Plan séquence - Mon Espace Santé, les ocam hésitent à décoller

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Alors que le secteur de la e-santé foisonne d’initiatives et que l’État lance Mon Espace Santé, les organismes complémentaires s’interrogent sur leur place dans le dispositif et investissent massivement dans le numérique en santé. Parviendront-ils à devenir des acteurs incontournables ou bien resteront-ils en périphérie du système de santé ?

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Par Mariona Vivar

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La galaxie de services entre dans une nouvelle ère

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Les débats récents sur la Grande Sécu ont fait froid dans les dos aux organismes complémentaires. Voyant leur existence menacée, ces derniers sont aujourd’hui contraints de prouver leur valeur ajoutée. L’un des enjeux du secteur est d’aller au-delà du rôle de complémentaire santé pour investir celui des services. Mais force est de constater que ces dernières années leur stratégie servicielle en santé s’est heurtée à des obstacles majeurs.

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L’exemple de Vigisanté est emblématique. Cette application de télésuivi de l’hypertension a été développée en 2010 par Malakoff Humanis avec Klesia et Humanis. Elle a permis de mener près de 5.000 dépistages en entreprise et d’accompagner les salariés hypertendus dans le suivi de leur hypertension et un coaching par des infirmières.

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« L’application digitale permettant de monitorer sa tension a rencontré beaucoup de succès mais l’usage diminuait avec le temps car les patients ne pouvaient pas partager les données avec leur médecin. L’application n’était pas directement connectée au parcours de soins », affirme Véronique Lacam Denoël, présidente et associée fondatrice de Proxicare.

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Ces freins seront levés avec l’arrivée de Mon Espace Santé, une plateforme digitale en santé qui « offre une possibilité inédite pour les ocam de proposer un service digital santé intégré au parcours de soin », selon Nathalie Beslay.

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Le monde de la e-santé est en pleine effervescence ces dernières années, avec une multitude d’acteurs, start-up et medtech qui essaient de percer sur le marché, créer de l’usage et trouver un modèle économique.

Parallèlement, la France a pris du retard sur la création d’un espace numérique de santé pour chaque patient, tellement les acteurs du système de soins sont éclatés. Dans le cadre de Ma Santé 2022, le gouvernement avait lancé en 2019 une feuille de route sur le numérique en santé et créé la délégation au numérique en santé (DNS). Pourtant, certains projets comme le dossier médical partagé ont rencontré un succès très limité, avec seulement 9,3 millions de DMP ouverts en 2020, bien loin de l’objectif de 40 millions de DMP envisagés à horizon 2023. Le Ségur numérique est venu accélérer la feuille de route avec un investissement inédit de 2Mds d’euros dans le secteur du numérique en santé pour faciliter le développement des usages.

Mon Espace Santé est le carrefour numérique de la modernisation du système de santé. A la différence du DMP lors de son lancement, il n’est pas nécessaire de demander l’ouverture du dispositif. Mon Espace Santé est géré par un système d’opt-out et donc tous les Français disposent d’un espace santé sauf s’ils s’y opposent.

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Dans cet espace virtuel, ils auront accès à quatre fonctionnalités majeures pour gérer leur santé :

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A ce stade, uniquement le dossier médical partagé et la messagerie sécurisée sont disponibles. L’agenda et le catalogue d’applications devraient être opérationnels d’ici la fin 2022. Dans un premier temps, les applications du catalogue ne seront pas connectées aux données du dossier médical du patient. Il faudra attendre 2023 pour que ces applications puissent déverser des données vers Mon Espace Santé et/ou s’alimenter des données médicales du patient.

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Avec le catalogue d’applications, l’État a la volonté de libérer l’accès à l’innovation, à condition que les applications digitales respectent un certain nombre de règles éthiques, d’interopérabilité et de sécurité. Dans ce projet, Dominique Pon et Laura Létourneau, délégués ministériels au numérique en santé auprès du ministre des Solidarités et de la Santé, ont eu pour ambition de permettre aux patients de prendre la main sur leur santé.

