DTx in Belgium: It's Time to Embed Digital Therapeutics in Clinical Pathways

[00:00:00] Dear listeners, welcome to Faces of Digital Health, a podcast about digital health and

[00:00:07] how healthcare systems around the world adopt technology with me Tjasa Zajc.

[00:00:13] Belgium is a small European country with 12 million people but it's still in a way the

[00:00:28] heart of Europe because the European Parliament is based in Brussels.

[00:00:34] Did you know that Belgium started with the idea of regulating digital health medical

[00:00:39] apps already in 2018?

[00:00:44] A clear framework was formed with all the main stakeholders involved from health insurance

[00:00:50] to industry, to the federal agency for medicines and health products.

[00:00:57] And why are you not hearing more about DTX from Belgium?

[00:01:02] This is the topic of today's discussion.

[00:01:05] You will hear from Dr. Steven Van der Boot, he is the advisor for Digital MedTech and Services

[00:01:11] and Technologies Home Systems in Belgium.

[00:01:14] He's managing the M-Held Belgium portal and since 2019 has been a representative for B-Med

[00:01:21] Tech, the sector federation that represents the industry of medical technologies in Belgium.

[00:01:29] Enjoy the show and if you haven't yet make sure to subscribe to the podcast

[00:01:33] and also check out our newsletter, you can find it at fodh.substag.com

[00:01:39] that's fodh.substag.com

[00:01:43] Now let's dive in!

[00:01:52] Steven, hi and thank you so much for joining me for a discussion for faces of digital health.

[00:02:10] To discuss a little bit where digital therapeutics are in Europe, we keep talking about Germany

[00:02:17] which has had a clear framework for so-called degas since 2019.

[00:02:23] We've learned a lot from that example.

[00:02:26] Now France is around a year in the framework called the PICON, but actually you are from Belgium

[00:02:37] which has had ideas about regulating digital therapeutics since 2018 and I look forward to discussing

[00:02:46] your experience in this discussion today.

[00:02:52] Yes indeed I'm one of the coordinators of the M-Held Belgium initiative which is on the national level,

[00:02:58] on Belgium level, the initiative that wants to help creating awareness about mobile medical

[00:03:05] applications to on the one hand citizens but also on the other hand healthcare professionals and

[00:03:10] all stakeholders in the domain and since 2018 we have this joint initiative. It started with a joint

[00:03:15] initiative both by industry and government but meanwhile this change but we can go later in

[00:03:21] in the details how it is now but indeed it's a portal on www.mheld Belgium WEE that wants to provide

[00:03:28] information which medical apps fulfill certain criteria that are set by government.

[00:03:35] Let's go back in time a little bit so this was already set up in 2018. Can you talk a little

[00:03:42] bit about how the conditions look like for this initiative to happen? So just to clarify the pyramid

[00:03:51] that kind of classifies digital therapeutic apps has been designed and agreed upon between

[00:03:57] three organizations, the federal agency for medicines and health products and then the national health

[00:04:05] institute or the national institute for health and disability which is an insurance basically

[00:04:10] institute and the industry. So this is already a huge success because many countries that are looking

[00:04:19] at big eyes and pick on they just don't know where to start how are you going to design a group

[00:04:25] that's going to in the end facilitate the design of a framework and its enforcement so how did

[00:04:31] this go down in Belgium? I can definitely explain but maybe first highlights it didn't start in 2018

[00:04:39] basically it always started in 2016. In 2018 it's only the pyramid stores but in 2016

[00:04:45] the previous Minister of Health, Maggie DeBlock on the federal level already decided to investigate

[00:04:52] what mobile health could mean, what the value could mean in the Belgian landscape when we use

[00:04:56] such mobile medical applications and what she did is she launched a call for pilot projects

[00:05:02] and 24 of these pilot projects got some subsidies and they run for six to 12 months all these

[00:05:09] pilot projects were in a combination of healthcare professionals tech providers in different settings,

[00:05:14] hospital setting, home care setting and out of these 24 pilot projects that were subsidized

[00:05:20] they did an evaluation after one year and a half and it's that at that evaluation that made clear

[00:05:26] there is a need to have a validation framework and that the validation framework became then

[00:05:33] the validation pyramid with the three layers as you said indeed and that started off

[00:05:38] end of 2018 and then the portal became rent life as a website in beginning of 2019.

