Global Health Insurance Leaders Expand Digital Health Footprint: UnitedHealth, Kaiser Permanente, Aetna and Others File IPO Prospectus

Currently, China is in an accelerated phase of healthcare reform, and internet-based healthcare is experiencing rapid growth fueled by favorable policies. In this golden era, how can commercial insurance giants remain indifferent? Like all startups, top-tier health and medical insurance companies both domestically and internationally have entered the market one after another, strategically positioning themselves across various niche segments. Amidst the fierce competition for market share, they aim to reach the tipping point as quickly as possible and bring the battle to a close.

In China, Ping An Insurance has taken the lead in entering the internet healthcare sector with the fastest pace. In late 2014, Ping An Health Internet Co., Ltd., a key member of Ping An’s internet division under Ping An Insurance Group, launched a mobile app called “Ping An Health Manager (Ping An Good Doctor),” which focuses on online consultations and provides round-the-clock specialist medical consultation services. The app was officially launched on April 21 this year.



Ping An’s foray into internet healthcare is characterized by the following features:

1. These specialists are full-time medical professionals hired directly by Ping An, with the plan to reach 1,000 on-staff medical personnel by the end of 2015; 2. The online medical consultation services provided by the platform are underwritten by Ping An Property & Casualty Insurance, ensuring that users receive actual compensation for losses in the event of doctor-patient disputes; 3. Consultation services offered by "Ping An Good Doctor" are completely free and significantly reduce user wait times for responses; 4. Ping An integrates resources across multiple sectors, such as pharmaceutical companies and chain pharmacies, and provides home medication delivery services, aiming to establish a self-sustaining healthcare ecosystem; 5. In addition to O2O medical services, it has established a large-scale knowledge database, including a health cloud database to assist physicians in diagnosis and the creation of personal electronic health records.

In addition to the attention drawn by Ping An Good Doctor, it was reported in June that Samsung will enter China’s healthcare market and partner with Ping An Insurance to develop a comprehensive integrated internet healthcare platform, while accelerating the development of remote health monitoring systems in China.

In contrast to Ping An, China Life has been somewhat hesitant in the internet healthcare sector. It was only in June of this year that China Life began planning its O2O health service system, focusing on building an online health service platform and launching various offerings—including health management, diagnostic and treatment services, disease prevention, and disease management—to enable users to access medical care from the comfort of their homes.

On the other hand, we are advancing the transformation and upgrading of our internal health examination centers, transitioning them into health management service centers. Leveraging offline platforms as a foundation, we are building a network of contracted medical institutions, a pool of specially appointed medical experts, and an in-house physician team to provide operational support for online services. Therefore, Life Insurance’s planning in the internet healthcare sector is just beginning.

So, how have established overseas commercial insurance companies strategically positioned themselves in the realm of internet healthcare? VCBeat has conducted a preliminary review, analyzing eight major insurers: UnitedHealthcare, Kaiser Foundation Health Plan, Aetna, Humana, CIGNA, Blue Cross Blue Shield, BUPA, and AXA PPP Healthcare. The findings are summarized as follows:

I. United HealthCare
UnitedHealth Group, founded in 1974, has six subsidiaries, including UnitedHealthcare. UnitedHealthcare primarily serves entrepreneurs from small and medium-sized enterprises, while also providing network-based health benefit services to individuals and families.

A representative example is myuhc.com, a meticulously designed and robust online portal by UnitedHealthcare. Users can download claim forms, search for specialists—including dentists, ophthalmologists, and psychologists—locate pharmacies to fill prescriptions, check health insurance account balances, estimate medical expenses, record and archive personal healthcare activities, and access online medical education resources.

How to Look Up Information? Users can enter their local postal code to search for healthcare facilities or services available in their area. They may perform an advanced search by filtering based on average medical costs or by specifying particular medical services. The website automatically recommends physicians for users to consider, allowing them to make informed choices based on factors such as cost, distance, and service quality rankings.

In addition to myuhc.com, enrolled members are provided with free access to the “My Healthcare Cost Estimator” tool. This tool comprehensively calculates final out-of-pocket expenses by integrating data such as medical services rendered, deductible amounts, insurance premiums, and co-payments, thereby helping patients understand medical costs and achieve autonomous cost control. Users can access this feature by logging into myuhc.com or by using their health insurance or social security accounts. The 24-Hour Nurse service offers a toll-free number that connects users with nurses possessing 15 years of clinical experience. Available 24/7, this service addresses user inquiries, provides online consultations for illnesses or injuries, assists in finding physicians and scheduling appointments, offers guidance on chronic disease management, answers questions regarding medication usage, drug selection, and cross-reactivity, and provides education on disease prevention.

