Luo Ningzheng: Patient-Centered Innovation in Tiered Healthcare Delivery

Since 2014, national policies have continuously signaled support for the tiered diagnosis and treatment system. As a key direction of future healthcare reform, establishing a tiered diagnosis and treatment system with rational allocation of medical resources has undoubtedly become a critical factor in the success of the new healthcare reform. How to implement these policies, achieving initial diagnosis at primary care institutions, two-way referrals, separate management of acute and chronic conditions, and coordination between different levels of healthcare providers, is a question that the entire healthcare industry needs to consider.

CEO of 160 HealthcareLuo Ningzheng

This week, the VB Group Interview features Mr. Luo Ningzheng, Founder and CEO of Shenzhen Ningyuan Technology Co., Ltd. (Jiuyi 160), to discuss new models of tiered diagnosis and treatment, offering a patient-centric perspective on reimagining this healthcare delivery system.

The most fundamental background of the tiered diagnosis and treatment system is the policy initiative and advocacy launched by the government to address the severe imbalance in medical resources, characterized by overcrowded large hospitals and underutilized community healthcare institutions.

Against this backdrop, the issue can be divided into two aspects: first, the extreme imbalance in the allocation of medical resources poses significant challenges to China’s healthcare and medical service systems; second, the inadequacy of services resulting from such uneven resource distribution.

When all patients flock to large specialized hospitals, leaving primary care facilities understaffed, the overall cost of healthcare services rises due to the precious nature of hospital resources. Amidst resource scarcity and continuously escalating medical costs, China experiences significantly more severe doctor-patient conflicts than other countries, despite having a per-capita physician count comparable to that of the United States.

To this day, despite the government’s continuous increase in investment and ongoing expansion of hospitals, the imbalance in medical resources remains unresolved. Therefore, it is time to shift the entry point of healthcare services from hospitals to community-level facilities, thereby implementing a tiered diagnosis and treatment system. In general, the government’s promotion of tiered diagnosis and treatment aims to, on one hand, improve service satisfaction, and on the other, reduce costs.

Government-led tiered diagnosis and treatment has largely focused on one issue: how to facilitate two-way referrals between community health centers, primary care institutions, and higher-level hospitals. This perspective primarily considers the viewpoints of hospitals and medical institutions, while rarely addressing tiered diagnosis and treatment from the perspectives of patients and physicians. However, the widespread adoption and promotion of tiered diagnosis and treatment cannot be achieved without substantial patient participation and the concrete implementation by physicians.

Therefore, JiuYi160 proposes a new approach: moving beyond the current government perspective to genuinely consider the viewpoints of patients and physicians, and leveraging internet-based methods to promote the establishment of a patient-centered tiered diagnosis and treatment system.

To establish a patient-centered tiered diagnosis and treatment system, the first step is to cultivate user habits by raising patient awareness of effective tiered care policies, thereby facilitating efficient triage and fostering beneficial healthcare-seeking behaviors. The second step involves popularizing health education and promoting scientific medical consultation practices, such as providing evidence-based guidance on the primary therapeutic focuses, specialized strengths, chronic disease management, and rehabilitation services offered by specialized hospitals or large tertiary medical centers.

Jiuyi160 will establish a patient-centered tiered diagnosis and treatment system in two phases. The first phase leverages the advantages of the internet to better educate, promote, and guide patients in seeking medical care, thereby enabling effective triage and patient navigation. This includes producing videos to introduce hospital specialties and promote scientific healthcare-seeking habits; providing patient guidance through articles and videos on the website; and conducting effective triage and navigation via manual voice services.

The second phase involves promoting a referral model driven by clinical urgency, with active participation from physicians. Specifically, it advocates for the involvement of specialists from large tertiary hospitals in establishing a condition-priority referral system. From the patient’s perspective, this ensures that those requiring specialized care receive timely treatment. From the perspective of hospitals and physicians, it enables doctors to admit patients whose conditions better match their specialty expertise.

Tiered diagnosis and treatment should not remain merely at the governmental level or in the form of policy documents; instead, physicians’ initiative should be mobilized to engage more doctors in establishing triage and patient-guidance systems. By leveraging internet-based approaches, more patients should be guided to develop scientifically sound healthcare-seeking habits.

Regarding two-way referral, many people hold a misconception that only two parties are involved in promoting it: the government, which formulates policies, and traditional hospital software companies, which facilitate data flow and provide data interfaces. In reality, this is not the case. A third party is also required—namely, an internet platform acting as an operator. There are three reasons for this:

First, the existence of third-party platforms facilitates effective data exchange and referrals between different hospitals and community health centers.

The second reason is that third-party platforms have assumed the role of operators, responsible for coordinating resources and cultivating user habits.

The third reason is that third-party platforms can serve as intermediary operational platforms, collaborating with the government to facilitate two-way referrals and thereby achieve tiered diagnosis and treatment.

Hierarchical Diagnosis and Treatment Has Been Proposed for Many Years. Despite the Government's Numerous Attempts to Promote It, True Implementation Remains Elusive, with Two Key Challenges Identified.