[00:05:45] If we look now to the three levels in the pyramid it's important to know that there is an hierarchal

[00:05:51] structure so it all starts with level one, level one is the broad basis there an applicant

[00:05:56] start and then it can rise into the pyramid from level one the basis towards level three

[00:06:01] towards level two first and then ultimate aim for many of these tech providers for many of

[00:06:06] these applications is of course to be financed in the system and that's where a level three

[00:06:11] comes into the picture so it's a broad basis level one towards a narrow top level three because

[00:06:16] the ID or the aim is not that all applications that enter level one also will reach level three

[00:06:23] it's not all applications that fulfill the basic criteria about CE certification etc i'll dive

[00:06:29] into that in the next minutes that need to have financing on the national level but of course

[00:06:35] many will aim for that so if I look correctly there's basically three levels and one is

[00:06:43] to just be classified and then the third one is to also be reimbursed by the national insurance

[00:06:50] so indeed level one is the broad basis and there the federal agency for medicine health products

[00:06:55] who is the agency responsible for patient safety doing inspections of let's say farm and

[00:07:00] medic world there the basic criteria is to have a CE labeled so you need to be a medical device

[00:07:06] so it's only those apps those tools that do medical claims wherever it is the diagnostic therapeutic

[00:07:12] monitoring that doesn't matter the pathology domain also doesn't matter but only if they do medical

[00:07:17] claims and are ever CE label then they can be classified in level one that's where it all starts

[00:07:22] then level two originally level two was more about some iCT criteria you have to fulfill

[00:07:29] think about authentication identification of the user how you have to check the relationship

[00:07:35] between patient and healthcare professional there you need to fulfill of course certain standards

[00:07:39] to do that it is that the connection is safely done and then level three it's enough of course

[00:07:45] the top level that's there the decision is made by the national institute for health and

[00:07:50] disability insurance which is the national parity and they judge and evaluate of course the dossier

[00:07:56] where you have to show your social and economic evidence and add a value you bring into the care system

[00:08:04] and in the beginning 24 applications were assessed in a year long period what happened to those

[00:08:13] applications then or what's happening with them today are these applications that are still alive

[00:08:20] or yeah what happened yes some went into the pyramid some some not this was let's say all

[00:08:27] consortia of different stakeholders but several of these tech providers who were involved in this

[00:08:33] consortia have afterwards listed their application on the portal but the portal is now open as in

[00:08:38] students 19 for all so it doesn't it's not anymore linked to those 24 who originally started in a

[00:08:44] pilot case now it's open for every Belgian and international company doesn't matter it's on the

[00:08:49] Belgian landscape that you have to that can become active and if you provide the information according

[00:08:55] to the criteria the animal Belgium coordinator like me we just act as a notary we verify whether

[00:09:01] this valid or not and then we grant you the animal Belgium quality seal if you fulfill the criteria

[00:09:07] the judgment about the reimbursement is of course done by the national pay or to retain themselves

[00:09:12] okay how many applications or solutions are currently in the m health Belgium portal and what I'm

[00:09:19] wondering there is like how does that help vendors or healthcare providers if they see these

[00:09:27] applications on the portal how well is it utilized yeah it's I think it's it's quite important as a

[00:09:34] kind of marketing and communication tool as well because in the beginning it was not so well known

[00:09:40] widespread among the different stakeholders healthcare professionals but meanwhile this change of

[00:09:45] course and what I hear is that many hospitals or healthcare professions that want to use it really

[00:09:51] verify whether the application when a vendor comes to them and offers some telemortruring application

[00:09:56] or whatever that they check is it on listed on the ml Belgian portal so with the quality seal becomes

[00:10:02] important the quality seal doesn't mean you will be financed or the risk reimbursement but it's