To control healthcare costs, the United States has implemented a fee-for-service and value-based payment model, thereby enabling price transparency in the healthcare industry. Last May, UnitedHealthcare announced collaborations with two other insurance giants, Aetna and Humana, as well as with the Health Care Payment Learning and Action Network (HCP-LAN), to build a transparent database of healthcare service payments. This initiative makes medical prices publicly available as free information for the general public.

In the field of telemedicine, UnitedHealthcare partnered with InstaMed in January 2014 to announce the launch of its myEasyBook service, an online healthcare booking platform that enables users to more easily schedule appointments with local medical specialists, including same-day visits. A key feature of this app is the transparent display of medical costs, which has saved users an average of 30% on expenses.

A year later, in April of this year, UnitedHealthcare partnered with three companies: Doctor On Demand, AmWell (American Well), and NowClinic, a subsidiary of its own Optum division. These three providers offer telemedicine services via mobile apps or PCs, enabling UnitedHealthcare members to consult with physicians remotely via video from the comfort of their homes at an affordable cost. This development is particularly significant for remote areas with scarce medical resources. The Doctor On Demand platform currently has 1,400 physicians. The company plans to enable its 20 million insured members to consult doctors via smartphone by the end of 2016, facilitating easier access to healthcare services and thereby reducing costs.

In addition, insurance companies have consistently demonstrated proactive engagement in out-of-hospital health management, with gamification serving as a distinctive approach to encourage user participation.

In April 2015, UnitedHealthcare partnered with Walgreens, the largest pharmacy retail chain in the United States, to pilot a program that leverages digital health solutions and the Health4Me app to incentivize patients to adopt healthier behaviors. For instance, users could earn rewards credited to their Walgreens accounts by completing physical activities such as walking.

Optum, a subsidiary of UnitedHealthcare, has acquired a majority stake in Audax Health. The financial terms were not disclosed. Audax Health previously partnered with commercial insurers such as CIGNA and leveraged the Zensey platform to help users engage in online health management through gamification. Its approach featured gamified elements, social interaction, and the sharing of health data, rewarding users with points for consistent exercise and healthy eating habits.

Additionally, targeting obese children abroad, UnitedHealthcare has partnered with Konami and Zamzee to launch an innovative healthcare initiative. This program features the “Dance, Dance, Revolution” game project, designed to help reduce childhood obesity. Konami is a digital entertainment company, while Zamzee has developed a wearable activity monitor. By clipping Zamzee’s triaxial accelerometer onto children’s shoes or clothing, exercise intensity and frequency can be measured. Integrated with Konami’s video game format, this system encourages children to engage in physical activity.

UnitedHealthcare also leverages traditional communication methods for health management. In May 2014, it announced that residents in York City, Allegheny County, and the Philadelphia area who were enrolled in its Medicaid plans would be eligible for the Txt4health and Text4kids programs. These programs use text messages to remind individuals to adhere to disease prevention guidelines, take medications on schedule, keep medical appointments, monitor their weight, engage in physical activity, and maintain a healthy diet.

Managed outside hospital settings, this medical initiative is well-suited for internet-enabled healthcare projects, particularly chronic disease management. On January 7, 2014, it launched an online education program tailored to patients with diabetes, aiming to improve the management and control of chronic diseases through high-quality, informative, and engaging content. Notably, the program is accessible even to non-members, demonstrating the company’s commitment to its mission of enhancing public health.

The United States has enacted a series of laws concerning electronic health records (EHRs), enabling interoperability among in-hospital EHR systems and thereby facilitating the flow of data and information. In this environment, insurance companies have naturally sought to enter this sector. For instance, UnitedHealth Group has actively acquired EHR system technology service providers.

On January 26, 2013, Humedica, a Boston-based digital health company, was acquired by UnitedHealth Group for several million dollars. Humedica was a promising company specializing in data integration and descriptive analytics, with two core business lines. First, it operated one of the largest electronic health record (EHR) systems, capable of extracting and integrating data. Second, it possessed valuable user data resources that could be resold to third parties, such as insurance companies and pharmaceutical firms.

In April 2015, Optum, a subsidiary of United Health Group and a leading provider of electronic health record (EHR) systems in the United States, acquired MedExpress, a company operating urgent care services. This move aligns with the growing demand for expedited medical access, as patients can receive care on a walk-in basis without prior appointments.

In the realm of mobile app development, on April 6, 2015, AARP (American Association of Retired Persons), in collaboration with Pfizer and UnitedHealth, launched an experimental study led by the Georgia Tech Research Institute to explore the development of mobile apps and medical devices tailored for adults aged 50 and older.

UnitedHealthcare’s flagship app is the consumer-oriented Health4Me, which was updated to version 4.1 in February 2015. It lists charges for 755 items and fees for 500 medical services, enables real-time access to and viewing of family members’ health information, offers online consultations with physicians, helps locate nearby doctors and emergency rooms, and allows users to check their personal health insurance accounts, making it a multifunctional mobile application.



