Public-Private Partnership Empowers Grassroots Healthcare: YiXunTong's Innovative Approach to Chronic Disease Management and Family Doctor Services

From May 17 to 18, the “2017 China Primary Healthcare Innovation Practice Forum” was held in Chengdu. During the conference, Mi Guoqing, former Inspector of the National Health and Family Planning Commission; Zhuo Bing, investor at Yixuntong; and Cai Junfang, General Manager of Yixuntong, were interviewed by VCBeat. They engaged in discussions on how government and enterprises should collaborate in primary healthcare services to foster deep integration between healthcare and social service systems, and actively explore new models for the prevention, management, and care of chronic diseases.

In 2017, China’s healthcare reform continued to deepen, with numerous policies introduced in succession. Among these, policies concerning family doctor contracting and medical consortiums were particularly emphasized. Mi Guoqing and the management team of Yixuntong provided insights from governmental and corporate perspectives, respectively, on how to implement primary healthcare services under the guidance of these national strategic directives.

Mi Guoqing (right), Former Inspector of the National Health and Family Planning Commission

Zhuo Bing (left), Investor at Yixuntong and Executive Director at Bio-Wealth

Mi Guoqing first stated that to implement the two initiatives of family doctor contracting and medical consortiums, local governments must first deeply recognize them as critical national policies. Without a high level of attention from local governments, it will be difficult for these initiatives to achieve their expected outcomes.

Mi Guoqing believes that medical consortiums and family doctor contract services are two distinct issues. Medical consortiums operate within the healthcare system to address collaboration among medical institutions. The implementation of family doctor contract services is an effective measure to facilitate the decentralization of medical resources and ensure that patients with serious illnesses can be treated within their county, while also serving as a powerful tool to prevent poverty caused by illness and relapse into poverty due to medical expenses; thus, it addresses the development of the social service system.

As Yixuntong serves as a supportive system for government-led family doctor contracting services, Mi Guoqing focused his discussion on the implementation of these services.

Mi Guoqing believes that excelling in this work is not limited to the signing of contracts itself; the key lies in ensuring that follow-up services are effectively implemented. “Once these services are in place, health issues among grassroots populations can be identified promptly, allowing for early intervention and control. This prevents minor ailments from progressing into serious diseases or even complications. Consequently, the widespread problems of poverty caused or exacerbated by illness among grassroots communities can be effectively prevented and controlled,” said Mi Guoqing.

In the provision of family doctor contract services, the government plays a crucial role. Mi Guoqing believes that the work of family doctor contracting cannot proceed without the understanding and strong support of governments at all levels, particularly leadership at the municipal and county levels.

Municipal leaders primarily perform management functions such as planning, promotion, guidance, and assessment. They ensure the implementation of these initiatives through issuing directives, deploying tasks, conducting inspections and guidance, and performing evaluations and acceptances, with oversight and performance appraisals serving as safeguards. County-level governments operate at the operational level, responsible for mobilizing and coordinating various local resources. The county Health and Family Planning Commission serves as the implementing agency, tasked with carrying out the specific work.

Can family doctor contracting be achieved merely by raising awareness and providing support? Mi Guoqing’s answer is no. To deliver high-quality contracted services, an effective mechanism must be established, encompassing robust tools and well-organized grassroots personnel and teams for concrete implementation. This represents the key point of government-enterprise collaboration in this project. Family doctor contracting is a governmental mandate, operating within the government-led administrative system. Outside this system, support from social resources is required, driven by technology and innovative institutional mechanisms. These are areas where enterprises can fully leverage their potential and make significant contributions.

Next, the management team of Yixuntong shared their insights on fostering close collaboration between government and enterprise.

The state is driving healthcare reform, with the primary current objective being to address challenges in primary care. In addition to enhancing and perfecting the medical service delivery system, it is essential to establish a complementary social service system. Enterprises can leverage their competitive advantages to participate in the implementation of government policies, thereby supporting the government in achieving its objectives while fostering their own development. This model of development is particularly critical in the healthcare industry.

Currently, there are many problems in primary healthcare. For example, the overall quality and technical level of primary care physicians are generally low and need to be improved urgently. Patients do not have enough trust in primary medical institutions, and there is a shortage of some conventional drug varieties at the grassroots level.