[00:10:07] at least a validation that has been done according to criteria that are set originally by government

[00:10:13] currently there are between 35 and 40 applications who have that quality seal who are listed either

[00:10:21] in level one level two one there was one also who got temporary reimbursement was in level three

[00:10:26] but that's again changed one year ago so currently there is no one who is really being financed by

[00:10:32] the national pay authority but still it's an important tool for communication visualization and I hear

[00:10:38] from the companies who are there that in the market it's it's still important to be listed there

[00:10:44] yeah it definitely builds up the credibility of the company so there's 35 applications listed

[00:10:50] and none of them is actually financed or reimbursed by the insurance at this moment none is really

[00:10:58] financed no that's true why unfortunately why that's a long and difficult story but let's try to

[00:11:06] to explain it in a as simple as possible way it started with the fact that in 2019 when the portal

[00:11:12] became live level three was still not alive so the template the procedure for reimbursement

[00:11:18] to request was not active so that only is happening since beginning of 2021 which is also already

[00:11:24] three years ago and then there were several dossiers submitted several companies submitted the dossier

[00:11:31] did a reimbursement request show their added value into the market both clinically but also

[00:11:37] organizationally in different domains ranging from amber tree care for oncology patients for

[00:11:43] sleep up nia for heart failure patients etc but then they got evaluated by the pay authority

[00:11:50] and most got positive evaluation which is good and that happened all in six months time but then

[00:11:56] there is a second part of face and that face is like a bit black box model what's happening there

[00:12:04] they got positive evaluation so they really showed their added value the pay authority and

[00:12:10] healthcare professionals really believe they bring added value into the system but the

[00:12:15] financing has to be changed and that's difficult and why we are in Belgium and I think in many

[00:12:21] countries we still have a fee for service mechanism in the in the financing our healthcare so it

[00:12:28] means very basically that every act every consults everything is paid case by case so there's also an

[00:12:36] incentive to let for instance people come chronic patients let them come on consultation every six

[00:12:42] months every year depending from pathology to pathology but there is no real incentive to do the

[00:12:49] follow-up via digital tools via telemortem etc because then they will not be financed for their act

[00:12:54] for their knowledge for the follow-up they do so the pay authority is aware of that and they want

[00:13:00] to change it and therefore they want to go away from the the way the financing is done nowadays

[00:13:06] the fee for service mechanism and they want to involve into another system which we can call

[00:13:11] for a system bundle payment system but that requires of course a big change and every change as

[00:13:20] when all we know every change comes with resistance resistance from people in the field

[00:13:25] and then it's good to know that in our country we have a quite complex consultation model

[00:13:30] I don't explain it in detail but it comes down to the system that the the people working

[00:13:38] in the administration they don't decide themselves it's up to the on the one hand the health ensures

[00:13:45] the public health ensures or the other hand representatives of the healthcare professionals

[00:13:50] who have the voting power and they have to come to a consensus and that's very difficult

[00:13:55] because there is always a bit of fear that the change will harm them or will bring a less positive

[00:14:01] future also financially for them so that's the reason why first those applications they do submit

[00:14:09] the dossier they often get positive evaluations but then the black box model stores because then

[00:14:15] the financing has to be changed for that pathology domain and they one will not finance

[00:14:22] the product itself one aims to finance the care pathway in which the technology can be used

[00:14:29] and that care pathway from eight to z of course it has to be the boundaries have to be set

[00:14:34] that pathway will be the finds via a bundled payment via a first system

[00:14:39] and that requires of course they have big discussions and that's and there is no fixed time as

[00:14:45] discussed there or agreed there and that's why several of these applications in the different

[00:14:50] domains that I explained from sleep monitoring to follow up cancer patients in an ambulatory setting

[00:14:56] heart failure etc one is still figuring out with the resistance of course of the different

[00:15:01] stakeholders involved and we expect in 2024 we expect a few of these care pods be listed and be

[00:15:09] financed differently and then of course not only the submitter but also other applications who

[00:15:15] are in that domain will be financed so 2024 should be an important year but it's already a