Another app released by UnitedHealth, “Smart Patient,” also received a version update in October 2014, enabling it to calculate the caloric content of consumed foods.

Overall, UnitedHealthcare’s bold moves have overshadowed other companies, as it has partnered not only with CareSpeak, a disease management software company, but also with Fitbit, a manufacturer of wearable wristbands.



II. Kaiser Foundation Health Plan
Kaiser Permanente is a highly integrated healthcare system that combines health insurance with medical services, thereby aligning the interests of healthcare providers and insurers. The group emphasizes “prevention first, integrating prevention and treatment,” merging health management with clinical care.

Although Kaiser is a vertically integrated system, it actually consists of the following three distinct entities.

Kaiser Foundation Health Plans: A nonprofit public-benefit organization that provides comprehensive healthcare services through prepaid contracts with individuals and groups.
Kaiser Foundation Hospitals: A nonprofit, public-benefit organization that operates community hospitals and outpatient facilities across multiple regions in the United States, arranges for the provision of hospital services, and sponsors charitable, educational, and research activities.
Kaiser Permanente Medical Groups: Professional organizations formed by physician partnerships, independent from the Health Plan Foundation, providing medical services to members.

Kaiser Permanente has established a foundation. In November 2014, its investment fund entered into a long-term partnership with Rock Health’s third-party fund to provide stable investments of $250,000 to late-stage healthcare startups.

Kaiser Permanente introduced the KP HealthConnect system as early as 2004. This system offers multiple functionalities, including an electronic health record (EHR), comprehensive inpatient and outpatient medical records, clinical decision support, and real-time integration with laboratory, pharmacy, radiology, and other ancillary systems.

Established a secure doctor-patient information transmission system, while maintaining personal medical records and an electronic information automatic integration system, enabling online access to laboratory results and supporting telephone or remote consultations.

Today, Kaiser Permanente has become the institution with the most comprehensive electronic health records (EHR) in the United States, solidifying its absolute leadership in hospital informatics. For independent hospitals, building such a system is typically prohibitively expensive, averaging $80,000 per physician. However, as an integrated organization, Kaiser Permanente operates its own hospitals, pharmacies, and laboratories, and its physicians care exclusively for enrolled members. This structure enables the direct sharing of patient information across all platforms.

Kaiser Permanente’s website development and mobile design also feature numerous highlights, such as enabling users to search for suitable physicians and facility services on the PC platform by city, physician name, specialty, and other criteria. Thanks to the outstanding performance of Kaiser’s internet healthcare services, the group has received numerous honors and accolades.

On July 11, 2013, the flagship product “Kaiser Permanente APP” won the Silver Award from an internet healthcare website. Other notable apps included “KP Preventive Care for Northern California,” “KP HRA/HSA/FSA Balance Tracker,” “Every Body Walk!,” and “My KP Meds (NCAL only).”

In the same year, Kaiser Permanente received four awards related to internet healthcare, recognizing the outstanding online consultation capabilities of its website and mobile platform. Whether viewing medical records, scheduling appointments, ordering prescriptions, reviewing test results, or messaging physicians, the Kaiser app enables seamless doctor-patient communication anytime and anywhere.



On August 25, 2014, Kaiser Permanente also received honors related to the Internet Healthcare Resources and Tools Award. Its main web interface featured a more user-friendly design, and it established highly practical personal health management tools, including “My Health Manager” on kp.org, as well as healthcare websites such as medicare.kp.org. Notably, “My Health Manager” received the highest honor of the awards—the Best Interactive Media Award.



Amid the intensifying competition in internet-based healthcare, although Kaiser has performed well on its mobile web platform, senior management decided to make a strategic adjustment. In December 2014, an administrator of the Kaiser Foundation Health Plan stated that Kaiser would no longer engage in the health and medical app business, as the market had become overly competitive with too many participants. Instead, Kaiser should leverage its core strength—outpatient care—and focus its efforts in this area, where continuous improvement is more readily achievable.

At times, a scattergun approach that tries to cover every base proves utterly ineffective in improving doctor-patient relationships; some have even suggested that Kaiser’s killer app is simply secure email communication.

Furthermore, entering the field of medical big data is also a key development focus for Kaiser. As early as 2013, it was reported that Kaiser Permanente achieved early prevention of sepsis by analyzing medical big data, opening API interfaces, and leveraging medical analytics tools, population health tools, and chronic disease management tools.

Now, Kaiser Hospital has also adopted the InTouch Health® RP-VITA® robot, enabling physicians to visualize and communicate with patients and their families, while allowing patients to engage in comfortable remote consultations with their doctors from home.



