Yuhuan Healthcare Reform (I): Activating Chronic Disease Management through Payment Reform by Collaborating with Banks and Insurance Institutions

“Morning mist encircles the island, forming a ring-like shape; flowing waters above are as white and pure as jade.” This is how Yuhuan is described in Taiping Huanyu Ji, the comprehensive geographical gazetteer of the Northern Song Dynasty.

Yuhuan is one of the 14 island counties (county-level cities) in China. In April 2017, it was approved by the State Council to upgrade from a county to a county-level city. Since Yuhuan City was designated as Taizhou’s only “Pilot City for Comprehensive Medical and Healthcare System Reform in Zhejiang Province,” the Municipal Committee of the Communist Party of China and the Municipal People’s Government of Yuhuan have promptly made comprehensive arrangements for the reform, issued relevant policies, continuously increased investment in healthcare, clarified the government’s role and responsibilities in the provision of medical and pharmaceutical services, strengthened governmental safeguards, and truly ensured government leadership to vigorously advance all reform initiatives.

In 2018, Yuhuan achieved remarkable accomplishments in the healthcare sector, successively earning honors such as the National Demonstration Zone for Comprehensive Prevention and Control of Chronic Diseases, the National Pilot County for Health Promotion, the National Model Demonstration Zone for Digital Health, the National Key Demonstration Zone for Comprehensive Prevention and Control of Infectious Diseases, the Best Chinese City for Hypertension Prevention and Control, and the Zhejiang Province Strong County in Healthcare. These achievements laid a solid foundation for Yuhuan City’s subsequent development of its chronic disease management program.

According to Wang Bisheng, Director of the Yuhuan Municipal Health and Family Planning Bureau, Yuhuan has consistently adhered to the policy of “prioritizing primary care, driving development through reform and innovation, emphasizing prevention, placing equal importance on traditional Chinese medicine and Western medicine, integrating health into all policies, and fostering joint participation and shared benefits among the public.” By coordinating medical and health service resources and establishing a City-wide Health Community (hereinafter referred to as the “Health Community”), Yuhuan has achieved comprehensive unified management of personnel, finances, and materials within the Health Community. This approach builds a complete ecological chain for disease prevention and control from the grassroots level upward, facilitating a shift in the healthcare sector from being “treatment-centered” to “people’s health-centered.” It has formed a trinity health service model integrating “prevention, treatment, and rehabilitation,” thereby safeguarding residents’ health in an all-around and full-cycle manner.

At the national level, China has been intensifying its healthcare reforms in recent years. The Government Work Report delivered at the 13th National People’s Congress in early March this year addressed major issues concerning national welfare and people’s livelihoods, outlining key tasks and objectives for China’s healthcare sector in 2018. It proposed implementing the “Healthy China” strategy within medical insurance and deepening reforms of the pension insurance system. The report also called for continuing to advance the tiered diagnosis and treatment system, strengthening the workforce of general practitioners, and setting clear requirements for drug regulation, privately run healthcare institutions, public health, breakthroughs in tackling critical diseases, and medical artificial intelligence. Furthermore, it emphasized an innovation-driven healthcare development strategy, enhancing the technological innovation system with enterprises as the main actors, and promoting mass entrepreneurship and innovation to reach higher levels.

In April this year, the General Office of the National Health Commission issued the “Notice on Doing a Good Job in Family Doctor Contracted Services in 2018,” which explicitly states in Article 4: Encourage social forces to participate in contracted services. The supply of contracted services should be expanded through joint efforts by the state, collectives, and individuals. Socially operated medical institutions are encouraged to play an active role in contracted services to meet residents’ multi-level and diversified health service needs. Support shall be given to the development of commercial health insurance that is aligned with basic medical insurance, so as to provide coverage for health management needs.

From the perspective of Zhejiang Province, following the phased achievements in the construction of the “Healthy Zhejiang” strategy, the Provincial Party Committee and Provincial Government reiterated the importance of building “Healthy Zhejiang” this April. They proposed the comprehensive implementation of the “Big Health” strategy, strengthening the coordinated reform of medical care, health insurance, and pharmaceuticals (the “Three Medicals”) and the integrated development of prevention, treatment, rehabilitation, health promotion, elderly care, and palliative care (the “Six Medicals”). The aim is to advance the high-quality and high-standard development of Healthy Zhejiang, achieving “high-quality health services, competitive health industries, and modernized health undertakings,” thereby establishing Zhejiang as a provincial demonstration zone for the Healthy China initiative. Subordinate cities and districts must adjust their healthcare reform policies in alignment with the “Healthy Zhejiang” strategy.