Regarding how to resolve these issues and address existing shortcomings, Mi Guoqing believes that a combination of multiple factors has made problems in primary healthcare numerous and complex. However, we should start by addressing the principal contradiction, and subordinate issues will then be readily resolved.

He stated, “Why have doctors been slow to deploy to the grassroots level? The difficulties and high costs faced by grassroots populations in accessing medical care have persisted, and the issue remains inadequately addressed. The core problem lies in the lack of an inherent connection and effective channels between doctors capable of providing services and the grassroots populations in need of such services. Therefore, to resolve this challenge, it is essential to establish a mechanism that fosters linkage between these two groups.”

In recent years, there has been extensive practice at the grassroots level, where enterprises can play a significant role. Mi Guoqing cited Yixuntong as an example to introduce their work in Henan’s grassroots healthcare sector. Yixuntong establishes a platform that connects doctors at all levels with the grassroots population.

Through this platform, senior physicians at the provincial level provide guidance to county-level physicians, who in turn mentor township-level physicians, and township physicians guide village doctors. Meanwhile, higher-level physicians accept patient referrals from lower-level providers, thereby gradually establishing a tiered diagnosis and treatment system.

However, the establishment and operation of such an interconnected platform require the involvement of social resources (or enterprises). Once this mechanism is properly established, it will ensure that grassroots tiered diagnosis and treatment operate on the correct track, thereby resolving long-standing issues that have remained unaddressed.

From the perspective of grassroots public needs, there is a gap in the capabilities and standards of primary care physicians and primary healthcare institutions, which urgently need to be improved.

Currently, to establish a service system for the prevention, treatment, and management of chronic diseases, primary care physicians and medical institutions must go beyond mere treatment; more importantly, they need to focus on patient management. With scientific training and the introduction of practical technological tools and products, they can address the majority of challenges in primary care chronic disease management.

Zhuo Bing believes that the chronic disease management issues to be addressed at the primary care level are not entirely determined by the level of medical expertise, but rather require resolving problems related to patient adherence and strengthening support from social service systems.

General practitioners are the key players in managing chronic diseases at the primary care level. In developed countries with robust primary healthcare systems, general practitioners account for 30% to 60% of the physician workforce, whereas in China, they constitute less than 4% of the total number of physicians.

Although China is vigorously training general practitioners, the pace of training falls far short of societal demand. Yixuntong believes that one of the tasks enterprises should undertake is to provide support to primary care physicians, particularly those in township health centers, to empower them with the competencies of general practitioners.

For instance, Yixuntong leverages its Micro-Clinic product as a platform to build teams of primary care physicians. Simultaneously, it empowers the system by providing access to high-caliber physician resources, support from an expert committee, assistance from chronic disease management centers, and a comprehensive social service support framework encompassing poverty alleviation funds, social welfare funds, and social insurance.

Cai Junfang, General Manager of Yixuntong

From a corporate perspective, achieving commercial interests is its goal.

A key focus of this interview is to explore the perspectives from which enterprises can engage in primary healthcare, ultimately promoting tiered diagnosis and treatment. Yixuntong believes that a company’s positioning is crucial; it must closely align with healthcare reforms and clearly understand their objectives and policies to ensure its services are accepted by both the government and users.

Why Are More and More Companies Entering the Healthcare Industry? It Is Because Healthcare Reform Is Driving Industrial Transformation, Which in Turn Creates More Business Opportunities. Meanwhile, Technological Advancements Are Also Propelling Change in the Healthcare Sector. Enterprises Should Seize the Opportunities Presented by These Two Major Drivers of Industrial Impact.

Yixuntong focuses on chronic disease management. Its leadership also explained to VCBeat why they chose this sector for pilot initiatives and breakthroughs in primary healthcare. Statistics show that 42% of poverty caused by illness and relapse into poverty due to illness are attributable to chronic diseases, while high medical costs and limited access to care are among the main reasons why the progression of chronic diseases has not been effectively curbed in China.

Cai Junfang stated, “Whether it is family doctor contract services or chronic disease management, what matters more is establishing a comprehensive healthcare service system. In the future, China’s health and wellness system cannot focus solely on treatment; it must be supported by a social health service system. This is the objective of healthcare reform.”

YiXunTong has developed its product for the family doctor contract service support system primarily from three directions.