III. Aetna
Aetna Global Benefits (AGB) was formerly known as Goodhealth Worldwide, which was acquired and renamed by Aetna in November 2009. Established in 1982, Goodhealth provided high-quality international medical insurance services to expatriates. Aetna is one of the leading diversified health benefits companies in the United States, and AGB operates as part of Aetna’s international business segment. It delivers comprehensive health service solutions to employees of multinational corporations worldwide.

On August 25, 2014, Aetna announced that it would shut down its CarePass platform by the end of the year. As CarePass had maintained a high profile and remained highly visible to the public, the news came as a surprise. CarePass was a software platform designed for health tracking and data integration. However, Aetna stated that this decision did not signal an abandonment of its digital health initiatives; rather, the company would treat the experience as valuable and continue to explore and advance in this field.

In November 2014, Aetna acquired bswift, a health insurance exchange platform company based in Chicago, for $400 million. In the same month, Aetna joined Samsung’s internet healthcare platform, alongside 24 other partners including CIGNA and Humana.
As early as 2011, Aetna acquired the digital health app company iTriage, laying the groundwork for future mobile application development. Later, in an interview, the president of iTriage explicitly stated that the company would undertake significant reforms in 2015 and pilot telemedicine consultations.

In January 2014, Aetna launched the “Resources for Living” app to help users alleviate stress and anxiety, achieve work-life balance, and track their emotional well-being. Meanwhile, Aetna’s original flagship app, Aetna Mobile, continued to receive updates and added tools for payment budgeting.



In addition, medical guides serving various countries and regions have been released, such as the Aetna China Provider Directory for China, the Aetna Middle East Provider Directory Tool for the Middle East, the Aetna Europe Provider Directory Tool for Europe, the Aetna Southeast Asia Provider Directory Tool for Southeast Asia, and the international Aetna Intl Provider Directory.

In February 2015, digital health company Wildflower Health and health insurer LifeMap partnered to launch a mobile application called LifeMap Due Date Plus. Targeted at expectant parents, the app offers features such as tracking physiological metrics for pregnant women, monitoring key milestones, and providing critical medical alerts. Aetna subsequently joined the initiative, recommending the app to its members. Notably, LifeMap’s parent company, Cambia, is a member of the Blue Cross Blue Shield Association.

This year, Aetna and Newtopia partnered to announce a patient-engaged remote monitoring pilot program. Newtopia will provide an engagement platform for several of Aetna’s large corporate clients, leveraging methods such as genetic sequencing and lifestyle assessment to generate personalized nutrition, exercise, and behavioral management plans for users. Additionally, Newtopia integrates wearable devices to support online education and social features on users’ mobile platforms.

In the wake of the Anthem data breach scandal, Aetna has pursued utmost rigor in privacy protection. According to a Fortune magazine survey, Aetna achieved a perfect score among all healthcare companies, whereas the average score for healthcare firms was only 17.

IV. Humana
As a well-known U.S. health insurance company, Humana has moved somewhat more slowly than its industry peers. Nevertheless, the company has consistently updated its mobile app and has not missed opportunities to collaborate with tech giants such as Apple and Samsung.

In October 2014, Apple and health insurance giant Humana jointly announced that they had reached a cooperation agreement on data sharing via the HealthKit platform. Reports indicated that Apple and Humana had actually been collaborating for several months, with both parties continuously sharing health data through HealthKit.

Humana is the first insurance company seeking to expand its business through HealthKit. When users observe deteriorating health conditions via the HealthKit platform, they can directly consult Humana for medical insurance services. In most cases, however, Humana proactively contacts users after obtaining health data—such as heart rate and blood pressure—offering a more convenient approach for both users and the insurer.

In addition to partnering with Apple’s HealthKit, Humana has also built its own platform. In October 2013, Humana acquired Healthrageous, a company that develops internet-based healthcare apps. Following the acquisition, some Healthrageous employees transitioned to work for Humana, a move widely regarded as a signal of major reforms to Humana’s health app, HumanaVitality.

The HumanaVitality health app has always been targeted at corporate employees. In August 2014, Humana released an update that enables the recording and tracking of exercise intensity, guides users toward healthy weight loss, and provides evaluative feedback. The app also integrates with other devices and applications, leveraging competitive features to stimulate users’ desire for challenges, thereby enhancing user retention. A new feature, Vitality Bucks, has recently been added, allowing users to purchase Amazon gift cards.

To evaluate the effectiveness of health applications, Humana conducted a dedicated survey and experiment. The data revealed that users who consistently engaged with the app-based health programs for over two years achieved an average monthly reduction of $53 in medical expenses and a 56.3% decrease in work absenteeism.

