"Care needs to be fundamentally rethought." - An interview with Inka Beste
In June, we spoke to Inka Beste, Managing Director of MED Management GmbH, about current and future challenges in outpatient cardiology care in Germany. Why do we need cross-sector collaboration between doctors, health insurers and digital providers? What makes models such as DOQUVIDE so successful - and what can be learned from them for the care of those in need of care? Inka Beste provides insights into over fifteen years of care reality, talks about proven digital care concepts and explains how projects such as BlenCon can help to meaningfully interlink care, medicine and technology. A conversation about the logic of care, digital infrastructure - and the question of what it takes for innovative care concepts to remain effective in the long term.
About
Inka Beste is Managing Director of MED Management GmbH - one of the leading care service providers for innovative, quality-assured care concepts in cardiology and related care areas. Together with partners from the medical profession, health insurance companies and the digital healthcare industry, MED Management has been working for over fifteen years to make outpatient cardiology care in Germany more efficient, networked and patient-centered. In this interview, Inka Beste talks about the importance of cross-sector collaboration, tried-and-tested contract models such as DOQUVIDE and the BlenCon care project - and what digital care could do to make the future more secure.
SEMDATEX: Ms. Beste, you are the managing director of MED Management and an expert in telemedicine solutions for private practice specialists and clinics. What exactly does MED Management do, and what role does telemedicine play in this?
Inka Beste: Our goal is to develop cross-sector care models—especially in outpatient cardiology. A central focus is on telemedical care and support for patients with implant-based therapies. To this end, we work closely with health insurance companies such as DAK, TK, and IKK Classic. We have also concluded a quality assurance agreement (DOQUVIDE) with the German Foundation for the Chronically Ill, which enables us to measure the quality of telemedical care scientifically. Over the past 15 years, we have helped shape and mold the medical landscape with this care, and I have personally witnessed the many changes and developments from the very beginning.
That sounds like an exciting career. Can you tell us more about the DOQUVIDE quality assurance measure before we go into more detail about your other projects?
DOQUVIDE is a structured quality assurance measure that we developed together with the German Foundation for the Chronically Ill. The aim is not only to enable the care of patients with cardiac implants within the framework of telemedicine, but also to systematically monitor it and verify its medical effectiveness. An essential component of DOQUVIDE is the derivation of medical measures after the occurrence of certain events, such as atrial fibrillation or ventricular tachycardia, or indications of a general deterioration in the patient's health by the participating institutions. These events are recorded by the treating physicians using standardized documentation forms. The completed forms are then pseudonymized and sent to the German Foundation for Chronic Illnesses, which carries out a central evaluation.
What is the goal?
The goal of this evaluation is to make the quality of telemedical care transparent and visible, and to identify the specific measures that were taken in the care process—such as adjusting medication or device settings—to enable high-quality, reliable outpatient care with telemedicine. At the same time, the central analysis provides a better understanding of how physicians in different regions or care contexts respond to specific events. This allows patterns to be identified, care processes to be optimized, and overall better outcomes for patients to be achieved. Participating physicians receive regular reports on how the measures they have taken for individual patients compare to the overall collective of patients included in the study. DOQUVIDE thus not only contributes to quality assurance, but also creates a valuable basis for the further development of telemedical care – both in everyday medical practice and in the context of health policy.
Telemedicine still plays a rather minor role in the care sector today – where do you see the greatest opportunities for telemedicine in care?
Telemedicine is now an integral part of healthcare in Germany – but it is still underrepresented in care. People in need of care often have limited access to medical care, whether due to mobility issues or limited communication skills. Telemedicine can be of enormous help here: remote monitoring allows health data to be recorded regularly and changes to be detected at an early stage – without the need to visit a doctor's office. General practitioners in particular should work with care facilities or services to develop telemedicine concepts. However, what we are seeing is that many care facilities are not yet digitally equipped to implement such solutions across the board.
Are there already tried-and-tested approaches in nursing care that integrate telemedicine in a meaningful way?
Yes, some outpatient care services are already working with digital solutions, mainly in the form of “lighthouse projects.” Outpatient nurses collect the relevant parameters on site at the patient's home, which are then transmitted to a telemedicine center and monitored there. These models work well depending on the project – but there is still a lack of regular billing bases. While telemonitoring for heart failure can now be billed using fixed reimbursement codes, this is not yet the case for other diagnoses or care settings. New financing options are urgently needed here.
In your experience, which care models have already proven themselves, especially for heart failure patients?
Telemonitoring for heart failure is a very well-established model. Patients regularly record values such as blood pressure, ECG, oxygen saturation, and weight at home, which are then transmitted to a telemonitoring center, or TMZ for short. There, they are evaluated, and in the event of critical changes, known as threshold violations, medical intervention can be provided quickly with the aim of avoiding hospital admissions. This works particularly well for those affected when their medication is correctly adjusted. The situation is more complex in nursing care, because patients usually have several conditions at the same time – not just heart failure, but also wound healing disorders or mental illness, for example. This is referred to as multimorbidity. Telemedicine could also make a big difference here, but has rarely been used structurally to date. I can imagine that this would be desirable and hope that more will be done in the future. Just as we have already done with the BlenCon project.
Can you tell us a little bit about the BlenCon project and how it came about?
BlenCon is our first major telemedicine care project in the nursing context – developed and implemented in close partnership with Techniker Krankenkasse (TK) as part of the Innovation Fund. The collaboration with TK was a key factor in our success right from the start: as a long-standing and reliable partner, Techniker Krankenkasse not only brings experience to the table, but also the stability and reliability needed to drive such a complex project forward in a sustainable manner. This allows everyone involved to focus on what matters most: providing the best possible care for nursing home residents.
