4 Possibilities for Internet Healthcare and Commercial Insurance 10% of online medical payments?

Since this year's outbreak, Internet medical treatment ushered in a major breakthrough for the payment side, medical insurance to the Internet medical opening, especially in Beijing, Shanghai and other large public hospitals, almost on-line Internet medical services at the same time connected to health insurance payments, several head of Internet medical enterprises under the Internet hospital also included in health insurance, can promote the transfer of patients online.
, however, in the case of stricter control fees and large differences in policies, it will take time for medical insurance to be fully rolled out online, and commercial insurance will naturally become a potential payer, especially for Internet medical enterprises.
, what are the models of Internet medical and commercial insurance combination? What are the challenges? What is the long-term connection value? We explore the answers to these questions through product service information from 10 companies and interviews with a number of industry insiders.
B2C's compensation is only part of the commercial insurance as the payer of Internet medical care, the most direct is the reimbursement of online medical and medical expenses.
the artery network after research learned that some Internet medical enterprises and insurance companies have cooperated to launch related products.
Commercial Insurance directly to the Internet medical patients compensation model (incomplete statistics), source: public information, interviews, arterial network drawing as early as 2017, micro-medical and public security insurance jointly released the first domestic Internet medical health insurance, the introduction of home-oriented micro-medical home protection - Internet hospital outpatient insurance products, patients can pay for online diagnosis and treatment and drug costs.
2020, the company will launch door-to-door emergency insurance covering online services based on its Internet hospitals, and will also be free to pay for drugs incurred by online medical treatment.
, the micro-network nurse protection program also provides patient-specific protection.
Xuhuiyun Hospital, in combination with its enterprise cloud infirmary and partner's enterprise group insurance, launched the staff online medical treatment of the direct compensation.
, head of micro-medical group Micro-Medical Group, believes that in the future, health insurance and commercial insurance will become the basic payment form of Internet diagnosis and treatment.
first, the purchaser of medical services is health insurance, to help people realize the payment of basic medical services, and second, health insurance, can more comprehensively meet the people's more personalized health needs.
although there are not many products that are directly reimbursed to patients at this stage, these products are on the rise from 2017 to 2020, and Arterial Network understands that some companies will be launching similar products in the near future.
online and offline medical and reimbursement characteristics, source: public information, interviews, arterial network drawing for a different angle, combined with online medical scenes, medical payment structure and other characteristics: online, medical scenes include outpatient and inpatient.
" commercial health insurance is mostly millions of medical and serious illness insurance, paid for or paid for inpatient scenarios.
Xuejian, head of Zhiyun Health Insurance Business Department.
data from the official website of the CIRC show that of the recorded life insurance products, only 109 have "door emergency" insurance and 1,661 have "hospitalization" insurance.
the same is true of medicare, which claims far more for hospitalizations than for outpatients.
online, Internet medical care can only be located in outpatient clinics, can not directly assume the function of inpatient treatment.
Though there is currently no accurate market data, but through the above comparison can be seen, even if the online health insurance payment widely spread, commercial insurance products widely covered, patient compensation this part is also very much to reach the overall offline payment volume.
this also determines that patient-based outpatient insurance will be part of the Internet medical payment system, the industry continues to develop more payment channels to consolidate.
three B2B co-operation models, although Internet medical can not afford hospitalization, resulting in this part of the loss of compensation.
But good in the Internet's endegiance can alleviate the scarcity of high-quality medical resources, inefficient traditional access to medical care, information asymmetry between doctors and patients, Internet medical treatment will also have the opportunity to benefit from it.
that there are still three B2B models between Internet healthcare and commercial insurance payments.
the model of Internet healthcare as a provider of commercial insurance is mainly that Internet medical enterprises provide a range of online health care services to insurance companies, which integrate these services into products to provide to customers.
Ping An medical insurance technology related person in charge of the introduction, the model of products and services in the traditional commercial insurance simple additional online medical services, such as millions of medical products attached to online consultation and other services, to enhance the competitiveness of insurance products.