In addition to this app, Humana has developed other applications for members and consumers, such as MyHumana, Humana areMatch, Humana Pharmacy, and Humana Core. In July 2013, it launched RightSource, an app for managing and reordering prescriptions. This January, a medication reminder feature was added to ensure users take their medications on time. Recently, the MyHumana app has added a Spanish-language version and enabled users to check drug prices by taking photos with their mobile phones.

Humana’s member-facing app, MyHealth by Humana, has also received feature updates. Last November, it added the ability to link a HumanaVitality account, followed shortly by the introduction of single sign-on for all Humana applications. In January this year, practical features for measuring weight and blood pressure were also added.

In terms of external collaborations, Humana has maintained a low-key and discreet approach, avoiding widespread publicity. Therefore, it is difficult to determine whether any private initiatives have already been undertaken; however, it is indeed listed among the 24 partners in Samsung’s ecosystem. In August 2014, Humana also entered into a strategic partnership with Apple Health. Additionally, UnitedHealth is one of Apple’s collaborators. The focus of Apple’s partnerships with insurance companies is on employee wellness, specifically leveraging activity trackers to monitor employees’ daily physical activity and weight-loss progress. When employees successfully lose weight, employers can reduce their health insurance premium contributions.

V. CIGNA
In 1982, two U.S. companies, INA and CG, merged to form the new insurance company CIGNA. INA (Insurance Company of North America), established in 1792, was the first marine insurance company in the United States. CG (Connecticut General Corporation), a life insurance company, was founded in Hartford. Following the merger, the entity rapidly emerged as a leading provider of property and casualty insurance, life insurance, and employee benefits services. CIGNA International, a subsidiary of the CIGNA Group, is a global health services and related insurance company.

CIGNA’s presence in the internet healthcare sector is also distributed across various areas. With the advancement of wearable technology, corporate employers are most likely to foot the bill for sensors, serving as a bridge between wearable technology and insurance companies. In 2013, CIGNA launched a pioneering project that distributed BodyMedia-produced wearable armbands to thousands of employees. Survey results showed that employees at risk of diabetes who wore the armbands reduced their disease risk, demonstrating its effectiveness in disease management.

In October 2014, Cigna launched an internet-based healthcare education and training program called “Cigna Health Matters,” specifically targeting its 14 million members. The initiative incorporated social media and gamification elements, along with a web-based reward mechanism. Specifically, it began with a gamified online health assessment that evaluated indicators such as BMI, cholesterol, and blood pressure, assigning users a score to incentivize continuous improvement in health awareness. In October 2013, Cigna partnered with GoYou, an app aggregation and sharing platform, allowing users to log in directly to GoYou via their MyCigna or Facebook accounts. GoYou also announced its participation in Cigna’s Health Matters program.

In addition, like two other insurance giants, CIGNA has entered into a multi-year partnership agreement with Samsung, focusing on Samsung’s mobile health application, “S Health.” The two parties subsequently launched the “Coach by CIGNA” program, which is integrated into the S Health app. The program provides guidance on various aspects of daily life, including exercise, dietary nutrition, quality sleep, stress management, and weight control. It is available in 26 languages across 36 countries.

In January 2015, CIGNA assisted ORCAS, a developer of health intervention apps, in completing a study called FitBack, which found that providing targeted health guidance to individuals can effectively alleviate lower back pain.

VI. Blue Cross Blue Shield
Blue Cross Blue Shield (hereinafter referred to as "Blues") has numerous branches across the United States, which is a distinctive feature of the company. After six months of intensive promotion, Blues has secured partnerships with prominent corporate employers, enabling their employees to use the newly developed mobile app.

In August 2014, Blues expanded its mobile and online services with the launch of OneHealth, aiming to strengthen its mental and behavioral health programs. OneHealth provides 24/7 peer support, online education, and post-injury rehabilitation assistance. It also incorporates social media features, enabling real-time tracking of users’ emotional states and offering anonymous peer encouragement to help users maintain calmness. Similarly, BCBS introduced a Personal Health Record (PHR) project, developing a website for recording users’ health status, which holds significant importance for health management.

Three other Blue Cross and Blue Shield organizations—Independence Blue Cross, Florida Blue, and BlueCross BlueShield of Tennessee—have added new features to their flagship apps.

Independent Blue Cross’s app, IBX, has added a “Blue Button” module to help users automatically record their electronic medical records. Users can also view transfer expenses. In August 2014, the app introduced a feature allowing users to change their primary care physician, as well as check account balances and request ID card numbers.

In October 2014, Blue Cross and Blue Shield of Florida redesigned its physician search function and updated the registration user interface for 2015.
BlueCross BlueShield of Tennessee’s app, called My Blue TN, has added a “My Discounts” feature that allows members to independently select from a variety of services, such as acupuncture and massage, fitness trackers, and the purchase of apparel and equipment.