Together, we were determined to address the care sector in order to rethink the sometimes inadequate medical care provided through digital and telemedicine solutions. To this end, we developed the project with various partners, including the Technical University of Munich, four nursing care chains, and KJK Health Care GmbH (a provider of e-health solutions). One of these is SEMDATEX, an IT service provider that offers digital healthcare solutions: We jointly specified SEMDATEX's own digital documentation platform for the project and integrated it as a key component of the supply.
What is BlenCon's goal?
BlenCon's goal is to fundamentally improve medical care in nursing homes with the help of telemedicine structures – in an evaluated, practical setting. We are bringing digital visits, regular monitoring, and close coordination between general practitioners and specialists to approximately 300 nursing home residents with cardiac conditions, where these services have been virtually non-existent until now – in the residents' rooms. The evaluation goal is to significantly reduce hospital admissions and emergency and rescue service calls compared to a control group without telemedicine care, while at the same time optimizing the use of medications through appropriate centralized documentation.
This is made possible by a strong and highly committed consortium with all its participants. Not only do the aforementioned parties play a key role in the success of the project, but so do the individual managers in the care facilities, the participating general practitioners and cardiologists, and the care recipients themselves. Together, we are continuously developing the technologies used with the aim of integrating them even more efficiently and user-friendly into everyday care.
Can you say anything about the duration of the project?
The project work began in October 2023 with a preparatory phase. The actual intervention phase started in June 2024 and will run until September 2025. This will be followed by a follow-up period during which the evaluation will be carried out by the Technical University of Munich. The evaluation of the comparative data will begin around six months later, meaning that the overall project will run until the end of September 2026.
What does the care concept look like in concrete terms?
A total of eight care facilities in Berlin are participating. A designated GP and cardiologist has been assigned to each facility. Residents receive regular telemedical care, which includes digital visits combined with regular measurement and transmission of medical parameters such as blood pressure, oxygen saturation, weight, ECG, including long-term ECG, and telemedical functional analysis for pacemaker patients. The family doctor is primarily responsible, and the cardiologist is consulted as needed. Up to six visits by a family doctor and four visits by a specialist are planned per resident per quarter – often significantly more than these people previously received in terms of medical care.
What technical solutions are used?
We work with a mobile telemedicine vehicle equipped with a monitor, camera, and medical measuring devices. The nurse on site assists the residents in taking the measurements and connects the doctor digitally for the visits. This creates a very practical, location-independent form of care. It was important to us to use existing structures and not to overburden the nursing staff, always with the aim of providing the best possible care for the residents. We are convinced that telemedicine can only reach its full potential when care, technology, and structures really work hand in hand – especially in nursing care.
What challenges did you face during implementation?
A key issue in projects like this is always the additional work for the nursing staff – especially in an already overburdened system. It was therefore crucial to establish fixed procedures, such as regular visits instead of spontaneous ad hoc appointments. In addition, the digital requirements varied greatly between the facilities. Not every care facility was technically or organizationally equipped at the start of the project, so the lead time for the project was very important in order to make the care provision usable in a targeted manner. There is a lot to learn from this for the future. Before a care reform towards hybrid care models can really take place, a few adjustments still need to be made.
In your opinion, what is the added value for care facilities – apart from improving care for residents?
A reduction in hospital admissions or emergency and rescue service callouts relieves the burden on nursing staff in their daily work. Despite the additional project work, the aim is to achieve a real reduction in workload by enabling early response to changes in residents' health thanks to digital visits and medical monitoring, thereby keeping residents healthier and reducing the workload for nursing staff. Digital coordination between nursing staff and general practitioners and specialists is also intended to shorten communication channels and thus reduce the workload.
What feedback have you received from nursing practice about BlenCon and your digital care models?
The experience has been very positive overall. As already mentioned, however, there were also clear challenges, as technical hurdles had to be overcome in some care facilities, such as inadequate Wi-Fi or structural limitations. However, these issues were resolved and the technology is now running smoothly. There has been a lot of positive feedback from doctors, especially regarding the possibility of providing regular telemedical care to people in need of care. This is a real step forward, especially for older people who have little or no access to specialist doctors. Care workers specifically commented that simpler processes lead to greater acceptance. This is generally the challenge with digital care—creating structures and processes that can be integrated into everyday life without causing disruption, as additional, unplanned work puts a strain on already scarce capacities.
And how do those in need of care themselves respond to the offer?
Here, too, the picture is mixed. Some residents are already very old and, despite the support of the nursing staff, are personally overwhelmed by the technology. Most, however, see the regular digital visits as a real improvement: they feel better cared for, can communicate their needs, and finally see a doctor regularly again – and, above all, a specialist. This creates a feeling of security and well-being for those affected and their relatives.
In your opinion, what structural or political changes are needed to improve care in Germany in the long term?
Care needs to be fundamentally rethought. It is not enough to optimize existing structures a little—we have to ask ourselves: What is really needed? And then create new solutions or further develop existing ones in a targeted manner. Care facilities face enormous challenges: rising costs, an increasingly elderly and sick population—and at the same time a shortage of young people because the nursing profession seems unattractive. The working conditions are physically and emotionally demanding, and the pay is often inadequate. If we do not address these structural problems, the potential of telemedicine will remain limited. It can achieve a lot – but only if there are sufficient capacities to support it.