[00:15:21] long time ago since we started in 2021 with the with having the financing potential

[00:15:27] yeah yeah I totally get that it makes sense if you have an app that is basically just a piece

[00:15:35] in the whole puzzle of the bundled payment then somebody needs to decide how big that piece is

[00:15:41] and how that's going to be paid for it's you need to adjust the piece because the technology

[00:15:46] is a mean the technology is not the aim and that's what the the Belgian authorities also think about

[00:15:51] and they want to finance not the technology they want to finance the use of the technology

[00:15:56] in the whole framework of a care pod and finance the care pod as such

[00:16:01] how do then these companies finance themselves how do they survive is it all out of pocket

[00:16:07] how much are they looking also into other markets such as Germany or France one thing that I

[00:16:12] thought was really interesting is that basically in Belgium you have to be in three languages

[00:16:19] one of them is French so I'm wondering how many companies are looking at the French model now but

[00:16:25] I know I asked three questions so let's start with the first one how did they survive

[00:16:31] that's a good and a tricky question because of course some of these companies are

[00:16:35] multinational established companies and and then it's an add-on on their classical let's say

[00:16:40] equipment and systems or implants or whatever business but several of these companies are also very

[00:16:45] focused and in the niche domain of digital technology that's their only product that's

[00:16:49] their only way of surviving there's your only thing they can bring to the market so that's also

[00:16:54] where the revenues have to come from and then it's difficult because if you don't have

[00:16:57] if there is no financing and nobody's using it because of that reason so we see that there is less

[00:17:03] appetite indeed they have to go to other markets even the Belgian companies who have good products

[00:17:10] they have to go elsewhere one of the good cases here is freebie check freebie check is an application

[00:17:16] for heart age refubulation patients but not via a whole trip recording but just via putting your

[00:17:22] finger on the camera of his smartphone and they do via intelligent AI algorithms detects

[00:17:27] age refubulation and other things but they can't live they can't generate revenues just from being

[00:17:34] with that medical product on the Belgian market so they have to look first over years ago

[00:17:39] they look to different generating incomes generating revenues different ways

[00:17:44] but they have partnerships with Fitbit and we've consumer consumer markets

[00:17:48] they have with private health insurers they also went not anymore to the Belgian market but they

[00:17:53] look abroad they are in the NHS system and the UK they have success in the Netherlands because

[00:17:59] in the Netherlands there is a different healthcare mechanism and it's more already in the bundle

[00:18:04] payment system and then of course if you as a healthcare professional can use such technology

[00:18:10] and you still have the same amount of money you will get then you use a technology instead of

[00:18:16] just letting the patient come to your office for an extra consultation so they have to look abroad

[00:18:22] they have to look to order ways of generating revenues partnerships etc and that's how they do

[00:18:28] and we see also that the appetite in the market and became much less in Belgium the last years

[00:18:35] because of the fact that we don't have this clear vision or there is a vision but we don't have

[00:18:41] success stories and that's really pity because then they have to look abroad and so they go to

[00:18:47] surrounding countries and they're basically disappointed again even for Belgian companies we can say

[00:18:55] there is no home market success even when it's in the pipeline but if you don't know when it will

[00:18:59] happen in six months in one year and a half two years it's difficult to survive as a company

[00:19:05] yeah based on the things I'm seeing in the US or in Germany still we're going to see what's

[00:19:13] going to happen in France but in these two markets so US and Germany I see that there's like

[00:19:21] a lot of disappointment and people are giving up because there's no clear reimbursement mechanism

[00:19:28] or because yeah these technologies while they are very useful are not a solution like pills are

[00:19:39] so it seems that the industry as such is giving up a little bit on the DX not quite yet

[00:19:49] but I'm wondering what's going to happen after that. The lack of perspective is very difficult if

[00:19:53] there is a lack of perspective it's difficult to go on in my opinion I see that adoption and

[00:20:01] adoption on a bigger scale comes in the help to remain with two things on the one hand of course

[00:20:08] there need to be trust into the product and into this system and the second thing is often

