Yuhuan Healthcare Reform (III): Multi-party Collaboration Among Banks, Enterprises, and Insurers to Build an 'Internet+' Health Ecosystem
By Luo Mei, Nie Guanghong
Under the premise of adhering to “government leadership,” Yuhuan’s healthcare reform has engaged banks, enterprises, and insurance institutions. It aims to improve the supply channels for medical services by adopting an integrated online-offline operational model, raising participants’ awareness of prioritizing and investing in health, thereby changing public healthcare-seeking behavior, controlling medical costs, and enhancing the overall health status of Yuhuan’s population.
Dong Yin, a member of the Party Committee of the Yuhuan Municipal Health and Family Planning Bureau, spearheaded the design of an “Internet+” specialty project that integrates health management services into financial products and commercial insurance. The initiative involves multiple stakeholders, including Yuhuan Rural Commercial Bank, PICC Health Insurance Company Zhejiang Branch, WeDoctor Group, and KingMed Diagnostics.
Yuhuan City pioneered the implementation of a chronic disease management plan under its “Health + Finance” initiative across China. By leveraging “Internet Plus,” it integrated health management services into financial products and commercial insurance, thereby establishing the “Health + Finance” project. The Yuhuan Municipal Health and Family Planning Bureau provided overall guidance to the Yuhuan Rural Commercial Bank, with the Zhejiang Branch of PICC Health Insurance Company participating in the initiative.
It is reported that the Yuhuan Municipal Health and Family Planning Commission issued letters to banks in Yuhuan to seek partner banks for the “Health + Finance” project. Only Yuhuan Rural Commercial Bank submitted an application, which was found to meet the requirements upon review. Therefore, the Yuhuan Municipal Health and Family Planning Commission provided the design framework for the “Health + Finance” project, while Yuhuan Rural Commercial Bank is responsible for its implementation.
As a local bank in Yuhuan City, Yuhuan Rural Commercial Bank is committed to inclusive finance, striving to ensure that every resident of Yuhuan enjoys convenient and beneficial financial services. The "Health + Finance" initiative is a livelihood-focused project through which Yuhuan Rural Commercial Bank aims to leverage its banking resources to provide Yuhuan citizens with more extensive, broader, and comprehensive services.
Reforming the payment mechanism is a key focus of healthcare reform. In Yuhuan, the top priority for medical insurance payment reform lies in chronic disease management. It is understood that most patients with chronic diseases bear a heavy out-of-pocket financial burden, and there is a lack of health insurance products specifically tailored to chronic conditions on the market. Among Yuhuan City’s annual medical insurance expenditures, hypertension and diabetes account for the largest proportion. These chronic diseases consume substantial social resources. Therefore, the “Health + Finance” chronic disease management initiative targets these two conditions as entry points, driving reforms in chronic disease management through changes in medical insurance payment methods.
Yuhuan Rural Commercial Bank, in collaboration with PICC Health Insurance Zhejiang Branch, has jointly developed projects such as commercial financial health insurance and “Internet + Health” management software. By launching the “Wealth & Health Together” deposit product, the bank has transformed the traditional model of rewarding deposit customers with interest-based profits, instead providing them with health services focused on the prevention and improvement of common current health risks.
“Wealth & Health Companion” Deposit Product is primarily designed for patients with chronic conditions such as hypertension or diabetes. The product has a term of one year and is issued monthly, with the subscription period running from the 1st to the 15th of each month. Subscriptions are made in units of RMB 50,000 per share, with each share entitling the holder to one year of comprehensive health management services. These services include: health management services, critical illness insurance, inpatient medical health insurance, health testing and screening services, and humanized services provided by social work organizations.
Starting in September 2018, chronic disease patients aged 18 to 65 with hypertension or type 2 diabetes can purchase a one-year exclusive product under the “Health + Finance” Chronic Disease Management Plan and enjoy a 0.31% yield by depositing RMB 50,000 at any branch of Yuhuan Rural Commercial Bank between the 1st and 15th of each month and signing an informed consent form. The bank will then verify the information with the insurance company. Upon successful underwriting by PICC (People’s Insurance Company of China), the bank will use the deposit returns to provide citizens with commercial health insurance, family doctor services, social worker assistance, health testing and screening, wearable devices, and other benefits. If underwriting is unsuccessful, the product cannot be purchased.