The first aspect is the family doctor contract service. The government needs to carry out family doctor contracts, and how to handle follow-up services after the contract is completed is what Yixuntong needs to solve using technical means.

The second aspect is data security and sharing. The security risks associated with medical information sharing are significant and stem from numerous sources. It is essential to address how these data are utilized and integrated with the Yixuntong platform while ensuring robust security.

The third aspect involves the guidance and development of regional capabilities. In collaboration with county-level governments across Henan Province, Yixuntong has jointly established chronic disease management and service centers in each county. These centers integrate follow-up training, education, public awareness campaigns, and performance evaluation into a unified platform, thereby enabling the efficient utilization of diverse resources.

Family physicians represent a broad concept that is related to, yet distinct from, the healthcare system. Family physicians provide medical services as well as chronic disease management and intervention services. These management and intervention activities do not require hospital visits and can be completed through the family physician contracting system.

Recently, the National Health and Family Planning Commission issued an internal solicitation regarding internet hospitalsOpinionThe draft has set off a wave of heated discussion across the online healthcare community. In response to this development, three guests shared their perspectives.

First, Mi Guoqing, who has extensive experience working with the National Health and Family Planning Commission, stated: “Technological development comes first, followed by government oversight, and then further regulation; this is logical.”

Only with the emergence of advanced and mature internet technologies can online healthcare become a reality, prompting the state to prepare policies for industry regulation. The development of new entities undergoes a process of natural selection; the maturation of internet technology has led many enterprises to venture into online medical services.

After all, this represents a huge temptation, and many companies come here to pursue profits. However, whether enterprises have engaged in deep reflection, possess a sense of social responsibility, and understand what social responsibilities and obligations they should assume in the process of profit-seeking are questions that every enterprise, including Yixuntong, must carefully consider.

Mi Guoqing does not believe that the introduction of this policy signifies a negation of internet hospitals and internet-based healthcare. He stated, “The social responsibilities and obligations borne by enterprises must be clearly defined; they must address practical problems faced by grassroots communities, thereby achieving the dual goals of social and economic benefits. Therefore, the current regulatory efforts by the state are not aimed at halting well-performing and reasonable practices, but rather at shutting down companies that focus solely on profit-seeking without fulfilling their corresponding social responsibilities.”

Local policymakers must diligently study and thoroughly comprehend relevant national laws, regulations, and policies, keeping pace with the times. The challenges we face today are both complex and novel; therefore, we must adopt a new mindset to address them and have the courage to take responsibility. We are confident that leaders at all levels of government and related functional departments will take effective action, thereby benefiting grassroots communities.

Cai Junfang, General Manager of Yixuntong, welcomed the introduction of this policy, noting that from a long-term perspective, the implementation of relevant regulatory measures is actually beneficial to the industry and provides reassurance for the development of internet healthcare. “This policy clarifies what is permissible and what is prohibited in the industry, defines the red lines, highlights areas encouraged by the state, and indicates the strategic direction for enterprises.”

“Online medical practices indeed require regulation, which will have a certain impact on the development of internet hospitals in the short term. However, this has not significantly affected Yixuntong. Our role is supportive, assisting physicians in delivering medical services within their own healthcare institutions, rather than establishing online medical institutions for them to provide such services. This service platform operates under contracts with local governments and the Health and Family Planning Commissions, and it does not conflict with existing policies,” said Cai Junfang.

Finally, Mi Guoqing summarized the importance of chronic disease management at the primary care level. The concept of a new health model was proposed many years ago, but it could not be implemented at that time due to the lack of mature internet technology support.

To date, we have transitioned from the biomedical model to the biopsychosocial medical model. It is essential to shift away from hospital-centric and treatment-centric paradigms by implementing early prevention and control of chronic diseases to prevent their progression. This approach will significantly enhance the efficacy of subsequent treatments, thereby substantially improving both social and economic benefits.

A treatment-centered approach focuses on hospitals and patients, prioritizing intervention after disease onset. In contrast, the modern biopsychosocial medical model encompasses a broader scope; its practice extends beyond clinical care to include science popularization, medical education, humanistic care, and health management.

Therefore, the responsibilities of primary healthcare workers extend far beyond clinical consultations to include chronic disease management, and the participants involved are not limited to physicians. The implementation of primary care services relies on new technologies and platforms, with the key issue being whether these technologies are suitable for China’s primary care settings.