Empire Blue, a member of the Blues Group, has launched a telemedicine solution that provides Electronic Data Interchange (EDI) services. This service is accessible to healthcare providers, insurance companies, fiscal intermediaries, and other institutions. EDI is characterized by its speed, cost-effectiveness, security, and automation.

Highmark is a leading health insurer in the United States and an affiliate of Blue Cross Blue Shield, the fourth-largest such entity. In October 2014, Highmark announced that it would cover web-based teledermatology services starting in 2015. This service is supported by its parent company, DermatologistOnCall, a firm specializing in remote dermatological consultations.

HCSC has been engaged in a long-standing rivalry with Blues. In 2012, HCSC acquired certain assets of Blue Cross and Blue Shield of Montana, followed by an additional $23 million investment in 2013, underscoring HCSC’s unwavering determination to bring the Blues entities under its umbrella. In September 2014, HCSC launched its first-generation mobile health application for members, named Centered, which primarily focused on fitness tracking and medication adherence. The app calculates daily calorie expenditure, distance walked in kilometers, and exercise duration, among other metrics. Additionally, HCSC partnered with Healthbox, including a $7 million investment as part of its global partnership with the company.

In December 2014, the Oregon Health Plan (LifeWise Health Plan) partnered with an affiliate of Blue Shield Blue Cross to build a service platform for tele-diagnosis and treatment, disease prevention, health education, and disease management, primarily serving residents in three U.S. states. The tele-diagnosis platform was developed mainly in collaboration with Teladoc.

Actively seeking cooperation from various parties is one aspect; investing in internet healthcare companies is also a crucial strategic move for Blues. In September 2014, Florida Blue sponsored Johns Hopkins Medicine with $100,000 to specifically develop tracking devices and mobile apps aimed at guiding obese adolescents to change unhealthy habits.

In January 2015, the Independence Blue Cross Center made a strategic investment of $2.4 million in CareCam, a developer of chronic disease management apps. CareCam’s chronic care service, known as vHealth, enables patients to record videos related to their medical management, such as foot examinations or blood glucose monitoring for diabetes. All content is uploaded to a “flashboard,” allowing healthcare providers to monitor and assist patients in self-management.

Additionally, Independence Blue Cross, two other Blues companies, and a health technology firm jointly acquired NaviNet—the largest real-time secure communication network community in the United States. Designed specifically for physicians and hospitals, NaviNet identifies issues during clinical care and provides real-time alerts to ensure compliance. For instance, it reminds physicians not to overlook colorectal cancer screening, thereby helping to prevent postoperative safety risks.

In the realm of big data, Independence Blue Cross has collaborated with New York University and NYU Langone Health to develop machine learning algorithms, with the aim of applying them in healthcare for the early prediction of diabetes.
Similar achievements include BCBSNC’s development of a predictive model that assesses members’ health and disease risks by collecting a range of data, including user behavior, purchasing habits, leisure activities, and exercise patterns. Additionally, models have been developed to predict the risk of heart disease, the likelihood of emergency department visits, and the probability of requiring knee replacement surgery. These predictive tools can all enhance clinical treatment outcomes.

On December 3, 2014, WellPoint, one of the largest health insurance companies, was officially renamed Anthem. In 2004, Anthem Insurance Companies acquired WellPoint Health Networks, resulting in a merger that ultimately formed Anthem Inc., a for-profit organization under the Blue Cross Blue Shield Association. In February 2015, it was revealed that Anthem’s website had been hacked, leading to a breach of personal data.

VII. BUPA
BUPA was established in 1947 as an alternative to the newly created UK National Health Service, and it is a leading international health and insurance company. BUPA is a company limited by guarantee and has no share capital. This means that it can reinvest all of its profits into providing better healthcare services to its customers. BUPA does not pay dividends, indicating that it is not subject to speculative pressures.

It can be said that Bupa strategically positioned itself early in the future landscape of internet healthcare. In a groundbreaking announcement, it revealed collaborations with the International Telecommunication Union (ITU) and the World Health Organization (WHO) to further accelerate global research and development in internet healthcare. The initiative, titled “Internet Healthcare 2024,” clearly reflects Bupa’s ambitious vision for this sector. The company aims to continuously monitor key nodes in the progression of human diseases, track health status over time, intervene in behaviors, and guide users toward adopting healthy lifestyles. This approach evidently represents the future direction of healthcare, holding significant potential to transform our current methods of disease management and truly realize the goal of “prevention first, treatment second.”

How did Bupa initially enter the internet healthcare sector? As early as 2002, Bupa introduced Pegasystems’ intelligent customer management system, which enabled the company to better manage customer complaints and support services, ultimately facilitating personalized and differentiated customer management.