It is reported that the product is operating at a loss. Yuhuan Rural Commercial Bank has been striving to foster “government-bank cooperation.” In earlier stages, it partnered with the Social Security Administration to launch the “Social Security-Bank Connectivity” project, collaborated with the Housing Provident Fund Center to introduce the “Branch Extension” initiative, worked with the Market Supervision Administration to enable self-service business license processing at bank branches, and joined forces with the Administrative Approval Service Center to roll out the “Government E-Station” project, thereby extending the services of various government agencies and public institutions to its bank branches. The current collaboration with the Health and Family Planning Commission, WeDoctor, and PICC has further expanded Yuhuan Rural Commercial Bank’s “government-bank cooperation” portfolio. The launch of this product provides customers with diversified financial services, enhances the bank’s competitiveness in the local financial market, and broadens its customer acquisition channels.
Health insurance serves as a connector between patients with chronic diseases and community physicians. The Zhejiang Branch of PICC Health Insurance primarily fulfills two major functions in its “Health + Finance” initiative:
1. Provide insurance coverage by designing critical illness insurance for complications of chronic diseases and inpatient medical insurance covering out-of-pocket expenses for individuals with hypertension and type 2 diabetes, two major chronic conditions, thereby delivering high-quality insurance services;
II. Adopt a dual incentive mechanism: motivate insured individuals to proactively engage in health management through a health points program, and enhance family doctors’ enthusiasm for providing health management services through a health management incentive plan.
It is reported that the innovative incentive mechanism of this project allows the general public to increase their insurance coverage limits through interactive participation. In addition to basic insurance protection, insured individuals are eligible for variable sum-assured incentives tied to health management services. The medical insurance catalog is divided into items outside the catalog and items within the catalog. Coverage for items within the medical insurance catalog primarily consists of two components: out-of-pocket payments by individuals and reimbursements from social security.
Out-of-pocket expenses for items excluded from the national medical insurance catalog are jointly covered by a “base sum insured + variable sum insured.” Within the scope of out-of-pocket costs, Yuhuan residents can link their health data via the “Health Community” mini-program, earn points by participating in health-related activities—such as physical exercise, completing health questionnaires, and adhering to medical advice—and use these points to offset the “base sum insured + variable sum insured.” The higher the points accumulated, the greater the compensation amount.
The planned health insurance covers out-of-pocket medical expenses not reimbursed by basic medical insurance, and the coverage limit will gradually increase as the insured actively follows medical advice and participates in health activities, with a maximum payout of RMB 100,000.
“Health + Finance” Project Offers Insured Members Two Claims Settlement Options: Online and Offline.
1. Upon hospitalization at Yuhuan People's Hospital, Yuhuan Second People's Hospital, or Yuhuan Traditional Chinese Medicine Hospital, insured individuals may settle their medical expenses simultaneously with social medical insurance by presenting their medical insurance cards, thereby eliminating the need for upfront payment.
2. Applications for offline claims settlement may be submitted for complex cases: For situations such as medical treatment received in a different region, applicants may visit the designated medical insurance service window to submit materials including invoices and inpatient medical records for claims processing.
In addition to the complimentary “Yi Lu You Ni” card, the project’s value-added services include one annual medical escort service for insured individuals within Hangzhou’s urban area. By calling the contact number provided on the card, a health manager will proactively arrange appointment registration and provide medical escort services for the insured individual.
Introducing an insurance mechanism can leverage the economic compensation and leverage effects of insurance to reduce the medical burden on patients with chronic diseases. Meanwhile, through a dual-incentive mechanism, it can enhance the motivation of both insured individuals and community physicians, thereby helping to create a closed-loop service model of “health insurance + health management.”
For individuals with chronic diseases, participating in the “Health + Finance” program offers dual benefits. On one hand, it enables them to better access health management services provided by contracted physicians and engage more effectively in personal health management through health community platforms. On the other hand, given the high likelihood of chronic conditions progressing into severe complications associated with major diseases—thereby incurring substantial medical expenses—participation in insurance programs can effectively mitigate long-term financial risks.
It is reported that patients with chronic diseases such as hypertension and diabetes who have not been hospitalized within the past year are eligible to participate in the “Health + Finance” program.
One of the innovations of the Yuhuan Project is leveraging returns on customer deposits to provide commercial health insurance, particularly offering coverage for out-of-pocket expenses for individuals with chronic diseases, thereby helping to reduce the disease burden on the public.
In Yuhuan’s “Health + Finance” initiative, internet healthcare enterprises primarily provide informational support.