Furthermore, due to Yuhuan City’s geographical location as a county-level city under Taizhou and its proximity to Hangzhou and Shanghai—where medical resources are more abundant, particularly for patients with critical illnesses—there is a significant outflow of patients from Yuhuan seeking treatment elsewhere. The Yuhuan municipal government also aims to achieve the goal of “managing serious illnesses within the county” through healthcare reform, thereby retaining patients locally.

From the broader perspective of the healthcare industry, the “Internet + Healthcare” model is currently a hot topic. Following the relaxation of national policies, regions across China have prioritized the development of “Internet + Healthcare” in their medical reform efforts, collaborating with healthcare enterprises and third-party medical institutions to enhance local healthcare standards and better serve patients. Since 2014, Yuhuan has been committed to building a “Healthy Yuhuan,” continuously deepening reforms in its pharmaceutical and healthcare systems. With this latest initiative, Yuhuan aims to leverage the “Internet + Healthcare” model to elevate its medical reforms to a new level.

On October 18 this year, the Yuhuan Health and Family Planning Bureau of Taizhou, in collaboration with the Human Resources and Social Security Bureau, banks, commercial insurance companies, internet firms, social work organizations, and other stakeholders, jointly held a press conference to launch the Yuhuan “Health + Finance” initiative.

Yuhuan will integrate the development of medical consortia to pioneer province-wide reforms in establishing health communities, strengthen the “prevention + treatment + rehabilitation” health management model, build a comprehensive ecosystem for disease prevention and control, and facilitate the transformation of healthcare services from being “treatment-centered” to “health-centered.”

In the realm of healthcare services, with “Internet + Health + Finance” as the core, we leverage the combined strengths of the internet, insurance, banking, and other sectors to provide residents with specialized health management services, thereby transforming “passive medical care” into “proactive health.”

“The Sanming Model” has remained a focal point in the field of healthcare reform. Since 2012, Sanming City has implemented public hospital reforms characterized by the coordinated linkage of pharmaceuticals, medical services, and health insurance (the “Three-Medical Linkage”). The city has achieved remarkable results in reducing the proportion of drug costs and increasing service-based revenue, garnering significant attention and full affirmation from top national leaders, relevant central government departments, the medical and health sector, and society at large.

Dong Yin, a member of the Party Committee of the Yuhuan Municipal Health and Family Planning Bureau, also drew on the approach of the Sanming healthcare reform before pushing forward his own reforms. The difference was that his payer was a bank, rather than medical insurance.

In short, patients with chronic conditions such as hypertension or diabetes can purchase the “Cai·Kang Tongxing” deposit product at Rural Commercial Bank. The product has a one-year term, is issued monthly, and is available for subscription 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.

The comprehensive health management services here include: health management services, critical illness insurance, inpatient medical and health insurance services, health testing and screening services, and humanized services provided by social work organizations.

Moreover, the “Health + Finance” project has established a multi-stakeholder participation mechanism. Led by the government, a Health Community Expert Committee was formed, with members appointed by the Health Community Management Center from experts in relevant fields.

Innovative commercial health insurance is also being introduced. Leveraging "health + finance" products, commercial health insurance projects related to health management services are being developed, and new types of commercial health insurance are being customized. These products need to support the alignment of coverage (or premiums) with government prevention efforts and rehabilitation programs.

Planning for the Construction of a Unified National Health and Medical Application Platform. The platform’s core functions include appointment registration, referral requests, online consultations with specialists, prescription refills for chronic diseases, intelligent recommendations for personalized insurance plans, commercial insurance claims services, patient community forums for specific diseases, notifications for community health activities, and integration with smart devices.

Furthermore, plans have been made to establish a data exchange and sharing center and complete the construction of a big data platform for medical health, with the action goal of “At Most One Visit.”

Yuhuan’s healthcare reform centers on local medical institutions, using the “Health + Finance” initiative as an entry point to build a family doctor–centered health management system. This approach embodies a preventive-care-oriented, multi-stakeholder win-win health community reform. Led and designed by the Yuhuan Municipal Health and Family Planning Bureau, the project involves multiple parties in its operation, including Rural Commercial Bank, WeDoctor Group, PICC Health, and social work organizations, marking a highlight of Yuhuan’s healthcare reform.

