Swedish startup pushes a streamlined model for health care payments

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Amazon recently made headlines by teaming up with JPMorgan Chase and Berkshire Hathaway in a collaboration that might use e-commerce tools to wring inefficiencies out of the companies' health care coverage. It's an idea that's already underway in Sweden.

The Stockholm-based mobile health care on demand company called KRY recently received a $26 million investment from Accel Partners and added collaborations with third-party payment apps Apple Pay and Klarna to streamline payments, appointment scheduling and other health care transactions via an iOS or Android app. In a couple of years it has grown to account for 2% of all primary medical visits in Sweden.

While Sweden has a single-payer health care system, there are still myriad hurdles and inefficiencies. KRY has built a user base of more than 200,000 over the past two years for a centralized e-shopping, booking and payment experience tied to health care that's designed to turn wait times of up to several weeks or months to as little as a half hour.

The phrase "single payer" is misleading, since there are numerous health care payment systems in Sweden, and there are also provisions that allow private companies to provide coverage and access under certain conditions. Patients also have different comfort levels with technology, thus adding to the confusion.

"There are quite a lot of challenges since we have to be able to adapt to rules and processes in 21 single-payer systems," said Johannes Schildt, co-founder and CEO at KRY, referring to the 21 distinct regional subdivisions of Sweden's health care system. "All regions in Sweden have different processes for referrals, testing, etc."

KRY uses BankID, an electronic ID system in Sweden with about 6.5 million users (in a country of 9 million) for authentication. One in the app, users describe symptoms and answer questions. The consumer then books time for a video session with a doctor that usually lasts about 15 minutes. The app is designed to cut across the different systems inside Sweden to match supply and demand of medical services.

Prescriptions and referrals are sent back to the patient via an encrypted message, with payment options showing up in the same mobile booking session via a "buy button" that supports credit cards, Klarna and now Apple Pay's mobile wallet.

"From a patient perspective, the possibility of seeing a doctor at a time and place of your own choosing is generally very well received," Schildt said. "The issue to overcome is to inform the public that this opportunity now exists and is safe and secure. There is also a need to change the general perception of what is the normal way to receive health care. There is an ingrained belief that you need to physically see a doctor in order to get help."

The model could inspire other health care initiatives around the world. In the U.S., Amazon is collaborating with JPMorgan Chase and Berkshire Hathaway in an attempt to improve health care processes for their own employees. The three companies have not released a lot of detail about how they'll do that, but Amazon's e-commerce and fulfillment expertise would likely combine with JPMorgan Chase's payments and merchant services to remove paper-based and manual processes.

In a small way, in Sweden, KRY has demonstrated that these tools—a digital front and back end at scale—can reduce the steps needed to obtain medical care, determine how a specific treatment should be funded and paid for, execute that payment and deliver drugs and other at-home treatment, according to Nordic technology expert Patric Palm.

"In the U.S. there is amazing health care but it's not even distributed. In Sweden there's even distribution but there's challenges in having immediate access," said Palm, an entrepreneur who founded Hansoft, a Swedish project management startup; and Favro, a Swedish organization flow management company.

"[KRY] changes accessibility," Palm said. "It's all integrated. You get treatment, push the pay button and you have the medicine the next day in the mail."

There are, however, regulatory hurdles to the model. KRY has been successful in working within the Swedish health care system, where there's an open acknowledgement of the challenges to access and efficiency in payments and documentation.

KRY is available in other Nordic countries and wishes to expand to other parts of the E.U., but only as regulators allow, Schildt said. "There is continuous dialogue with regulators regarding how to define what we can do and how it should be reimbursed. In a lot of countries that could benefit from digital health care there is still no legal opportunity to launch."

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