In accordance with the relevant budget, the Yuhuan Municipal Health and Family Planning Bureau selected a cooperative enterprise through public investment promotion to complete the development of the information platform for Yuhuan City’s “Health + Finance” project (i.e., the Yuhuan City Health Community Commercial Insurance Informationization Project). Yuhuan City conducted investment promotion via its official portal website and ultimately selected WeDoctor Group (Guahao.com) as the partner, while other participating enterprises were determined by the bank.
To support the implementation of Yuhuan City’s medical reforms and the “Healthy Yuhuan” strategy, WeDoctor Group leverages its strengths as a healthcare technology platform to build an informatized community health platform, innovate chronic disease management models, and promote the development of “Internet + Healthcare.”
After integrating the healthcare and insurance needs of Yuhuan, WeDoctor leveraged internet and medical health resources to provide an information platform with big data analytics capabilities. It established the Yuhuan Regional Chronic Disease Management Health Information Platform, which aggregates health information from various sources and integrates insurance services, thereby facilitating residents’ self-management of their health and access to insurance services.
The “Health + Finance” project leverages WeDoctor Cloud’s capabilities in healthcare big data to integrate data from individuals, hospitals, basic medical insurance, and commercial insurance providers. It features a big data analytics and management backend, supported by the WeDoctor Commercial Insurance Platform, which facilitates claims adjudication for commercial insurance users during hospital visits.
In the construction of the information platform, the main innovations are as follows:
1. “One-stop” solution for health management and health insurance service needs.To enable users to more directly access their daily health data and manage their own health, WeDoctor has developed the “Health Community Mini Program” for use on WeChat, based on its information-based Health Community platform. Residents of Yuhuan can now enjoy high-quality medical and health services within their communities, truly realizing remote consultations and ensuring that major illnesses can be treated without leaving the county.
2. Developed a mini-program application, enabling residents to easily manage their own health.Users can upload health data via the mini-program to establish personal health records, access professional health management guidance from physicians, and receive health education services. Additionally, they can purchase insurance online, undergo social security data risk assessment and verification, exchange health points for insurance coverage, file claims at designated hospitals, and review policy details, truly enabling a “visit-at-most-once” experience.
3. Intelligent insurance services, including eligibility verification, policy inquiries, and claims processing.
In addition to providing platform and operational support, WeDoctor also provides the Xuanhutai Traditional Chinese Medicine (TCM) Intelligent Diagnosis and Treatment System to family doctor teams in Yuhuan City, aiming to enhance the TCM proficiency of primary care physicians and meet the local residents’ demand for traditional Chinese medicine services.
The Xuanhu Tai TCM Intelligent Diagnosis and Treatment System is a cloud-based platform for traditional Chinese medicine (TCM) health information, developed by WeDoctor using its “TCM Syndrome Differentiation and Treatment System” in combination with internet and artificial intelligence technologies. It provides services including electronic TCM medical records, assisted prescription generation, management of cardiovascular and cerebrovascular diseases, a TCM knowledge base, preventive TCM care (“treating potential disease”), and integrated HIS system connectivity. The system aims to popularize and enhance the TCM service capacity and diagnostic and treatment standards of healthcare institutions at all levels. To date, the Xuanhu Tai TCM Intelligent Diagnosis and Treatment System has been adopted by more than 320 TCM clinics across China, with over 2.2 million assisted prescriptions issued and serving more than 970,000 individuals in grassroots communities.
The health community informatization platform, developed by WeDoctor, integrates products and services from providers of smart wearable devices, commercial insurance, and genetic testing. It offers comprehensive, full-cycle health management and protection to residents within the jurisdiction. By enabling seamless data interoperability among municipal hospitals, primary care facilities, health kiosks, and personal monitoring devices, the platform provides thorough assessments and evidence-based management guidelines, facilitating self-health management for the public and ensuring efficient, unified information dissemination.
In addition to WeDoctor, another key player is KingMed Diagnostics. As the sole third-party medical testing institution to join Yuhuan’s “Health + Finance” initiative, KingMed is jointly contributing to the development of a healthier Yuhuan.
As a key partner in Yuhuan City’s “Health + Finance” initiative, KingMed Diagnostics offers the following advantages:
1. As a leading third-party medical laboratory enterprise in China, KingMed Diagnostics processes over 50 million specimens annually and offers approximately 2,500 testing items for clinical and research purposes, making it one of the healthcare institutions in China with the most comprehensive test menus;
2. KingMed has independently established a portfolio of high-quality, advanced testing technology platforms, enabling it to provide robust testing and inspection services for projects and ensuring the efficiency and accuracy of every test.
