Tianjin Dongli District Recognized with National Award for Digital Health Community Reform

On September 20–21, the “2024 Conference on Innovative Development of Primary Healthcare and the 6th Exhibition of Innovative Cases in Primary Care” was held in Qingdao, Shandong Province. Tianjin’s Dongli District was selected as an outstanding case in the category of “Comprehensive Reform of Primary Healthcare” for its healthcare reform achievements in “Enhancing Primary Care Service Capacity through the Construction of a Digital Health Community.” At the conference, Wu Zhenyun, Chief of the Medical Administration and Hospital Management Section of the Dongli District Health Commission, delivered a keynote address titled “Digital Health Community Empowering Primary Healthcare Reform.” He introduced how the district has fully leveraged digital and intelligent technologies to deeply integrate medical services, pharmaceuticals, and health insurance, thereby achieving “tri-medical synergy” and pioneering the practice of the “Dongli Demonstration Zone for Digital Health Communities” driven by digital intelligence.

Guided by the Department of Primary Healthcare under the National Health Commission and the Health Development Research Center of the National Health Commission, and with strong support and guidance from the Shandong Provincial Health Commission, this conference was held under the theme “Collaboration, Empowerment, and Quality Improvement.” Focusing on three key topics—“Comprehensive Reform of Primary Healthcare,” “Construction of Close-Knit County-Level Medical Consortia,” and “Enhancement of Primary Healthcare Service Capacity”—the event showcased 48 outstanding case studies. It brought together more than 2,000 experts, scholars, and industry representatives from across China to jointly explore pathways for the development of primary healthcare.

As one of the exemplary cases showcased at the conference, Wu Zhenyun shared Dongli District’s explorations and practices in building a digital health community from three perspectives: the background of grassroots healthcare reform in Dongli District, the strategic approach, and the empowering effects of the digitally intelligent health consortium.

 Figure | Tianjin Dongli District Selected as an Outstanding Case in “Comprehensive Reform of Primary Healthcare,” Sharing Practical Experience

It is reported that Dongli District boasts abundant medical resources, with 17 public medical institutions, including three tertiary hospitals, three secondary hospitals, and 11 primary hospitals, as well as 188 private hospitals. However, given the district’s permanent population of approximately 857,000—particularly the 100,600 residents aged 65 and above—and the growing population of patients with chronic diseases (including 31,000 with diabetes, 71,400 with hypertension, 24,000 with coronary heart disease, and 2,000 with chronic obstructive pulmonary disease), the traditional healthcare service model faces significant challenges.

The fee-for-service mechanism in traditional healthcare systems not only strains the expenditure burden of medical insurance funds but also increases the financial pressure of medical costs on the general public. Meanwhile, numerous bottlenecks exist in areas such as patient management and information interoperability; for instance, low patient adherence and the lack of integration between public health, medical insurance, resident health, and chronic disease management data severely constrain the ability of medical institutions to provide efficient and precise services to patients.

Guided by relevant policies issued by the Tianjin Municipal Party Committee and Municipal Government, as well as government agencies such as the Municipal Healthcare Security Administration and the Municipal Health Commission, the Dongli District Urban Medical Group was established under regional governmental coordination. With institutional innovation, mechanistic innovation, and technological innovation as its core development principles, the group launched a reform on June 1 this year to implement capitated global budgeting for family doctor contract services. Leveraging the foundation of institutional and mechanistic reforms and empowered by digital intelligence technologies, the group has rapidly integrated healthcare services, pharmaceuticals, and health insurance, achieving “three-medical synergy.” This has effectively enhanced the health management of patients enrolled in family doctor contract services.