[00:20:13] financing especially in healthcare because we are quite familiar that everything is I wouldn't say

[00:20:21] for free but it's cheap and it's not paid out of pocket different as in the US market of course

[00:20:26] where it's more a liberal market we are more in social markets

[00:20:31] regarding healthcare at least. But I think I'm just going to comment here I've been thinking about

[00:20:37] this and I think I guess what we need is some bravery in terms of somebody on the political level

[00:20:47] being yeah just bold enough to actually try and give these technologies a try to see what the

[00:20:54] brother impact could be because for example if you look at the Diga apps there's around 60 at the moment

[00:20:59] in the database and a lot of them are related to mental health, to depression, to

[00:21:07] anxieties etc. And I think broadly globally we've got a huge shortage of healthcare professionals

[00:21:15] so while these applications are not like a replacement for therapy and the discussions that you

[00:21:20] have with an actual therapist I think we are missing out on the potential that we could have

[00:21:26] leverage on just giving more people at least some support instead of nothing where waiting times

[00:21:35] for a clinical psychology evaluation can be a year or longer so I'm yeah I'm puzzled why nobody

[00:21:43] is really digging a bit more boldly. It's 100% true and I agree and I think we should even more

[00:21:52] stress the value it can bring because the value is not only for patients the value is also there

[00:21:56] for healthcare professionals to tackle shortages and other challenges we will face in our healthcare

[00:22:02] system. Shortage of staff is one we also see that patients are become more empowered not patient

[00:22:09] citizens overall so this also helps in taking their health in their own hands often and it's also

[00:22:17] delivering often better quality of care I think especially about chronic patients there is

[00:22:21] more accurate follow-up if you use often these technologies mental health indeed true there I have to

[00:22:28] say and then that's very specific for the Belgian context mental health is a bit out of scope

[00:22:33] in for the Belgian context because it's not anymore on the level of the on the national level

[00:22:38] that this is discussed and financed it's on the regions so that's more an other political complexity

[00:22:44] where is the responsibility and for prevention and for mental health in Belgium this is not

[00:22:50] anymore on the federal level but on the regional level and the system we have with Amel Bosom

[00:22:55] with the validation pyramid is a is a federal system but that's a bit okay out of discussion

[00:23:01] but I see indeed that in in the in the Dhegan Germany most applications or a lot of these

[00:23:06] applications are on data X and mental health focusing and there I have also to stress in Belgium we

[00:23:12] don't focus really on data X digital therapeutics we focus more on it's called Amel Bosom they focused

[00:23:19] on mobile health nowadays it's difficult to explain what mobile health is because mobile everything

[00:23:24] it becomes mobile but one aims basically those applications that are used by patients and a lot

[00:23:31] of them to interact and share data with healthcare professional and secondly also telemortrary

[00:23:37] applications so here's the here's the difference with what we see in Belgium as under Amel Bosom

[00:23:42] a lot of telemortrary applications for instance in Dhegan it's more focused on digital therapeutics

[00:23:48] where also the healthcare professional is not obliged to to interact in the Belgian setting

[00:23:54] the interaction with the healthcare professional is crucial and essential and obliged

[00:23:58] when you aim for reimbursement and that's similar in Pico in France there also the interaction

[00:24:03] with between patients and healthcare professional is really required.

[00:24:08] What are the differences that you see between the three frameworks so the French, the German and the

[00:24:17] Belgian how do we like maybe if we try to limit ourselves how does this look like from the vendor

[00:24:25] perspective how much the these frameworks help how much are they they are just debilitating

[00:24:31] for the vendor when trying to enter the market.

[00:24:35] From a vendor point of view there are similarities and like you need to see

[00:24:39] certification I think the proof of evidence regarding security, regarding authentication

[00:24:46] I see these standards interoperability is probably similar I don't know exactly where the

[00:24:54] differences but it's probably similar the evidence you have to bring this probably can be the same

[00:25:01] but it will be judged every case again so there is no harmonization on a European level so

[00:25:09] four that once let's say the evidence is just in one country that country two three or four

[00:25:16] also will agree on that. So that is of course from a vendor perspective a difficult one because

[00:25:22] maybe you can use or bring the same evidence in your dossier but the judgment and the procedures

[00:25:28] are in every country slightly different and has to be done again and again.