The concept of a health cloud platform is relatively trendy in China, but it is nothing new in the United Kingdom. On December 31, 2012, Bupa launched its internet-based healthcare cloud platform. Bupa Cloud Cover integrates all health data from cloud-based apps and connects with other mainstream applications on the market. Bupa analyzes all the data collected by these apps and uploaded to the cloud, providing feedback or recommending targeted products and services to specific users.

When it comes to telemedicine, Bupa was the first to apply it to psychological counseling services. In 2013, Bupa launched a service providing psychological counseling for professionals. With no appointment needed and available 24/7, users can communicate face-to-face or via phone with trained professional psychologists. The treatment is characterized by its short-term nature, and self-help online services are also provided to help white-collar workers quickly address psychological issues such as stress, anxiety, and depression.

In the realm of health management, Bupa has also been highly active. In November 2014, Bupa partnered with digital health startup Vigil Monitoring and Spark Ventures to propose innovative solutions aimed at addressing geriatric diseases and elderly care challenges. Vigil Monitoring develops a suite of digital services to enhance healthcare quality and reduce medical costs through information technology. Its target population comprises individuals aged 65 and above in New Zealand, a demographic projected to exceed one million by 2031.

In February 2015, Bupa and University College London jointly established the Global Internet Healthcare Association. This initiative has fostered interconnected collaborations between Bupa’s healthcare experts and academic researchers at the university. The project aims to quantify the effectiveness of internet-based healthcare interventions, assist patients in adopting healthy lifestyle habits, and ultimately reduce the future incidence of chronic diseases through its research findings.

In January 2012, BUPA partnered with The George Institute to develop the FoodSwitch app, which analyzes food composition and guides users and their families in making healthier dietary choices.

In January this year, as more companies recognized the importance of employee health, they began seeking suitable third-party service platforms. This led to the launch of the Bupa Boost mobile app, a health-tracking application that provides internet-based healthcare solutions to help employees better maintain their health.

This service is available to all employees, regardless of their insurance enrollment status. The app emphasizes four pillars of health: mental well-being, nutrition, relaxation, and exercise. Bundled rewards and interactive activities are designed for each module, with optional integration into third-party app platforms and wearable devices.

Bupa also offers several other distinct mobile applications. For instance, the Health Finder app guides users through a step-by-step symptom assessment to provide a preliminary disease evaluation and locate the nearest healthcare facilities. Additionally, Walk Your Way is a publicly accessible app that tracks users’ step counts to promote healthy exercise habits.

In January 2012, BUPA had already leveraged software for population health analysis. This predictive modeling tool was jointly developed by Health Dialog and The Dartmouth Institute for Health Policy and Clinical Practice.

Bupa offers the Population Health Toolkit, which integrates global disease risk prediction analytics with existing devices to optimize patient stratification by incorporating primary and secondary care data, thereby enabling effective population health management. Key features include providing prospective and retrospective insights into costs and risks.

VIII. AXA PPP Healthcare
AXA PPP’s history can be traced back to the London Association for Hospital Services in 1983. Its primary mission was to provide health insurance plans for the middle-income population in London. The company was established in 1940 with the support of the Royal Medical Colleges, the British Medical Association, and the King’s Fund.

In 1998, the company was acquired by Guardian Royal Exchange and was renamed AXA PPP Healthcare in 2002 to reflect its new identity. In 2009, AXA PPP Healthcare International was established to address the growing demand in the international market.

Today, AXA PPP Healthcare is one of the largest and most experienced private medical insurance providers in the UK and worldwide. In short, its business focuses on high-end medical insurance.

In the field of internet healthcare, the company has the following representative apps.
1. My Health APP: Gain a comprehensive understanding of your health status. It facilitates member registration and provides automated disease assessments based on simple symptom descriptions or data entry, with particular expertise in musculoskeletal disorders.

The app can identify underlying conditions prior to treatment and offers a wealth of medical information, covering over 800 diseases, location details for nearby doctors and hospitals, and comprehensive insurance guidelines for specific conditions. It also enables online consultations with medical experts.

2. AXA Health Gateway: This app integrates a wide range of tools, articles, and expert advice on health behaviors to help individuals improve their well-being. It encompasses five key elements: health, fitness, nutrition, lifestyle, and mindset. Leveraging this behavior-building tool, the iPhone is transformed into an activity monitor.



3. AXA PPP International (discontinued after February 2015) provided members with unrestricted access to medical information anytime and anywhere, divided into a “User” module and a “Doctor” module. Online Customer accounts allowed 24/7 login access. Through the MyGlobe module, users could search for 10,500 healthcare professionals, as well as access evaluations of healthcare systems by country, along with health and safety alerts. The “Blog” module enabled real-time synchronization and updates of blog content.