In healthcare institutions, it is understood that all three municipal-level public hospitals and 11 township (central) health centers and community health service centers in our city have been designated as entities for the construction of Healthcare Communities, resulting in the formation of two such communities. One Healthcare Community comprises the Municipal People’s Hospital, the Municipal Hospital of Traditional Chinese Medicine, Kanmen Central Health Center, Damaiyu Central Health Center, Yucheng Subdistrict Community Health Service Center, Lupu Town Health Center, and Haishan Township Health Center. The other Healthcare Community consists of the Second Municipal People’s Hospital, Chumen Town Health Center, Qinggang Town Health Center, Shamen Town Health Center, Longxi Town Health Center, Ganjiang Town Health Center, and Jishan Township Health Center.

The Health Consortium will improve the tiered diagnosis and treatment system, unify the allocation of medical and health resources, standardize information management, and integrate health management. It aims to establish a more scientific mechanism for division of labor and collaboration, as well as a smoother two-way referral system, thereby providing patients with continuous, high-quality medical services, enhancing the overall operational efficiency of the healthcare service system, and achieving co-construction and mutual benefit among medical institutions at all levels.

Taking Yuhuan City Second People’s Hospital as an example, a “National Standardized Metabolic Disease Management Center (MMC)” has been established at this campus. It is the only clinical medical research base for metabolic diseases in China located in a county-level Grade II Class A hospital. Ning Guang, an academician of the Chinese Academy of Engineering and Vice President of Shanghai Ruijin Hospital, attended the unveiling ceremony. Leveraging internet technology, the MMC enables effective health interventions, achieving systematic treatment, prevention, and management, thereby breaking down traditional departmental boundaries. As of the end of November, the center had established individual medical records for over 1,600 patients with metabolic diseases. Its quality control rate reached 91.9%, ranking among the top two nationwide in terms of quality control outcomes for enrolled cases. The follow-up compliance rate for the “three highs” (hyperlipidemia, hypertension, and hyperglycemia) increased by an average of 20% compared to the previous year. The center was honored as one of the Top Ten Excellent MMC Centers nationwide in the first half of 2018. Additionally, community metabolic centers have been successively established at Damaiyu Community Health Service Center, Qinggang Town Health Center, and Longxi Town Health Center.

“The Health Community is an innovation built upon the Medical Community, encompassing a comprehensive, all-encompassing collaborative approach that covers prevention and the entire process of treatment and rehabilitation. It is a new cooperative model led by a flagship institution within a regional area, with active participation from central township health centers and other township health centers,” introduced Fei Lun, President of Yuhuan Second People’s Hospital.

“This ultimately makes it more convenient and affordable for the public to seek medical care, while also mobilizing the enthusiasm of hospital medical staff and promoting an overall improvement in medical technical standards,” said Fei Lun.

From the corporate perspective, the Yuhuan Municipal Health and Family Planning Commission has taken two key initiatives: first, it has facilitated collaboration between insurance institutions and banks to drive chronic disease management reforms through changes in medical insurance payment mechanisms. Hypertension and diabetes account for the largest proportion of annual medical insurance expenditures in Yuhuan City, consuming substantial social resources. Therefore, the chronic disease management plan under the “Health + Finance” project specifically targets these two conditions, aiming to raise public awareness of personal health.

Starting this September, chronic disease patients aged 18 to 65 with hypertension or type 2 diabetes can purchase a one-year “Health + Finance” chronic disease management plan 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, thereby enjoying a yield of 0.31%. Upon successful underwriting by PICC (People’s Insurance Company of China), the bank will use the deposit returns to provide citizens with complementary services, including commercial health insurance, dedicated family doctor services, social worker assistance, health screening and testing, and wearable devices.

The Yuhuan “Health + Finance” project has established a health management service guarantee plan for patients with hypertension or type 2 diabetes, using family doctor contracted services as the entry point and leveraging exclusive products launched by the Yuhuan Rural Commercial Bank. 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 targeted at chronic conditions in the market. One of the innovations of the Yuhuan project is the use of returns on customer deposits to provide commercial health insurance, particularly offering coverage for out-of-pocket expenses not reimbursed by basic medical insurance for individuals with chronic diseases, thereby helping to reduce the disease-related financial burden on the public.

Second, linking with corporate partners. WeDoctor Group is the investor in the Yuhuan City Health Community Commercial Insurance Informationization Project and is responsible for its investment and development.

