How Ping An HealthKonnect Secures Leadership in the Industry with Acclaimed Technology and Services
2020 is destined to leave an indelible mark on the history of China’s healthcare sector.
On the one hand, affected by the global COVID-19 pandemic,The healthcare industry has been thrust into the spotlight, drawing sustained and in-depth attention from society and capital.; on the other hand, driven by the new infrastructure initiative, investments in foundational technologies such as 5G and AI have increased,The Informatization and Intelligent Upgrading of the Healthcare System Is Entering an Acceleration Phase. Among these, medical insurance cost containment, one of the “centerpieces” of healthcare security reform, has also made significant progress this year. Behind this achievement lie the continuous exploration and efforts of industry pioneers such as Ping An Health Insurance Technology.
As a key component of Ping An’s “Grand Healthcare” strategy,Leveraging its core strengths in technology, data, insurance, finance, and the healthcare ecosystem, Ping An Health Insurance Technology has long focused on the payment side—the most scrutinized aspect of health insurance reform. It is committed to building an integrated smart health insurance platform featuring “systems + services + operations” to comprehensively empower the National Healthcare Security Administration.According to public information, by the end of 2020, Ping An Health Insurance Technology had cumulatively won bids for 13 provincial and municipal medical insurance platform construction projects, maintaining a leading market position in the informatization of China’s provincial-level medical insurance platforms.
Throughout 2020, Ping An HealthCare Technology continued to build momentum and exert its strength.1. Technological Expertise Repeatedly Recognized, such as winning the championship in the “Macro Decision Support for Medical Insurance” category of the Beijing Digital Intelligence Medical Insurance Innovation Competition, receiving the “Best AI-Powered Risk Control for Medical Insurance Award” on Leiphone’s “2020 Best AI New Infrastructure Annual List,” and securing the third prize in the finals of the 2020 “Healthcare AI Beautiful 50.”Second, achieving repeated success in business operations, such as the successful final acceptance of the "Procurement Project for Business Application Software in the Construction of the Medical Security Information Platform of the National Healthcare Security Administration," and the imminent official launch of the Intelligent Supervision System Platform of Shandong Province's Medical Security Bureau.
As is well known, the healthcare industry differs from other sectors; it has long been regarded as a “slow business” from a commercial perspective. This implies that entering the healthcare field requires several times more time and effort than in other industries.Specifically, in terms of refined management of medical insurance, it is necessary to systematically organize massive, heterogeneous, and non-standardized medical information from the ground up., can useful experiences and algorithms be distilled, thereby empowering health insurance pricing and services. Therefore, in terms of the initial return on investment,Without a sufficiently pure original intention and focused determination, participants will find it difficult to achieve steady and long-term success in this field.
From empowering the payment side with smart medical insurance and smart commercial insurance, to empowering the industry side with medical leasing, and further to empowering the service side with smart healthcare and health (testing) centers, Ping An HealthTech has undoubtedly carved out a healthy development path. In early 2021, looking back at Ping An HealthTech’s performance in 2020, a review of its major events may offer insights into how this company has grown through practical experience, what its core intrinsic values are, and what lessons its growth holds for other enterprises.
In 2018, the National Healthcare Security Administration was officially established, integrating the three major social medical insurance schemes for urban employees, urban residents, and the New Rural Cooperative Medical Scheme. It centralized the previously fragmented functions of healthcare security funding, pricing, procurement, and management across various departments, assuming new historical missions such as enhancing coverage and achieving refined management.
Meanwhile, policy documents at various levels related to medical insurance have been frequently issued, making intelligent information-based supervision a key focus of current medical insurance work. In this process,Health insurance risk control systems with deep AI and big data integration are becoming increasingly important. This is because, compared with offline manual audits, big data and AI can achieve refined supervision of medical insurance funds, as well as informatization and standardization of the medical insurance system, thereby contributing to cracking down on fraud and deception in medical insurance claims and improving cost efficiency in medical insurance operations.
As healthcare insurance supervision enters the era of intelligence, Ping An Health Insurance Technology continues to deepen its innovation in technology.In July 2020, Ping An Health Technology’s case study, “Big Data AI Risk Control System,” won the Third Prize in the finals of the 2020 “MedTech AI • Pretty 50” competition.
This award-winning big data AI risk control system primarily targets and resolves the seven major pain points in medical insurance risk management.At the algorithm design level, a variety of anomaly detection algorithms featuring Ping An Medical Insurance Technology’s proprietary capabilities are employed, leveraging advanced AI integration solutions to effectively identify potential insurance fraud perpetrators. In the data governance process, automated code mapping and automated table alignment technologies are adopted to reduce manual coding costs. At the knowledge base level, a unique 360-degree profiling system has been constructed, along with scenario libraries, standard metric libraries, statistical rule libraries, policy rule libraries, experiential rule libraries, and specialized governance libraries, thereby supporting multi-dimensional anomaly detection. Architecturally, an innovative model-sharing architecture is applied to achieve a balance between rapid small-batch and large-batch data analysis, fulfilling multiple objectives including stability, speed, and resource efficiency.
Currently, Ping An Medical Insurance Technology's "Big Data AI Risk Control System" has been implemented and applied across multiple provinces and cities in China., providing provincial/municipal healthcare security bureaus with comprehensive solutions for the collection, storage, processing, analysis, and service of big data in healthcare insurance risk control, thereby enabling data-driven operations and decision-making.
It has not only been recognized for its technological innovation, but also highly acclaimed in practical applications.In August, the mid-term on-site promotion meeting for the construction of national demonstration sites for intelligent healthcare security monitoring was held in Weihai. During the meeting, Weihai’s “Intelligent Healthcare Security Supervision System” received unanimous acclaim from the expert panel and achieved outstanding results in the mid-term evaluation.
This system was jointly developed by the Weihai Municipal Healthcare Security Administration and Ping An Medical Insurance Technology. On the basis of ensuring the safe operation of Weihai’s medical insurance fund, it strengthens pre- and intra-process oversight of medical practices, enables dynamic monitoring and early warning, stores data on erroneous prescriptions and non-compliant charging behaviors, and helps curb unreasonable growth in medical expenses. It further standardizes diagnostic and treatment practices at designated medical institutions, encouraging healthcare professionals to deliver high-quality medical services to insured individuals.
In the same month, the DRG Integrated Management Platform for Ningxia Hui Autonomous Region People's Hospital, delivered by Ping An Medical Insurance Technology, was also affirmed by Zhang Bin, Deputy Director of the Ningxia Hui Autonomous Region Healthcare Security Administration.
(Ping An Health Insurance Technology Hospital DRG Integrated Management Platform Interface)
As of the end of 2020, Ping An Healthcare and Technology had cumulatively won bids for the construction of medical insurance platform projects in 13 provinces and municipalities, including Shandong, Qinghai, Hainan, Guangdong, and Xinjiang, securing a leading market position in the informatization of provincial-level medical insurance platforms across China.
Ping An Health Insurance Technology’s continuous investment in and commitment to innovation have enabled it to achieve ongoing breakthroughs in technology and applications, earning a strong reputation.As of the end of November 2020, Ping An Health Insurance Technology had cumulatively filed more than 720 patents across various fields. By leveraging foundational technological innovations—including AI and blockchain—as well as data processing technologies such as the DaaS-based healthcare insurance data middle platform, the intelligent medical coding platform, and the intelligent AI algorithm platform, Ping An Health Insurance Technology has achieved technological application innovations and data intelligence applications spanning smart health insurance, intelligent disease prediction, intelligent imaging screening, intelligent clinical decision support, intelligent healthcare cost control, and intelligent patient follow-up.
With advanced technology and high-quality applications and products, Ping An Medical Insurance Technology is also empowering the healthcare ecosystem in all aspects, leveraging its rich business scenarios.
Of course,To ensure the effective delivery of high-quality services, it is essential to conduct an in-depth analysis of pain points in medical scenarios. At the level of smart medical insurance, hospitals’ refined management has consistently drawn attention from policymakers, healthcare institutions, and society in recent years.As recently as last October, the National Healthcare Security Administration issued the "Notice on Printing and Distributing the Work Plan for Pilot Programs on Global Budgeting with Regional Point-Based Methods and Diagnosis-Intervention Packet (DIP) Payment," requiring that "within 1–2 years, pooled regional healthcare insurance global budgets be integrated with the point-based method to achieve a diversified composite payment system for inpatient care dominated by DIP." This is because,The new medical insurance payment methods will drive hospitals to shift from passive fee deductions to proactive management, thereby better safeguarding the “life-saving funds” of medical insurance and supporting the sustainable development of the medical insurance sector.
In response to this,Ping An Medical Insurance Technology leverages medical insurance control as its entry point, extending its scope to hospital, physician, and pharmaceutical management while empowering services.Taking Ping An Health Insurance Technology’s self-developed DRG-based Hospital Integrated Management Platform as an example, the platform leverages AI technologies such as an intelligent coding engine, natural language processing (NLP), and medical knowledge graphs to establish a closed-loop management system for medical record quality control, a standardized and comparable performance evaluation system, and a traceable and alert-enabled cost monitoring system.
In 2020, the Changzhou Medical Insurance Bureau launched a pilot program for its Diagnosis-Related Groups (DRG) project. After eight months of simulated settlements, the overall case-mix grouping rate in Changzhou rose from approximately 60% at the initial stage of simulated payments to the current 93.8%, with a significant improvement in medical record quality. Meanwhile, the average length of stay decreased, the growth rate of cost efficiency slowed down, the complexity of treated cases increased, and both the efficiency and capacity of medical services were enhanced, leading to a more rational allocation of medical insurance funds. In terms of service innovation supported by technology,Ping An Health Insurance Technology will inevitably accelerate the transition of hospitals from being “healthcare-centered” to being “patient-centered.”
Meanwhile, the Changshu Municipal Health Commission joined hands with Ping An Medical Insurance Technology to jointly advance the “Changshu Smart Healthcare Project,” building upon the foundation of the Resident Health Services Portal project.Focusing on the collection and open sharing of medical and health resources, we have leveraged technologies such as big data and cloud computing to upgrade and build a citizen health service platform with Changshu-specific features—“Changshu Smart Health.”. After more than a year of optimization and updates, the platform has continuously improved its hosting capabilities and has gradually become a new bridge for communication between Changshu Hospital and the public.At the year-end research symposium on medical insurance system reform in Changshu City, the Ping An Medical Insurance Technology Changshu Medical Project received high praise from the research team.
It is not difficult to see that,Ping An HealthCare Technology remains committed to its original mission, continuously striving for innovation in technology and services. This dedication has delivered tangible value to users, earning industry acclaim and customer trust.However, we recognize that the healthcare value chain is extensive, and each link requires solid efforts to ensure seamless integration. As a pioneer, what surprises will Ping An Health Technology bring to the medical and health industry? It is worth anticipating.