3. KingMed operates 37 medical laboratories across mainland China and the Hong Kong Special Administrative Region. By establishing a four-tier network comprising headquarters-level laboratories, provincial regional center laboratories, provincial laboratories, and prefecture- and city-level laboratories, KingMed has extended its on-site service network to the township and community levels. This network covers regions where over 90% of China’s population resides, effectively meeting the project requirements for “Health + Finance” and delivering high-quality medical testing services to grassroots institutions.
As a participant in the testing phase of this project, KingMed Diagnostics provides hypertension and diabetes screening for the participating public. Meanwhile, it shares the technical and expert resources of KingMed Diagnostics Group with medical institutions at all levels and grassroots health centers in Yuhuan City, offering specialist consultations to residents in the region and helping grassroots medical institutions enhance their laboratory testing capabilities.
It is reported that KingMed Diagnostics will specifically undertake the following tasks in this project:
1. Support the enhancement of chronic disease testing capabilities at county-level hospitals and community health centers in Yuhuan City, with testing items including electrolytes, renal function, glycated hemoglobin, insulin, and genetic testing;
2. Share expert and technical resources to provide on-site expert guidance and technical training for medical staff at regional healthcare institutions. KingMed Diagnostics has also co-established a “Pathology Diagnosis Center” with the Traditional Chinese Medicine (TCM) Hospital, where KingMed’s team of pathology experts provides services. For cases that are difficult to diagnose, samples collected by the TCM Hospital’s pathology department can be sent directly to Hangzhou for testing, allowing patients to simply await their test reports.
This approach not only improves the accuracy of test reports but also provides convenience to residents. To offer Yuhuan citizens accessible, self-service health screening services, Yuhuan City has established standardized “Resident Health Huts” at various primary healthcare institutions, while simultaneously conducting health education and providing personalized health guidance. The coverage rate of community-based self-service health screening points across the city reached 36.4%, and the coverage rate of Health Huts in primary healthcare institutions reached 100%.
In recent years, KingMed Diagnostics has aligned with the direction of healthcare reform, actively exploring the development of the regional laboratory testing market and striving to enhance overall regional medical service capabilities. Among these initiatives, the “Health + Finance” project in Yuhuan City represents one form of KingMed’s exploration in the county- and district-level laboratory testing market.
Yuhuan aims to leverage this healthcare reform to dismantle the remaining fragmented medical service system, overcome the barriers of managed care, and establish an integrated healthcare delivery system.
Yuhuan has improved the delivery of medical services through the “Internet+” model. By leveraging internet-based information technologies, it has extended health management, diagnostic and treatment services, and insurance services to mobile platforms, thereby enriching service offerings, enhancing convenience and satisfaction, and encouraging the public to adopt healthier health management practices.
By leveraging internet and Internet of Things (IoT) technologies, comprehensive health information of residents is aggregated. Through mobile health management platforms, full-process health management is implemented for residents, enabling them to enjoy high-quality health service experiences and enhancing their awareness and skills in self-health management.
Through channels such as family doctors, health commissioners, and news media, residents can learn about the Yuhuan Health + Financial Chronic Disease Management Plan. They may visit any branch of Yuhuan Rural Commercial Bank to complete enrollment procedures, thereby gaining access to health management services and chronic disease insurance coverage, ultimately improving their overall health status and level of medical protection.
By guiding eligible residents with chronic diseases in their jurisdiction to participate in the Yuhuan Health + Financial Chronic Disease Management Program, primary care physicians can earn health management service fees for providing health management services to these residents, and they may also receive bonuses based on annual performance evaluations of health management.
Overall, the significance of Yuhuan’s healthcare reform “Internet+” featured projects lies in not only providing additional security for Yuhuan residents and enhancing their sense of gain from medical services, but more importantly, improving overall health levels through this approach.
For commercial insurers and banking institutions, this not only enables them to acquire a large number of new customers and reduce underwriting and claims settlement costs, but also helps them broaden product distribution channels and develop targeted insurance products.
For healthcare service providers such as WeDoctor and KingMed Diagnostics, participating in the reform of medical supply is itself an affirmation and encouragement of their services and products, and can also help them enhance their brand and expand their business scope.