After integrating the healthcare and insurance protection needs of Yuhuan, WeDoctor has leveraged internet technologies and medical health resources to provide an information platform with big data analytics capabilities. The “Health + Finance” project, built upon WeDoctor Cloud’s healthcare big data capabilities, connects multi-party data from individuals, hospitals, basic medical insurance, and commercial insurance providers. It features a developed back-end system for big data analysis and management, supported by the WeDoctor Commercial Insurance Platform, which facilitates the calculation and processing of commercial insurance claims for medical expenses incurred by insured users during hospital visits.

To enable users to view daily health data more directly and manage their own health, WeDoctor has developed the “Health Community Mini Program” for WeChat, based on its informatized Health Community platform, thereby truly realizing remote medical consultations. Through the mini program, users can upload health data to establish personal health records, receive professional health management guidance from doctors, and access health education services. Additionally, they can purchase insurance online, conduct risk assessments and verification using social security data, exchange health points for insurance coverage, file claims with designated hospitals, and review insurance details, thus truly achieving the goal of “at most one visit.”

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 Healthy Yuhuan.

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, thereby offering expert consultations to residents within the region.

Third, the “Yuhuan National Standardized Metabolic Disease Management Center (MMC)” was established, which is not only the first of its kind in Taizhou City but also the only metabolic disease research base among secondary hospitals nationwide.

“MMC” stands for “One Center, One-Stop Service, Unified Standards.” The center offers specialized outpatient clinics for metabolic diseases, diabetic retinopathy, nutrition, dyslipidemia and hypertension, obesity, and thyroid disorders. It also provides related examinations, including blood pressure and weight measurement, patient registration, arterial stiffness assessment, fundus photography, and nerve conduction studies.

In the future, patients at MMC will need to register only once to access comprehensive diagnostic and therapeutic services, including full-scale testing, data analysis, disease diagnosis and treatment, and out-of-hospital management via a mobile app. This enables efficient, end-to-end care within the hospital and seamless, all-around data synchronization and sharing through the app outside the hospital.

Leveraging this platform, Yuhuan has promoted citywide chronic disease management, enabling it to truly reach grassroots medical institutions and ensuring the effective implementation of the “Double Sinking, Double Improvement” initiative in comprehensive healthcare reform as well as tiered diagnosis and treatment for metabolic diseases.

In the design of the Yuhuan Municipal Health and Family Planning Bureau, the “Health + Finance” project is structured around a “1+2+3+X” model, which also represents the member units of the project.

Taking the first batch of planned member units as an example, in addition to various medical institutions, “1” refers to the project lead unit, namely the Yuhuan Municipal Health and Family Planning Bureau; “2” denotes the project evaluation and quality control units, namely the School of Public Health at Fudan University and the Yuhuan Center for Disease Control and Prevention; “3” represents top expert teams in relevant specialty fields, namely Academician Li Lanjuan’s team in hepatology, Academician Ning Guang’s team in diabetology, and Professor Wang Jiguang’s team in hypertension; while “X” stands for project support units, including the Yuhuan Municipal Human Resources and Social Security Bureau, the Zhejiang Branch of PICC Health Insurance Company, Yuhuan Rural Commercial Bank, WeDoctor Group, KingMed Diagnostics, Yuhuan Tianyi Social Work Organization, and hardware companies specializing in wearable devices, among others.

“Internet + Health + Finance” service model, which combines the strengths of multiple parties including the internet, insurance, and banking sectors. Yuhuan aims to ultimately achieve: by providing residents with specialized health management services.

I. Leading the transformation in the healthcare sector by shifting from “passive medical care” to “proactive health,” thereby establishing a virtuous cycle of reduced disease incidence, milder illnesses, and delayed onset of disease.

II. Strengthen the “Big Health” concept, explore new models of “Health + Internet,” and enhance public understanding of tiered diagnosis and treatment; promote health knowledge to the public through integrated online and offline operations, raising awareness among participants to prioritize and invest in their health.

III. Facilitating the “At Most One Visit” Initiative. Improve the delivery channels of medical and health services by leveraging internet-based information technologies to extend health management, diagnostic and treatment services, and insurance services to mobile platforms. This will enrich service offerings, enhance convenience and satisfaction, and encourage the public to adopt improved health management practices. Achieve efficient and unified information dissemination to enable comprehensive interoperability among municipal hospitals, primary care institutions, health kiosks, and personal testing data, thereby providing thorough assessments and management bases to facilitate self-health management for the public.