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Le Ségur numérique introduit un nouveau modèle de logiciel pour les professionnels de santé pour qu’il soit très facile d’alimenter le DMP. En deux clics, ils vont enrichir le dossier du patient. Dès 2023, les compte-rendus des examens de biologie, de radiologie, de sortie d’hôpital, devraient se retrouver dans le volet médical du patient. Cela devrait ouvrir un nouvel espace de dialogue entre le professionnel de santé et le patient même si l’ampleur des usages patients reste incertaine à ce jour.

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Mon espace santé, should I stay or should y go ?

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Quelle sera la place des organismes assureurs dans ce projet ? Sont-ils légitimes pour faire référencer des applications santé ? Aujourd’hui, les assureurs regardent avec intérêt la naissance de Mon Espace Santé mais la majorité attend que l’usage s’installe avant de se décider à y aller.

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« La deuxième façon pour les mutuelles de s’inscrire dans Mon Espace Santé pourrait être via le catalogue d’applications. Les mutuelles pourraient proposer des applications avec leur casquette d’offreurs de soins, et notamment dans le domaine de la prévention. Les données qui transitent par ces applications ne sont pas accessibles aux assureurs, ce sont des projets étanches », complète Christophe Lapierre.

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C’est le cas du groupe Vyv, qui au travers de son activité de livre 3, fait partie des 30 projets retenus pour construire le catalogue d’applications de Mon Espace Santé, aux côtés d’acteurs comme Doctolib, La Poste, Nehs digital, Qare ou Withings. En ce qui concerne le groupe Vyv, c’est Vyv3 qui a participé au projet, avec son application mobile Mon Coach Ortho, qui accompagne les enfants et les familles tout au long du traitement orthodontique.

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« Mon Espace Santé est un projet intéressant pour Santéclair car nous avons déjà une plateforme de services qui pourraient être utilisés par un plus grand nombre de personnes. En revanche, nous avons identifié des obstacles. L’assuré n’a pas la possibilité de renseigner son organisme complémentaire lors de son inscription à Mon Espace Santé. Si nous voulions référencer nos services dans le store, nous ne pourrions pas proposer un accès direct et non-payant aux assurés des complémentaires avec lesquelles nous travaillons. Cela demanderait une double authentification alors que l’enjeu de la plateforme est de créer de la fluidité entre Mon Espace Santé et les services référencés », signale Marianne Binst, directrice générale de Santéclair.

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Par ailleurs, « le store ne référence que des services unitaires. Vous ne pouvez pas référencer des suites de services dans le cadre d’un parcours de soins. En cas d’hospitalisation, par exemple, Santéclair propose le palmarès des hôpitaux, le deuxième avis médical, des infirmières à domicile, des services de reprise de l’activité physique… Or, vous ne pouvez référencer que ces services séparément. Aucune association de plateforme de services ou d’assureurs n’a été impliquée dans le processus de co-création de Mon espace santé », regrette Marianne Binst.

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Enfin, les mutuelles et autres ocam sont un relais important pour accompagner le développement et le déploiement de Mon Espace santé. « Nous pouvons être promoteur de ces outils,  jouer un rôle militant pour inciter nos adhérents à prendre la main sur leurs données de santé », indique Christophe Lapierre, de la Mutualité Française.

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Malakoff Humanis, pour sa part, a conclu un partenariat stratégique avec la délégation du numérique en santé pour promouvoir l’ouverture de Mon Espace Santé auprès de ses adhérents. « Nous soutenons la majorité des initiatives publiques qui contribuent à transformer le champ de la santé via les nouvelles technologies et avons déclaré très tôt notre intérêt pour le MES que nous contribuons à promouvoir », annonce Sébastien Bachem, directeur de projets e-santé de Malakoff Humanis.