[00:25:34] Did you by any chance talk to any companies that are also trying to enter the French market?

[00:25:41] I'm yeah wondering if anybody has already any experiences with that process.

[00:25:46] There are a few who are also from Belgium started and they look now to Dika to there are several

[00:25:53] ones and also vice versa for instance we have in France there is resilience with a company doing

[00:26:00] activities for cancer patients the follow-up of cancer patients they got finest in in France

[00:26:07] not under pick-up but in another system because in France you have more than the pick-off system

[00:26:11] and now they are the first dossier that's admitted in the new Amherl procedure reimbursement

[00:26:17] request so they will be evaluated and judged in Belgium too. So it's also and I know also from

[00:26:22] Germany there are few who are preparing the dossier to submission on the Belgian level

[00:26:28] so it's in different directions that this is going. You're following this field very closely

[00:26:36] so we mentioned a lot of challenges that the space is facing and based on the fact that many

[00:26:46] approaches have been tried out in order to get these technologies used in practice in healthcare

[00:26:52] what are some of your expectations or I don't want to say predictions based on your knowledge

[00:26:57] where do you see that the field is going? I think on a European level

[00:27:05] yeah full free to say whatever you want about either country level or European level.

[00:27:09] But it's only let's start from a European level there is a there is a task force working on

[00:27:15] harmonization in terminology but also harmonization in how HDA health technology assessments has to

[00:27:20] look like specifically for digital health products. I hope I don't know where it will be true but I

[00:27:30] hope this will leverage it to bring technologies to different markets in a similar way faster and

[00:27:36] sooner because in the end that's what we aim for not only tech providers but also as a society

[00:27:42] bringing the technologies when they are creating value when they are validated that has to

[00:27:47] is very important of course bring them faster and bring the innovations faster to the market

[00:27:52] that they can be used easier and sooner by healthcare professionals of patients that's only in

[00:27:58] the advantage of the healthcare system overall. And on a Belgian level I would say but I already

[00:28:05] I'm still positive and though we have all these challenges over the last years but I hope that

[00:28:10] 2024 will be a bit a year of change and that's even those those who already are in the pipeline for

[00:28:18] a couple of years will land in 2024. I think about sleep monitoring I think about telemortering

[00:28:25] for heart failure patients also for cancer patients to follow up remotely this dossier should land

[00:28:31] and then we can have some success stories we can have some cases that are really used because nowadays

[00:28:38] these technologies are also used in Belgium but it's on an ad hoc basis. Hospital X Y and Z they

[00:28:46] want to be innovate innovative mind and they really use it of course they have to finance it themselves

[00:28:53] they have to arrange it because there is no national financing but they do it and these stories

[00:28:58] also help to put pressure on the governments, on the politics to really embrace it to really

[00:29:05] and larger system and make it easier to apply for and that things go faster.

[00:29:10] We have in the practical reality we have success stories but it's not widely used because

[00:29:17] it's not scalable at the moment is there is no financing? Yeah which again brings us to the complexity of

[00:29:25] how like the usability is one thing but we're still struggling with the how-to-best fit that into

[00:29:33] the system and there of course the difficulties of the financing and that's a bit the difference

[00:29:38] between Belgium and let's say the two other countries who are also embracing the innovation

[00:29:43] in Germany with Diga in France with Pico they have budgets for this sometimes large budgets

[00:29:51] and they also finance the products themselves in Belgium as I already explained earlier

[00:29:57] we don't have separate budgets so every budget is in silos and the digital health brings value

[00:30:02] in a transversal way over the different silos because if you prevent re-hospitalization okay

[00:30:09] use safe in hospitalization cost which you create of course the cost elsewhere which is maybe

[00:30:14] smaller and so in the end you do savings but if everybody is safeguarding their own silos,

[00:30:21] their own budgets it becomes difficult to implement it yeah so we have to overcome that way of thinking.

