Ruijin Hospital and WeDoctor Co-Build AI-Powered 'Six-Disease Integrated Management' Model to Unlock Key Bottlenecks in China's Healthcare Reform

Recently, China’s first “Six-Disease Co-Management” Center covering the full life cycle commenced operations in Sanming. By leveraging AI to transfer key medical technologies, the center has implemented a “Six-Disease Co-Management” service model that brings “academician-level” care down to the grassroots level. This initiative pioneers an innovative pathway for expanding high-quality medical resources, promoting balanced regional distribution, strengthening the management of major chronic diseases, and enhancing primary care capabilities in disease prevention, treatment, and health management.

As the “Six-Disease Co-Management” system is progressively deepened in Sanming, the city will become a demonstration base for the AI-driven transfer of key medical technologies. This will enable the Sanming Model of Healthcare Reform 3.0, centered on health, to be promoted nationwide, thereby facilitating the comprehensive advancement of healthcare reform and the Healthy China Initiative.

The first “Six-Disease Co-Management” Center covering the entire lifecycle was established at the Ecological New City Campus of Sanming First Hospital. There, Ning Guang, an academician of the Chinese Academy of Engineering and President of Shanghai Ruijin Hospital, prescribed the first “AI-Co-Managed” plan for the entire lifecycle to Ms. Deng, who has a long history of elevated blood glucose levels. The plan provides detailed treatment protocols and lifecycle management recommendations across six aspects: prevention, screening, diagnosis, treatment, management, and rehabilitation.

Prior to their remote consultation with Academician Ning Guang, doctors Zhang Yadong and Liu Jie from Sanming First Hospital had already inputted Ms. Deng’s medical records into the specialized AI-driven disease management system to analyze key diagnostic and therapeutic priorities, thereby obtaining preliminary recommendations for diagnosis and treatment as well as alerts for complication screening and other necessary tests. After thoroughly reviewing Ms. Deng’s condition via the intelligent mobile telemedicine management platform, Academician Ning Guang determined that this case represented a rare and complex form of diabetes complicated by peripheral neuropathy.

Qu Jieming, Party Secretary of Ruijin Hospital, stated that the “co-management” model differs fundamentally in philosophy from traditional hospital prescriptions. It not only includes initial disease screening but also provides health recommendations throughout the disease management and rehabilitation processes, representing a comprehensive approach to patient health management.

Academician Ning Guang introduced that the "integrated management of six diseases" across the full life cycle primarily focuses on managing four major chronic diseases and the health of the elderly and the young. The four major chronic diseases, including diabetes-based metabolic disorders, cardiovascular and cerebrovascular diseases, chronic respiratory diseases, and cancers, have become the leading causes affecting the health of the Chinese population. Coupled with the integrated management of reproductive medicine and geriatrics, the "integrated management of six diseases" represents a strategic choice from the perspective of full life-cycle health management.

The "Six-Disease Co-Management" model across the full life cycle establishes personal health profiles for patients, prescribes precise diagnostic and therapeutic regimens alongside health prescriptions, and formulates comprehensive health management plans. By preventing and managing co-existing common risk factors through a "comorbidity" approach, this model enhances the detection, treatment, control, and rehabilitation rates for patients with chronic diseases, thereby improving their quality of life, reducing premature mortality from major chronic diseases, and alleviating the disease burden associated with chronic conditions.

Currently, with the aging of China’s population and shifts in disease patterns, chronic diseases have become a major threat to the health of the elderly population. The Outline of the Healthy China 2030 Plan proposes prioritizing public health as a strategic development focus, shifting from a “disease-treatment-centered” approach to a “health-centered” one, and achieving proactive health management.

Recently, the Central Committee of the Communist Party of China and the State Council officially issued the National Medium- and Long-Term Plan for Actively Responding to Population Aging. When answering reporters’ questions about the Plan, a person in charge of the National Development and Reform Commission pointed out that, with regard to establishing and improving the health service system, it is essential to adhere to a people-centered approach to health, implement a comprehensive strategy for the prevention and control of chronic diseases, give full play to prevention, promote healthy lifestyles, reduce disease incidence, strengthen early diagnosis, early treatment, and early rehabilitation, and significantly improve population health levels.

Against the backdrop of comprehensively advancing the Healthy China initiative, the “Integrated Management of Six Diseases” targets key bottlenecks in building a comprehensive chronic disease prevention and control system and enhancing the service capacity of closely-knit county-level medical consortia. By leveraging key technologies such as digitalization and artificial intelligence, it aims to break through core obstacles and facilitate the downward flow of high-quality resources and critical technologies. “Ruijin Hospital has established a complete methodology for the full-life-cycle ‘Integrated Management of Six Diseases.’ Supported by artificial intelligence technology, this approach can achieve effective health management for the population of Sanming,” stated Academician Ning Guang.

Sanming Launches China’s First “Six-Disease Co-Management” Center Covering the Full Life Cycle, Establishing a Comprehensive Diagnosis and Treatment System and Multidisciplinary Care Model Encompassing “Prevention, Screening, Diagnosis, Treatment, Management, and Rehabilitation” Through the Integration of “Ruijin Technology, Sanming’s Advantages, and WeDoctor Support,” Thereby Achieving Population-Wide, Holistic, and Lifelong Chronic Disease Management.

It is reported that Ruijin Hospital and the WeDoctor platform signed a strategic cooperation agreement last December to jointly establish a Center for Co-Management of Six Diseases Across the Full Life Cycle, a National Intelligent Triage Center for Complex and Refractory Diseases, and a Demonstration Center for the Application of Frontier Medical Technologies. The two parties have conducted research on digital comprehensive prevention and control systems, developed co-management frameworks, and formulated medication guidelines for the “six diseases.” By leveraging artificial intelligence and AI technologies, they aim to achieve seamless transfer of management and technical expertise, extending Ruijin Hospital’s mature co-management system for the six diseases to primary care institutions. Additionally, in March this year, WeDoctor entered into a comprehensive partnership with Tencent, focusing on the “co-management of six diseases” as the cornerstone for developing intelligent specialty-disease products. It is anticipated that Ruijin Hospital, WeDoctor, and Tencent will subsequently roll out standardized intelligent specialty-disease products for the co-management of the six diseases, thereby significantly supporting the implementation and upgrading of tightly integrated county-level medical communities nationwide.

Currently, Ruijin Hospital has established collaborations with 12 general hospitals in Sanming. Behind each of these general hospitals lies a close-knit medical consortium that extends its coverage to county-, township-, and village-level medical institutions. This means that the joint establishment of the “Six-Disease Co-Management” Center for full-life-cycle care by Ruijin Hospital and Sanming is not merely a partnership with a single hospital. Instead, it involves the transfer of technology and management expertise to the lead general hospitals of each close-knit medical consortium, ultimately forming a health management service network that covers the entire Sanming region.

As a pioneer in healthcare reform, Sanming’s reforms have evolved from initially addressing chaos and curbing waste, to implementing coordinated reforms across medical services, health insurance, and pharmaceuticals (“Three-Medical” linkage), and further to establishing general hospital groups and adopting bundled payments for both medical services and health insurance funds. Today, Sanming has entered the 3.0 phase centered on “health-oriented care.” With the gradual establishment and improvement of the “Six-Disease Co-Management” system in Sanming, the city will develop experience in building health-community consortia centered on “health-oriented care,” which will be promoted nationwide.