IV. Promote Multi-Party Collaboration to Achieve Win-Win Outcomes for the Public, Government, Commercial Insurers, and Healthcare Service ProvidersThe public benefits from improved overall health levels and gains additional healthcare coverage through commercial insurance and internet-based medical services. Commercial insurance companies acquire new customer acquisition channels and develop new health insurance products; they can leverage extensive data to create more targeted insurance offerings. Healthcare service enterprises have the opportunity to participate in healthcare reform, thereby enhancing brand recognition and expanding their business scope. The government improves the delivery of healthcare services, reduces social security expenditures, facilitates the effective implementation of tiered diagnosis and treatment, and enhances residents’ health literacy.

Overall, Yuhuan has established a “prevention + treatment + rehabilitation” health management model through an “Internet + Health + Finance” service framework. Aimed at leveraging support from various sectors—including health and family planning authorities, social security departments, banks, insurance companies, and social work organizations—the initiative focuses on health as its core domain. It integrates medical and insurance resources to build comprehensive systems for online collaboration, health management, telemedicine, medical insurance settlement, and artificial intelligence. This effort creates a smart health service system to better support Internet-enabled health assurance initiatives.

The healthcare reform model of the Yuhuan Health Community has been steadily advancing and has gained recognition from leaders at all levels.

Recently, a research team from the Disease Control and Prevention Bureau of the National Health Commission visited Yuhuan City. Vice Mayor Wang Chao accompanied the team throughout their visit, conducting an in-depth assessment of Yuhuan City’s Health Community (hereinafter referred to as “Health Community”) work through methods such as listening to reports, visiting sites, and holding symposiums.

The research team visited Qinggang Town Health Center, Chumen Tianyi Social Work Service Agency, and the City’s Second People’s Hospital in succession. They carefully reviewed the operations of Health Huts, the Internet-based Health Management Platform, and the National Standardized Metabolic Disease Management Center, gaining firsthand insight into the changes brought about by the implementation of Yuhuan City’s “Health Community.”

The research team pointed out that Yuhuan should leverage the “Health + Finance” project to pool wisdom from all sides and unite efforts across sectors, thereby truly realizing initial diagnosis at the primary care level, two-way referrals, differentiated management of acute and chronic conditions, and coordinated collaboration between upper- and lower-level medical institutions. This will enable a more rational allocation of medical resources and make healthcare services more accessible to the public. Furthermore, Yuhuan should continue to advance comprehensive healthcare system reforms, jointly enhance its integrated capacity for health and medical services, and further improve people’s sense of gain and well-being.

Earlier, Mao Qun’an, Director of the Bureau of Disease Prevention and Control under the National Health and Family Planning Commission, also visited the Qinggang Town Health Center, where he toured the Health Kiosk, the Internet-based Health Management Center, and the Community Metabolic Disease Center. Established in 2017, the Internet-based Health Management Center at Qinggang Town Health Center leverages an internet-enabled medical and health service-sharing platform to provide residents within its jurisdiction with services such as remote consultations, remote diagnosis and treatment, two-way referrals, and online appointment registration, thereby enabling local residents to access urban hospital-level medical care without leaving their homes. Since 2018, the center has conducted 13 remote consultations, handled 136 remote outpatient cases, and provided 49 online medical consultations.

At the Tianyi Social Work Service Agency, Mao Qunan visited facilities such as the Health Hut and the Psychological Sandplay Room, and listened to reports on the implementation of collaborative projects between social work organizations and health institutions. In recent years, Yuhuan City has actively promoted medical-social co-construction initiatives. Starting with the Tianyi Health Hut, the city has explored the integration of social work into chronic disease management and prevention. To date, eight self-management groups for chronic diseases have been established, more than 200 health education activities have been held, and over 50,000 resident visits have been served, effectively enhancing residents’ awareness of health management for hypertension, diabetes, and occupational diseases within the region.

Since April this year, Yuhuan City has initiated the construction of a “Health Community,” implementing an incentive and constraint mechanism characterized by “global budgeting, monthly advance payments, retention of surpluses, and reasonable sharing of deficits.” This initiative strengthens health management through an integrated approach of “prevention, treatment, and rehabilitation,” explores a multi-party collaborative win-win model under the “Health+” framework, and is committed to building a comprehensive ecosystem for disease prevention and control. By coordinating medical and healthcare service resources and achieving unified management of personnel, finances, and materials, the city is driving a transformation in the healthcare sector from being “treatment-centered” to “people’s health-centered,” thereby safeguarding residents’ health in all aspects and throughout their entire life cycle.