[00:30:28] Yeah you know what that's exactly what I was thinking when I was talking about mental health apps

[00:30:33] before if you go to the Diga directory now they also have price tags there and some of them are

[00:30:39] I don't know between 300 or 700 euros so for an app that really sounds a lot but if you think

[00:30:47] that maybe the help of that app would prevent somebody from being on C-cliff for months

[00:30:55] that's a huge benefit and yeah economic value instead of paying I don't know a few thousand

[00:31:02] euros for somebody's leave of absence because of an illness and you put a few hundred euros in

[00:31:09] just so that person can still function and be productive there's a... It's true it's true because

[00:31:16] we all speak about value-based healthcare the way to go but in reality we often don't go into

[00:31:22] that direction and I think digital technologies are really an enabler they are not a goal but an

[00:31:27] enabler to do that yeah it still is difficult to implement it if everybody keeps on saving their

[00:31:33] own silos and protecting their own incomes etc. So the platform for applications in Belgium was

[00:31:43] managed if I'm not mistaken by the three collaborators that went into the project so the insurance

[00:31:50] the e-health platform and the federal agency for medicines and health products and that ended in 2023

[00:31:55] where if incorrect me if I'm wrong the B-MET tech basically took over the platform so can you

[00:32:04] just explain that the collaboration between the three organizations ended in 2023 so that kind of

[00:32:10] makes me wonder what's going to happen next did the national organizations give up what does

[00:32:18] that mean for the actual future so indeed it was a joint initiative originally and joint

[00:32:24] initiative of the three healthcare authorities decided the criteria and the two industry

[00:32:32] federations be met again I'm going to be met we did the operation management we built the platform

[00:32:38] we did the day operations etc. We also got some money to do that from the government and that

[00:32:44] in 2023 why because we did a lot of advocacy to improve it over the last years and there was also

[00:32:52] an report made by an independent organization that said how should it be better and the

[00:33:01] pay authority so the national institute for health and disability initiatives the pay authority

[00:33:06] used that report beginning of 2023 to come with a new procedure a new template etc. So there has been

[00:33:13] done changes in a good way and so the new procedure is active and with new templates etc.

[00:33:21] It's not only industry that can apply also the group of healthcare professionals hospitals

[00:33:26] health ensures they all can apply and that's only good that is not only driven by the industry

[00:33:31] themselves and that new procedure came into action we did a lot of advocacy towards that game

[00:33:39] to action since October 2023 and in that new procedure the submission for reimbursement requests

[00:33:45] can be done directly to the to the authority the pay authority so there is no officially there is

[00:33:51] no need anymore to cause via the emphabellation portal but of course the different actors still

[00:33:58] want to be listed there and we as be met again agoria as industry sector federations we decided

[00:34:05] to go on of course but adapted to the new reality so we believe it still brings value

[00:34:12] to list there the different apps beat only level one or also those who will be financed because

[00:34:19] it will be a given overview both for citizens both for healthcare professionals in which domains

[00:34:24] other apps who are financed or who are not financed and that overview is very important of course

[00:34:30] we have to be honest and we also believe it's useful to do a further advocacy to put pressure on

[00:34:36] the system but it's also bringing the information in a structured way is still valuable we believe

[00:34:43] so that's why we think that agoria continue in the new setting of course in an adapted way

[00:34:49] and we also want to bring more transparent information for instance also those in the past

[00:34:55] those applications who requested for level three for reimbursement it was not listed who was it

[00:35:01] etc now we really list those applications did they request they did the submission that date

[00:35:08] that was the evaluation outcome and we all want to bring that in a transparent way

[00:35:14] yeah it's definitely useful to have an overview also for decision makers in other countries

[00:35:19] that are trying to make sense and figure out how they might want to go about this field in their

[00:35:25] respective country Steven thank you so much for sharing all the insights and we are going to

[00:35:31] definitely circle back to Belgium say in a year to see what additional progress has been made

[00:35:39] my pleasure to do and definitely work to do a follow-up lecture

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