The first challenge is the scarcity of high-caliber community physicians; there are insufficient numbers of qualified practitioners capable of effectively managing referrals from community settings to specialized hospitals.

The second challenge is the issue of benefit distribution in patient referrals between different hospitals, and even between hospitals and community health centers.

The first initiative is to focus on large public hospitals, helping them enhance the patient care experience by providing services such as appointment scheduling, staff rostering, payment processing, and off-site specialty follow-ups.

Second, promote the establishment of a patient-centered tiered diagnosis and treatment system to supplement and improve the government’s existing tiered diagnosis and treatment framework.

Third, leverage the patient traffic generated by service-oriented communities and hospitals to attract more partners, jointly build an industry ecosystem, make healthcare services more comprehensive, and help patients access better medical and health services.

Q: What are the incentives for patients, doctors, and hospitals to participate in the tiered diagnosis and treatment system operated by internet companies?

Luo Ningzheng:The establishment of a tiered diagnosis and treatment system for patients is inevitable. Many patients do not necessarily resist seeking care at community health centers; rather, they often lack adequate understanding of these facilities. This highlights the need for a process involving patient education, outreach, and cultivation.

As for physicians, many highly skilled specialists need to admit patients who are better suited to their specific specialties. Tiered diagnosis and treatment can facilitate patient triage, enabling quicker and more convenient access to the appropriate specialty care.

From the hospital perspective, promoting tiered diagnosis and treatment enables a more rational allocation of high-quality physician resources. For specialized hospitals, patient screening and selection, along with priority-based referrals according to disease severity, can optimize the utilization of hospital and physician resources, thereby maximizing their value.

Q: Do you believe that the tiered diagnosis and treatment system in China should be government-led or market-driven? Hospitals should be the primary participants, but do hospital directors have the incentive to engage?

Luo Ningzheng:My view on this issue is that the government must take the lead in driving tiered diagnosis and treatment; however, it is essential to actively leverage market participation. It is highly necessary to further engage internet-based enterprises such as JiuYi160, as well as other mobile health startups, to collaborate in this endeavor.

Hospitals, as participating stakeholders, are indeed motivated. The approach is not to unilaterally pressure hospitals to refer patients to community health centers; rather, it also involves referring more specialized cases to tertiary specialty hospitals while retaining patients with minor ailments at primary care facilities in the community. By adopting this strategy, a balance of resources between both parties can be achieved, leveraging the respective strengths of all stakeholders and creating mutual benefits. Hospital directors would actively engage in such initiatives. Therefore, the key to successfully implementing tiered diagnosis and treatment lies in effectively balancing the interests of hospitals and physicians.

Q: Is the tiered diagnosis and treatment project currently being implemented by JiuYi160 primarily in collaboration with hospitals or with local Health and Family Planning Commissions?

Luo Ningzheng:To facilitate tiered diagnosis and treatment, JiuYi160 primarily employs three approaches. The first involves collaboration with the National Health and Family Planning Commission, encompassing three key aspects: First, a significant portion of appointment slots on the JiuYi160 platform is allocated directly to community health centers through government channels; 50%–70% of specialist appointments are reserved for referrals made by community physicians rather than direct patient bookings. Second, advisory guidance is provided: when patients attempt to book appointments with specialists, they are reminded to consider visiting nearby community hospitals first. Third, specialist outreach programs are conducted in community hospitals, wherein high-quality physicians from specialized hospitals provide consultations at community facilities, thereby attracting more patients to seek care within their communities.

The second approach is to collaborate with hospitals, facilitating two-way referrals between the host community medical institutions and the hospitals.

The third approach involves direct collaboration with physicians through the provider-facing platform of JiuYi 160, encouraging their participation in priority-based triage and referral to help them better screen patients.

Q: What is the current status of medical data sharing? Can electronic health records, laboratory test results, and imaging data be shared with primary care community hospitals? What role does the Juyi 160 platform play in this process?

Luo Ningzheng:Efforts are currently underway to leverage internet-based approaches for the effective sharing of medical record data. JiuYi160 plays a role in this process by storing patients’ medical records, laboratory test results, and imaging data in the cloud, making them accessible to community physicians and hospitals, provided that patient authorization has been obtained. In addition to this model, another approach involves storing such data on JiuYi160’s own servers, with clear disclosure to patients regarding this arrangement.

As tiered diagnosis and treatment are fully implemented in the future, patients will have deeper needs. The data they wish to store may no longer be confined to a specific hospital or region; instead, they hope these data can be stored at any node accessible to them. With patient authorization, such data should be storable in the cloud, provided that internet companies ensure proper custody and storage of the data. This would allow patients to access their data anytime and anywhere, and, with their consent, enable doctors and hospitals to retrieve the data, thereby facilitating medical consultations.

The sharing of medical data across hospitals, communities, and even cities by mobile health enterprises is highly valuable. Such data flows will ultimately deliver true value to patients in the management of chronic diseases and overall health.

We need clearer policies and better regulations to provide direction. In any case, it is essential to facilitate improved data sharing and flow while ensuring the protection of patient privacy.