Internet Medical as an insurance company service provider cooperation model, source: public information, interviews, arterial network drawing using this model of Internet medical enterprises and insurance companies more, Ping An good doctor is one of the typical enterprises. in its 2020 semi-annual report,
Ping An good doctor disclosed that on the one hand, continue to promote the development of health insurance, on the other hand, continue to work with commercial insurance, cooperation with commercial insurance and membership products remain its core business online medical sector of the main source of revenue.
Micro-medicine and AIA, magnesium letter health cooperation, jointly launched for breast cancer single-disease insurance products "guardian lily medical insurance", the three parties integrate their resources, through the medical treatment process, medicine, insurance core links, to provide customers with breast cancer disease from prevention, medical treatment, medication to rehabilitation of the whole process of closed-loop services.
, micro-medicine has also reached a long-term strategic cooperation with AIA.
AIA customers have priority access to a range of micro-medical health services, including appointment registration, online consultations, offline clinics, etc.
addition, Good Doctor Online, Micro-Pulse, Zhiyun Health, etc. have also launched cooperation with insurance companies.
The new version of the Health Insurance Management Measures promulgated in 2019 stipulates that health management services account for up to 20% of the cost of insurance products, and the Notice on Regulating Health Management Services of Insurance Companies issued in 2020 defines the scope of health management services, including: health check-ups, health consultations, health promotion, disease prevention, chronic disease management, medical services, rehabilitation care, etc.
that the scope of Internet medical services is highly in line with the health management content in the new regulations, there is room for further development of this model.
" Internet medical for health insurance to provide health management online services closed loop, health insurance from medical claims to health management of the migration of the possibility, which provides a new way for health insurance fee control model.
"Ping An health insurance technology related to the person in charge said.
Internet Medical as an insurance company's product design support is precisely because Internet medical can carry out efficient services, but also accumulated a large number of medical health and behavior data, so this advantage can be used as the insurance company's product design and wind control management service providers, for insurance companies to provide a reference for product design and rate development.
Internet medical as an insurance company's product design support model, sources: public information, interviews, arterial network drawing Zhu Cedar said, through the digital health platform, Internet medical as an efficiency enhancer and payment lever function will gradually integrate, forming a mutual cooperation, to protect the health of the insured HMO system.
Taking micro-medicine as an example, through the digital health platform, we can integrate all-round technical capabilities, medical capabilities and medical resources, on the one hand, to provide medical and health service support for commercial insurance companies, targeted big data, medical artificial intelligence and other technologies and medical insurance settlement support;
will eventually provide users with a full-process closed-loop service covering prevention, medical treatment, medication, payment, and rehabilitation.
health insurance technology related to the person in charge, slow disease management can achieve exclusive product risk control.
, for example, diabetes patients achieve risk control of complications through scientific management, making it possible to have exclusive diabetes insurance.
this regard, Zhiyun Health is working with insurance companies based on historical consultation data to develop customized products for single-disease species.
Zhiyun Health is working with insurance companies based on historical consultation data to develop customized products for single-disease species.
Liu Xuejian revealed that in the past a long time, Zhiyun Health has accumulated a great amount of data, can carry out deep mining, on the one hand to improve the diagnosis and treatment of chronic diseases and management efficiency, on the other hand, to help the product design.
Through Zhiyun Health's Chronic Disease Management and Insurance, for insured people, access to health care at the same time, enjoy professional digital health management services, for insurance companies, in the short term to ensure the health of customers, reduce the overall rate of payouts, in the long term can be based on more detailed data and assessment to enhance the ability to protect.
Health leverages its extensive experience in digitizing health management to work with insurance companies to explore solutions to control premium costs and risk control, and to design and develop slow-disease insurance products for chronic disease management and insurance coverage.
Based on the core capabilities of AI, Internet of Things and Big Data, Miao Health has built three platforms: Miao and IoT Health Big Data Platform, H-Health Risk Rating Management Platform and M-ARTIFICIAL Health Intervention Platform to quantify users' health levels through scoring indices, analyze health risks and intervene in a timely manner to cover the entire life cycle and reduce the risk of disease.
