention programs to their policyholders, offering guidance services. Today, when you have an illness or a pathology, how do you know where to go? Which is the right hospital? Which is the right professional? Today, it's complicated to know this, and insurers are developing a huge range of services in this area. So it seems that new technologies can bring them a lot of benefits. In this case, HealthTech is obviously an area they're following very closely. I would also add the management aspect, which shouldn't be overlooked, since here too, insurers are looking to improve management productivity. As I said, this is an important area in health insurance, and here too, technology can be of great help to insurers. Insurers are very attentive to what HealthTech or Insurtech are offering in terms of health insurance.

00:16:51
Lionel Reichardt: Actually, health insurance isn't the only one interested in HealthTech. How are other insurance sectors approaching these topics?

00:16:58
Stéphane Pénet: All areas of insurance are indeed very attentive to what new technologies can bring them, and what companies can bring them that, based on detailed knowledge of technologies, can bring breakthroughs in both service and management. I would say that the healthcare sector is without doubt the one where competition between insurers is strongest in these areas. And that's why I think it's a particularly interesting field for Insurtech and HealthTech.

00:17:33
Lionel Reichardt: What advice would you give to a digital health innovator looking to collaborate with the insurance world?

00:17:39
Stéphane Pénet: I don't think there are any rules for approaching insurers in this area. What I do know is that all insurers are very attentive whenever they are approached by companies that can bring them something new based on new technologies, so there are no rules. Some insurers have decided to create hubs or incubators to house start-ups working on subjects that interest them. It's a way for them, I'd say, to encourage innovation and possibly take advantage of it if they see that one of these start-ups could bring them something interesting. It's worth asking around, but there are insurers who have set up this type of incubator. Some insurers issue invitations to tender. We have to be attentive to the invitations to tender that may be issued, but I think the best solution is to be proactive, to find out how these companies are organized. As soon as you see that an insurance company involved in supplementary health insurance has an innovation department or a digital department, that's the person to go and see, because these people are generally very attentive and receptive to proposals or contacts they may have with this type of company, or with customer service or marketing departments. Finally, it's also true that some insurance companies invest in companies they consider to have strong potential, as long as they believe that these companies could eventually bring them, without knowing exactly what at the outset, but that they have the potential to provide new services, complementary to what they already offer as traditional insurers. So, there are no rules. You have to be proactive, and you have to know that insurers are very benevolent and receptive to what HealthTech or Insurtech can offer them.

00:19:47
Lionel Reichardt: Stéphane Pénet, thank you for this information.

00:19:54
Lionel Reichardt: Our episode is coming to an end, thank you for listening. We thank our two guests for their availability. Feel free to subscribe to the podcast on the listening platforms. We look forward to seeing you soon for a new episode of 100 Days to Success.

00:20:12
Voiceover: Those who are making e-Health today and tomorrow, are on the G_NIUS podcast, and all the solutions to succeed are on gnius.esante.gouv.fr