Shandong Accelerates Construction of Internet-Based Healthcare and Insurance Services; Jinan Zhangqiu District Achieves Full Coverage of Intelligent Medical Insurance Monitoring

The benefits of Shandong’s Medical Insurance and Big Health Initiative continue to materialize. Recently, the online service zone for outpatient chronic diseases in Zhangqiu District, Jinan, was officially launched on the Shandong Internet Medical Insurance and Big Health Service Platform (hereinafter referred to as the “Shandong Medical Insurance and Big Health Platform”). Residents of Zhangqiu can now enjoy one-stop services—including follow-up consultations and prescription renewals for outpatient chronic diseases, online medical insurance payments, and home delivery of medications via courier—without leaving their homes.

Meanwhile, Zhangqiu is one of the first districts in the province to achieve full coverage of intelligent health insurance monitoring. All designated medical institutions within the district have implemented intelligent regulatory systems, enabling end-to-end oversight through pre-event alerts, in-process controls, and post-event audits. By leveraging information technology, these measures standardize clinical practices and facilitate a shift from pure regulation to an integrated approach combining supervision, management, and services. Consequently, the focus of regulation has transitioned from controlling medical costs alone to the dual control of both medical costs and healthcare quality.

Effective May 1 this year, the Regulations on the Supervision and Administration of the Use of Medical Security Funds will come into force. The National Healthcare Security Administration is promoting a shift in medical insurance supervision from post-event correction to pre-event alerts and in-process monitoring, thereby further enhancing the regulatory capacity over medical security funds. The Jinan Medical Insurance Pre- and In-Process Supervision Platform, developed as part of the Shandong Medical Insurance Health Big Data Platform, is being fully rolled out for adoption by healthcare institutions across the city.

To address the rapid growth in the number of patients with chronic diseases, the increasing expenditure of medical insurance funds, overcrowding at large medical institutions, and the time-consuming and labor-intensive process for patients to seek medical care and purchase medications, the Shandong Medical Insurance Health Platform, with comprehensive support from WeDoctor, China’s largest digital healthcare service platform, has taken chronic disease management as its entry point and leveraged information technology as a means to actively explore an integrated mechanism linking “Internet + Medical Insurance + Healthcare + Pharmaceuticals.” By implementing full-cycle services, end-to-end process reengineering, all-around integration, and whole-process supervision, the platform has initially established a comprehensive chronic disease management service system in cities such as Tai’an, Jinan, Weifang, and Dezhou.

Previously, Tai’an, Shandong Province, took the lead in exploring pilot initiatives. In September 2019, the Tai’an Municipal People’s Government signed a strategic cooperation agreement with WeDoctor to advance the digital coordination of medical care, pharmaceuticals, and health insurance through the development of a Digital Health Community, using the Taishan Internet Hospital for Chronic Diseases as its platform. Focusing on resolving challenges in chronic disease management, Tai’an implemented significant reforms through targeted interventions, pioneering the “Tai’an Model” for chronic disease management under the “Internet + Health Insurance + Medical Care + Pharmaceuticals” framework.

Digital management of chronic diseases has reduced the time required for follow-up visits and medication pickup from two to three hours to under 30 minutes. More than 30 types of outpatient chronic conditions, including hypertension and coronary heart disease, have been included in the scope of online follow-up visit reimbursement. On June 18, 2020, the Shandong Provincial Healthcare Security Administration held an on-site conference in Tai’an City to promote innovative services for chronic disease management through the integration of “Internet + Healthcare Security + Medical Services + Pharmaceuticals,” rolling out Tai’an’s best practices across the province.

Innovative models are beginning to take root and flourish in Shandong Province. In April last year, Weifang launched the construction of an Internet-based medical insurance and big health service platform, and by the end of October that same year, it initiated pilot programs for innovative outpatient chronic disease management services at six hospitals. This made Weifang one of the first cities in Shandong Province to respond to the promotion of the “Internet + Medical Insurance + Healthcare + Pharmaceuticals” innovative chronic disease management model.

In September last year, Texas launched the construction of the Texas Medical Insurance Big Health Platform, which will include a chronic disease management service platform, an online diagnosis and treatment service platform, and a medical insurance plus commercial insurance platform. It will be the first in China to implement entrusted management for insured individuals with chronic diseases and “two diseases” (hypertension and diabetes).

In March this year, the Digital Health Community project in Jinan High-Tech Zone was launched. The project is jointly built by Jinan High-Tech Zone, WeDoctor Group, and Shandong Internet Medical Insurance and Big Health Group. It aims to accelerate the construction of "Healthy Gaoxin" by creating a national model for the Digital Health Community. The chronic disease management model of "Internet + Medical Insurance + Healthcare + Pharmaceuticals" will also be accelerated.

As of early April this year, the Chronic Disease Management Service Center has achieved full coverage of all secondary and higher-level medical institutions in Tai’an City, with implementation underway in Jinan, Weifang, Dezhou, Linyi, and other cities. The pre-event and in-process monitoring system has been integrated into 9 hospitals in Tai’an and 76 hospitals in Jinan, with plans to fully onboard over 200 institutions in Tai’an and more than 1,000 in Jinan in the future. Additionally, an Intelligent Healthcare Security Monitoring Data Analysis Center for Shandong Province has been established.

As the Shandong Medical Insurance Big Health Platform is further implemented and developed across various cities, the demand for digital healthcare and health services will become increasingly large-scale and diversified. In the future, deeper integration of more platform services will deliver higher-quality, multi-tiered health services to the public.