At present, Miao Health is also working with reinsurance companies and insurance companies to promote risk protection and health management integrated health promotion policies, trying to through insurance agents, health managers and other multi-point interaction, play the integrated function of commercial insurance payment, to achieve a comprehensive upgrade of insurance product health protection.
under the above-mentioned cooperation model, more Internet-based medical single-disease insurance is possible.
, patients, insurance companies, and Internet healthcare companies benefited from the HMO system.
internet medical as the insurance company's product channel, Internet medical can also be used as the insurance company's channel, set up insurance products display sales and consulting platform.
Internet Healthcare as an insurance company's product channel model, sources: public information, interviews, arterial network map micro-medicine Internet health insurance platform covers the health insurance portal, insurance claims services and health accounts three core.
integrate the advantages of each insurance company to provide users with online purchase, health care and claims services.
's APP offers an online purchase channel for special medicine insurance.
addition, Liu Xuejian revealed that Zhiyun Health also recently acquired a online sales license, plans to start online and offline customers to set sales scenarios, to do insurance product conversion.
this model is relatively more direct and simple, that is, Internet medical enterprises use their own traffic advantages, for commercial insurance to build a sales scenario, expand access channels.
challenges and trend Internet healthcare lack large-scale payer, commercial health insurance products and services need to be upgraded.
in the exploration of the patterns in the above 4, the two are already starting to connect based on their respective needs, but still face some challenges.
is the challenge of data connectivity and sharing.
In Wang Yanhua's view, the in-hospital medical data and out-of-hospital health data are a huge obstacle to the realization of precision control fees.
We understand that the failure to connect data interfaces between healthcare, healthcare, pharmaceutical and retail organizations is hampering the further integration of digital technologies such as big data and medical artificial intelligence into the traditional healthcare industry.
, patient-centered medical and health data sharing methods and systems need to be improved.
is the challenge of user size and transformation.
Internet medical treatment is located in consultation and re-diagnosis, the impact of diseases and population is limited, the overall scale is still unable to be compared with traditional medicine.
even though some platforms already have a large number of users, it's a long and arduous task to get users to pay.
these challenges, in addition to improving product quality, service quality, and operational capabilities, governments need to promote the establishment and connectivity of health data.
, the industry surveyed is still generally optimistic about the combination of the two trends.
from the perspective of the open policy of health insurance, Ping An health insurance technology related to the view that the Internet medical support health insurance settlement, will speed up the integration with commercial insurance speed.
From the perspective of the real needs of commercial insurance, Wang Yanhua said that the current health insurance payout rate is basically about 30%-40%, in previous years even only 10%-20%, the proportion is very low;
The reason is that health insurance expenses are more in the guest stage, marketing and channel costs accounted for a large proportion of the real application of compensation and medical services costs are not much, cost control and risk management capabilities need to be improved.
these reasons, the combination of the two is more clear.
" business insurance in the short term on the Internet medical most clear demand includes: whether to get customers, control fees, improve customer satisfaction plays a key role.
," Liu xuejian said.
, how can Internet healthcare help businesses win customers, control fees and improve customer satisfaction? There are two main directions: for patients, to provide a range of pre-hospital, in-hospital and post-hospital services.
hospital is mainly to build a hierarchical diagnosis and treatment system, accurate matching of medical resources, first on-the-internet consultation, there is a need to go to the hospital, cost savings.
hospital mainly embedded Internet medical treatment in the hospital, improve the efficiency of doctor's consultation, shorten the number of days in hospital, thereby reducing medical costs.
hospital is mainly to provide follow-up management for patients, to help patients recover as soon as possible, to avoid minor illness into serious illness.
for healthy people, Internet medical treatment can carry out professional health monitoring, health guidance, play a "cure the disease" role, improve the overall health management awareness of residents, to meet the daily health needs of residents.
with AI and big data, we can create accurate solutions for users in health management and chronic disease management, spending premiums on prevention and reducing disease risk, thereby reducing spending on treatment.
, Wang Yanhua also mentioned that the direction of health care reform can be used as a reference.
, for example, by collecting medical resources to control costs, digitally unite hospitals, doctors, and pharmaceuticals to seamlessly connect products and services in a volume-based procurement or membership-based manner. < b