In practice, Dongli District has leveraged the “Four Clouds” platforms—“Cloud Management,” “Cloud Pharmacy,” “Cloud Services,” and “Cloud Testing”—developed under the Tianjin Digital Health Community initiative to comprehensively accelerate the construction of primary healthcare information systems. It has also established standardized chronic disease management centers to build a robust chronic disease management framework. The district took the lead in incorporating patients with chronic conditions such as hypertension and diabetes into the standardized chronic disease management system of the Digital Health Community. Through the cloud service platform, with resident registration at local community health centers as the core, it implements centralized operations, unified management, clear division of responsibilities, and tiered services, providing residents with 60 convenient and high-quality home-based medical nursing and health management services, including urinary catheter replacement, nasogastric tube replacement, and venous blood sampling. The Cloud Pharmacy platform serves as an important supplement, addressing shortcomings in medication supply assurance at the primary care level and offering free home delivery of medications to patients. Furthermore, the Cloud Testing platform has significantly enhanced the capacity of primary healthcare institutions to screen for and monitor major chronic diseases, providing strong support for early detection and intervention.

Powered by the “Four Clouds” as its core engine, Dongli District is significantly enhancing the enabling role of digital intelligence in family doctor contract services. Leveraging the innovative “3+1+N” service model, the district has established a robust family doctor service team comprising public health personnel, family doctors, nursing staff, and specialist physician teams, along with professionals such as health managers and pharmacists. This model not only optimizes the overall workflow of contract services and improves service quality but also substantially strengthens interaction and trust between patients and providers, achieving deep integration and effective coordination among medical care, pharmaceuticals, and medical insurance. By standardizing physicians’ diagnostic and treatment practices and habits, it improves clinical efficiency and effectively mitigates the risk of claim denials by medical insurance payers.

Furthermore, by leveraging the expert guidelines and the autonomous learning capabilities of large language models within the Digital Health Consortium for six major chronic diseases, including hypertension and diabetes, Dongli District has successfully replicated expert diagnostic and treatment capabilities and experience, enabling intelligent co-management. This system enhances pre-diagnostic efficiency and improves in-diagnostic quality, thereby delivering more effective and higher-quality medical services.

Wu Zhenyun introduced that, to date, against the backdrop of capitation-based global budgeting for family doctor contracted services, Dongli District has achieved a “two increases and one decrease” by leveraging digital intelligence capabilities to empower the stages of prevention, screening, diagnosis, treatment, management, and rehabilitation. Specifically, this refers to an enhancement in regional healthcare service capacity, an improvement in residents’ health status, and a reduction in medical insurance expenditures. The “Dongli Experience” has drawn the attention of participating experts, scholars, and health commission leaders from various regions, who engaged in in-depth discussions after the conference on the implementation and outcomes of Dongli District’s family doctor contracting program.

Reporters have learned that the “Dongli Experience” is merely a microcosm of Tianjin’s efforts to deepen healthcare reform. In recent years, guided by relevant policy documents issued by the National Health Commission and the National Healthcare Security Administration, Tianjin has continuously introduced and refined policies to support the deepening of healthcare reform. The city has established the Tianjin Digital Health Community, which supports pilot programs for capitated global budget payments for outpatient special care patients with diabetes across the municipality. Building on this foundation, Tianjin has gradually implemented capitated global budget payments for family doctor contracted services, thereby forging an effective pathway for shifting from a “treatment-centered” to a “health-centered” model. Since late 2023, districts in Tianjin—including Xiqing, Dongli, Jinnan, and Hebei—have successively signed agreements with WeDoctor. Leveraging the municipal-level Digital Health Community jointly established by the Tianjin Municipal People’s Government and WeDoctor, these districts are upgrading to build regional Digital Health Communities, further developing close-knit regional medical consortia, and implementing capitated global budget payments for family doctor contracted services.

The digital health consortium model, pioneered and practiced in Tianjin, has become a key healthcare reform experience promoted at the national level. The "Key Points for Digital Rural Development Work in 2022," jointly issued by five national ministries and commissions, explicitly proposes to "guide localities in exploring the construction of grassroots digital health consortia." Furthermore, this year, the National Health Commission has held three consecutive press conferences to promote the healthcare reform experience of Sanming, requiring nationwide coverage within five years. Among these efforts, elevating "medical consortia" to "health consortia" and establishing a "collaborative management system for six diseases" have become key directions in deepening Sanming’s healthcare reforms.