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« Les organismes complémentaires ont investi dans les réseaux de soins et créé des sociétés d’assistance. Ils proposent des services souvent en partenariat mais ils sont rarement propriétaires de leurs applications santé. C’est donc à l’éditeur de l’application de se faire référencer sauf à ce que les assureurs décident de développer leurs propres applications ».

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multi_color_overlay="uvc-multi-color-bg" multi_color_overlay_opacity="" seperator_enable="" seperator_type="" seperator_position="" seperator_shape_size="" seperator_svg_height="" seperator_shape_background="" seperator_shape_border="" seperator_shape_border_color="" seperator_shape_border_width="" icon_type="" icon="" icon_size="" icon_color="" icon_style="" icon_color_bg="" icon_border_style="" icon_color_border="" icon_border_size="" icon_border_radius="" icon_border_spacing="" icon_img="" img_width="" ult_hide_row="" ult_hide_row_large_screen="" ult_hide_row_desktop="" ult_hide_row_tablet="" ult_hide_row_tablet_small="" ult_hide_row_mobile="" ult_hide_row_mobile_large="" notification="" full_width="stretch_row_content_no_spaces" equal_height="" content_placement="" design__empty_1="" full_height="" columns_placement="top" background="" background_image_type="static" background_image__effect="" bg_size="initial" bg_position="center-center" row_bg_image="" bg_repeat="no-repeat" 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background_color_type__color_color1="rgba(44, 74, 228, 1)" bg__empty_2="" background_color__effect="" background_color__direction="left-to-right" parallax="" parallax_speed_bg="1.5" parallax_image="" video_bg="" video_bg_url="https://www.youtube.com/watch?v=lMJXxhRFO1k" video_bg_parallax="" el_id="" gap="0" disable_element="" settings__tag_1="" viewport_lg="" viewport_md="" viewport_sm="" viewport_xs="" settings__empty_1="" el_class="" version="1" css=""][vc_column extend="false"][vc_row_inner][vc_column_inner extend="false"][vc_column_text] [/vc_column_text][vc_column_text]

Les espaces client des assureurs qui permettent de gérer son contrat et suivre les remboursements ne peuvent pas être référencés par Mon Espace Santé car 80% de l’application référencée doit être du domaine du parcours de santé, d’après le cahier de charges. « La finalité n’est pas de référencer des espaces assurés, mais des applications qui puissent dialoguer avec les services socle de Mon Espace santé et notamment le DMP, pour autant une navigation sans couture peut être conçue avec l’espace assuré », détaille Véronique Lacam-Denoël.

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Les organisations complémentaires ont une réflexion à mener sur quelle application référencer. Par exemple, ils pourraient proposer des services dans le prolongement de la gestion du parcours de risque, autour des postes les plus coûteux comme l’optique, le dentaire ou l’audition. Une autre option serait d’aller vers la prévoyance, dont la sinistralité a augmenté depuis la crise Covid, en proposant des applications de prévention autour des troubles musculosquelettiques ou la santé mentale.

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Les données des applications des assureurs pourront être déversés vers le dossier médical du patient et cette nouveauté peut favoriser le développement les usages des applications des assureurs et notamment pérenniser ces usages dans le temps.

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Par ailleurs, le fait d’obtenir le label de Mon Espace Santé, est un gage de confiance vis-à-vis des assurés. La commission qui référence les applications veille à ce que les solutions numériques respectent un standard éthique, de sécurité et de confidentialité des données.

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Pour pouvoir référencer une application, il y a un travail technique et métier à mener pour modifier le parcours utilisateur afin qu’il puisse s’interfacer avec les services socle de Mon espace santé et notamment avec le dossier médical du patient.

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La dématérialisation de la carte vitale peut représenter par ailleurs une menace pour les organismes complémentaires. Les professionnels de santé et pharmaciens munis d’un lecteur de carte vitale pourront avoir accès aux informations personnelles de l’assuré social et ses ayant droits tout comme leurs informations sur l’assurance complémentaire qui sont aujourd’hui contenues dans la carte de tiers payant.