By referencing the initiatives of international commercial health insurance companies, we can summarize the general categories of activities in the field of internet healthcare. First, insurance companies have established comprehensive information communication systems with hospitals, physicians, pharmacies, and patients, enabling remote interaction or online communication among participants in the healthcare ecosystem. While specific formats may vary, these systems generally provide online consultation services; offer telemedicine for certain conditions such as dental, ophthalmic, and psychological disorders; partner with local pharmacies to allow direct prescription fulfillment; ensure transparency in medical service charges; calculate health insurance account balances; establish personal electronic health records (EHRs); and permit data exchange between institutions, thereby achieving a wide range of functions from shared resource data to equitable information exchange.

In contrast to the current state of healthcare in China, although some hospitals have adopted internal information systems, medical record data remains stored within individual institutions. The lack of genuine exchange and sharing of electronic health records inevitably creates barriers for patient referrals and follow-up visits. Furthermore, due to policy restrictions, online sales of prescription drugs have not yet been realized. This is largely because hospitals, prioritizing their own financial interests, are reluctant to release prescriptions externally, leaving patients in a predicament where they cannot independently purchase medications without a doctor’s prescription. Regarding inquiries into medical insurance account balances, commercial insurance companies abroad serve as the primary payers. Consequently, there is a strong demand for cost containment, and these insurers possess comprehensive data on users’ medical expenditures, enabling them to easily offer features for checking insurance account balances. It is evident that such internet-based models cannot be implemented in China at the present stage.

What actions can commercial insurance companies in China take? As demonstrated by Ping An Good Doctor, which offers free online consultations with expert medical professionals, any approach that enhances users’ health outcomes is likely to become a focal point for commercial insurers. With the gradual establishment of a tiered diagnosis and treatment system, patients in China can also search online for nearby clinics or community hospitals based on geographic location, thereby avoiding the overcrowding of large hospitals for minor ailments.

Beyond single-episode online consultations or telemedicine, long-term continuous management of chronic diseases has become a key focus for foreign commercial health insurers. These insurers not only provide users with online health education but also track and record various physiological data—such as diet, exercise, and step count—to calculate and feedback information on users’ health status, thereby guiding users and implementing behavioral interventions to improve health. The delivery formats may incorporate gamification elements and typically adopt an integrated model combining mobile apps, wearable devices, and traditional communication channels. Furthermore, given that the primary population affected by chronic diseases is the elderly, it is particularly important to explore devices and apps suitable for older adults.

In this field, domestic commercial insurance companies can fully draw on overseas chronic disease management methods. For instance, Ping An Insurance is exploring the extent to which chronic disease management can reduce premiums, aiming to establish a “health management + health insurance” model. The company plans to incorporate health management services into its health insurance products in the future, including physical examinations, genetic testing, and appointment services with renowned specialists. This model is essentially an internet-based version of the Health Maintenance Organization (HMO) package. HMO is a form of managed care prevalent abroad, where institutions and patients agree on certain discounted rates, and institutions provide bundled medical services that are more affordable yet maintain controlled quality. This represents a key advantage of commercial insurance companies over individual patients: insurers can negotiate with hospitals to secure lower group-purchase prices.

In the realm of medical big data and health prediction, Chinese insurance companies can also adopt a pragmatic approach by proactively leveraging advanced international biotechnologies and data modeling techniques to achieve disease prevention and control, as well as reduce healthcare costs. However, the core challenge with big data lies in the sufficiency of data sources and volume. If the number of insured individuals is too small, it fails to constitute meaningful big data research.

From a macro perspective, foreign healthcare systems are centered on the PPP model involving patients, physicians or hospitals, and payers. Payers consist primarily of governments and well-developed commercial health insurance companies, whereas China’s basic medical insurance is mainly subsidized by the government. Consequently, domestic commercial health insurers have long experienced unbalanced development, characterized by a narrow customer base and a focus on the high-end market.

However, over the past year or two, China has continuously introduced favorable policies. For instance, on August 13, 2014, the State Council officially issued the “Several Opinions on Accelerating the Development of Modern Insurance Services” (hereinafter referred to as the “Ten National Measures”), which set forth development goals for the insurance industry: by 2020, insurance penetration (premium income/GDP) would reach 5%, and insurance density (premium income/total population) would reach RMB 3,500 per capita.

“The Ten National Measures” explicitly state that in the field of insurance services, particularly in health, efforts should be made to promote the integrated development of the insurance service industry and the medical service industry, support insurance institutions in participating in the integration of the health service industry chain, and actively explore and advance the provision of various medical insurance administrative services by qualified commercial insurance institutions.

Therefore, with the steady development of commercial insurance in China, the ideal vision that is currently difficult to achieve will ultimately break through and become a reality in the future.
Appendix: