Ping An Healthcare Technology Accelerates Interoperability of Health Big Data Through National Medical Insurance Platform Innovation

On May 21, the 2020 “Two Sessions” officially convened, reigniting widespread discussion around the term “data.” In a proposal, Sun Jie, a member of the National Committee of the Chinese People’s Political Consultative Conference (CPPCC), stated that a unified health and medical data platform should be established, and that healthcare institutions should be encouraged to pursue data interconnectivity and integration with the insurance industry. Impacted by the COVID-19 pandemic, governments, enterprises, and the general public have all recognized the urgent need for “interconnectivity” of data and information. As we enter the post-pandemic era, how to govern, apply, and open up national health and medical data, thereby fully unleashing the value of big data in healthcare, has become a critical issue that the entire industry is accelerating its reflections on within China’s new round of healthcare reform.

In fact, the “institutionalization, standardization, and normalization of big data in health and medical care” is not a new concept in the healthcare sector; it has drawn close attention from various stakeholders across the industry chain, with pioneering examples already in place. Since the establishment of the National Healthcare Security Administration in 2018, this “super payer” has made it one of its historic missions to build a nationwide, technologically advanced, and centrally managed healthcare security information system.

According to a relevant document released by the National Healthcare Security Administration in June last year, “China’s medical security system has been established and operated for more than 20 years, but a unified standardization system has not yet been formed, making it difficult to meet the requirements of modernizing medical security governance. At present, problems such as institutional fragmentation, structural imbalance, decentralized management, and low efficiency still exist. It is necessary to continuously regulate, innovate, and improve the medical security system, operational mechanisms, service methods, and standards and norms. In this process, informatization and standardization will play an irreplaceable role in providing important support and guidance.”

Therefore, in 2019, the monumental and epoch-making “National Healthcare Security Administration Healthcare Security Information Platform Construction Project” was officially launched.

The nationally unified healthcare security information platform and its diverse applications are akin to a comprehensive, interconnected highway network. Once completed, it will cover nearly 1.4 billion people in China, 3,260 medical insurance handling agencies, 120,000 medical insurance staff at all levels, 990,000 medical institutions, 500,000 pharmacies, 7,600 pharmaceutical manufacturers, 26,000 medical consumables manufacturers, and 30 million insured entities. This forward-looking national-level deployment was clearly implemented well before the new infrastructure big data centers, which only gained significant momentum earlier this year.

In recent years, with the continuous opening and application of government data, the value of data in the healthcare sector has gradually become apparent: it not only meets public needs but also promotes the cultivation of new business models and creates new drivers of economic growth.

Following the National Healthcare Security Administration’s project, provincial-level medical insurance information platforms will be rapidly implemented within two years, creating a market opportunity worth over RMB 10 billion and thus becoming a highly contested battleground. The vendors that won bids for the 14 subsystems under the “National Healthcare Security Administration Medical Insurance Information Platform Construction Project” are precisely such pioneers and profit-seekers; they represent the leading third-party forces in China’s current medical insurance informatization sector. Leveraging their advantage of familiarity with national data standards, these vendors are playing active roles in the subsequent construction of provincial medical insurance information platforms.

Some securities analysts believe that there were originally 13 vendors providing China’s “Golden Insurance” (social security) systems, but the bidding process for projects under the National Healthcare Security Administration reshuffled the landscape. Among traditional Golden Insurance vendors, only four—Neusoft Corporation, Jiuyuan Yinhai, Chuangzhi Heyu, and E-Lianzhong—were shortlisted for the project, while three leading healthcare IT companies, Donghua Software, Winning Health, and Creative Information Technology, seized the opportunity to enter the medical insurance information system market.

Notably, Ping An Health Insurance Technology, a unicorn in the healthcare sector under Ping An Group, has been selected for a project by the National Healthcare Security Administration. It serves as the contractor for Package 7 of the platform (comprising the Macro-Decision Big Data Application Subsystem and the Operation Monitoring Subsystem), and has gained prominence and achieved rapid advancement in multiple provincial platform projects.

It is reported that the two subsystems undertaken by Ping An Medical Insurance Technology serve as the “central brain” of the entire project, functioning as a data aggregation and analytics hub as well as an intelligent output interface. The construction has now entered the preliminary acceptance phase. Among them, the Operation Monitoring Subsystem aggregates data from various subsystems of the National Healthcare Security Administration (NHSA) Information Platform. It provides healthcare security administrators with multi-terminal, comprehensive visualizations of healthcare security operations and fund utilization through charts and graphs, completely eliminating the previous “black box” status of operational data. This enables administrators to gain timely and thorough insights into fund performance, offering quantitative analytical support for rapid decision-making.

The Macro-Decision Big Data Application Subsystem leverages big data and actuarial technologies to enable healthcare security administrators to dynamically monitor the operation of medical security systems across China, assess the impact of internal and external environmental changes on policies, uncover underlying patterns, and provide early risk warnings, thereby offering decision support for the continuous optimization of healthcare security resource allocation and the improvement of the medical security system.

Building on the exploratory initiatives of the National Healthcare Security Administration platform, Ping An Health Insurance Technology continues to pioneer innovation by actively rolling out integrated big data governance solutions featuring a “data middle platform + data applications” model across various regions, thereby comprehensively supporting local governments in advancing the modernization of healthcare security administration.

At the end of last year, Ping An Health Insurance Technology won the bid for the “Shandong Provincial Healthcare Security Administration Intelligent Supervision System Information Platform Construction Project.” According to the project manager, once the Shandong platform is established, Ping An Health Insurance Technology will assist the Shandong Provincial Healthcare Security Administration and healthcare security departments across all cities in the province in fully achieving data information sharing, application synergy, and open collaboration across horizontal and vertical dimensions, internally and externally, and between government and market entities. This will effectively enhance the efficiency of fund supervision and strengthen the risk resistance and sustainable coverage capacity of the healthcare security fund.

Meanwhile, interconnected and standardized data have also made external applications (including insurance applications) feasible—bringing CPPCC member Sun Jie’s proposal for “data interconnection and integration between medical institutions and the insurance industry” closer to reality.

Reviewing Committee Member Sun Jie’s proposal this year, “Relevant government departments, including the National Health Commission, the National Healthcare Security Administration, and the China Banking and Insurance Regulatory Commission, should establish a joint working mechanism to promote the creation of a national-level medical health data platform. This involves formulating unified standards for data interoperability and connectivity, improving data quality, transforming the current fragmented data management landscape, and making data usage more institutionalized, standardized, and normalized.” This clearly aims to leverage the momentum of “New Infrastructure” to facilitate the integration of big data platforms across various single-function ministries in the healthcare sector. The goal is to elevate the governance and application of healthcare big data to the level of top-level design, unlock the value of healthcare data, foster new data application industries, serve the public with “smart” solutions, and enhance people’s sense of experience and gain in the field of medical health.

This “intelligence” is precisely what “smart healthcare insurance” companies, represented by Ping An Health Insurance Technology, are relentlessly pursuing. Some argue that urban informatization in the 2.0 era should not merely stop at making cities “smarter” through intelligent technologies; rather, it should leverage technology as a means to make cities more “inclusive.”

“With regard to smart medical insurance, the goal is to comprehensively enhance the modernization of medical insurance governance while simultaneously improving the quality and convenience of medical insurance services; strengthen the integrity, systematicity, and synergy of the coordinated reforms across medical insurance, healthcare delivery, and pharmaceuticals; and ensure that the public has access to high-quality, efficient, and affordable medical services,” Fang Weihao, Co-Chairman and CEO of Ping An Medical Insurance Technology, frankly told reporters. “Therefore, while professionally serving the nation and acting as a capable assistant in the implementation and execution of national policies, we are committed to fulfilling our historic mission of ‘reducing healthcare costs, enhancing the service experience for insured individuals, and improving their level of coverage.’ This is the ultimate significance we relentlessly pursue in leveraging ‘big data + medical insurance.’”