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« Avec l’arrivée de l’apCV à partir de 2023, l’usage des applications des assureurs risque de baisser. Le pharmacien muni d’un lecteur et d’un logiciel adaptés aura accès aux informations d’assurance complémentaire du patient. L’assuré ne sera donc plus obligé, via son smartphone, de montrer sa carte de tiers payant logée dans l’espace client de son assureur. Les assureurs ont donc un véritable intérêt à accroître la valeur ajoutée de leurs espaces digitaux, notamment via les applications santé. »

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Ces ocam qui ouvrent la voie

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Des réflexions sont en cours chez plusieurs organismes complémentaires afin d’étudier la possibilité de référencer des applications dans le catalogue de Mon Espace Santé. C’est le cas d’Axa France, qui affirme : « Nous avons une meilleure compréhension de la fonctionnalité du store de Mon Espace Santé. Nous étudions l’intérêt de déposer un dossier de candidature parmi les services de notre offre ».

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D’autres acteurs sont plus avancés dans leurs réflexions. Sébastien Bachem a rejoint Malakoff Humanis en mars 2022. En recrutant l’ancien directeur du pôle des projets de e-santé de l’agence du numérique en santé, le groupe de protection sociale met toutes les chances de son côté pour faire référencer son application.

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« Les assurés pourront retrouver l’application Malakoff Humanis dans le catalogue d’applications de Mon Espace Santé. L’utilisation de cette application sur Mon Espace Santé contribuera à fluidifier la relation patients/professionnels de santé dans une logique de parcours. L’enjeu est d’avoir des données utiles et utilisables non seulement par les professionnels de santé mais aussi par les patients. Ces données sont anonymes. Leur accès est sécurisé et elles ne peuvent pas être utilisées à des fins assurantielles ».

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Ces ocam qui volent haut

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A la marge des travaux de Mon Espace Santé, les plus grands organismes complémentaires investissent dans la santé numérique toujours avec cette idée en tête d’aller au-delà de leur rôle d’organisme complémentaire et d’apporter de la valeur au parcours des assurés.

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Mai 2022 - Malakoff Humanis, le groupe Vyv et Pro BTP ont injecté 65 millions d’euros dans Cegedim Santé. Ensemble, ils détiennent désormais 18% du capital de ce dernier. Grâce à cette augmentation de capital, Cegedim Santé affiche désormais une valorisation de 360,9 millions d’euros, d’après un communiqué, et envisage de recruter 500 personnes dans les prochaines années. Dans le cadre de la transaction, Cegedim Santé fait l’acquisition de la société MesDocteurs, détenue par le groupe Vyv et qui propose des téléconsultations sans interruption 24 heures sur 24 et 7 jours sur 7. Au-delà de l’opération financière, il s’agit d’un partenariat industriel dont l’objectif est de travailler ensemble afin de devenir un acteur incontournable du parcours de soins.

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Juin 2021 - Generali, Sanofi, Capgemini et Orange lancent Future4care, un accélérateur de start-up sur le domaine de la e-santé. Les quatre industriels ont mis 24 millions d’euros sur la table pour créer un accélérateur de start-up dans le domaine de la santé.

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Décembre 2020 - La Maison de l’innovation de la médecine spécialisée regroupe des médecins de la CSMF, Doctolib, Withings, Medaviz et AG2R La Mondiale. C’est une des premières réalisations d’Isabelle Hébert depuis son arrivée chez AG2R La Mondiale en tant que directrice de la stratégie, marketing, digital et relation client. Le groupe paritaire devient le premier partenaire assureur à rejoindre la MIMS (Maison de l’innovation et de la médecine spécialisée). Ce laboratoire d’idées regroupe des médecins libéraux de la CSMF, des startups comme le spécialiste de la prise de rendez-vous en ligne Doctolib, la société de télémédécine Medaviz ou le fabricant d’objets connectés Withings. Chaque partenaire apporte une contribution financière de 50.000 euros.

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