What's behind the insurance company's call for big data sharing in health care?

Recently, under the guidance of the Health Insurance Working Committee of the China Health Information and Health Care Big Data Society, led by China Taibao and tai security association, the White Paper on The Frontier Development Model of Commercial Health Insurance under the Big Data Ecology (hereinafter referred to as the White Paper) was officially released.
is seen as one of the technologies most likely to change the way the insurance industry operates, according to the White Paper.
First, big data is conducive to solving insight problems, insurance and data naturally fit, the inherent logic of health insurance is based on health care data;
, it helps business health insurance to form a new era of digital decision-making and digital management.
photo source: Tu worm creative demand side: eager to diversify multi-level protection In recent years, China's GDP level has been growing steadily and rapidly year by year, 2020 GDP is the first time to exceed 1 million U.S. dollars.
the rising income level of consumers, the demand for healthy financial security is significantly increased.
2020 new crown pneumonia outbreak has increased consumer concerns about risk protection, especially the increased demand for health insurance.
The White Paper surveyed thousands of consumers and summarized four major trends in health care needs, from "I want to be insured" to "I want to be insured", from "simplification" to "diversity", from "singleness" to "interactivity", from "guaranteed foundation" to "health".
survey data show that only 16.9% of consumers think they are healthy, 47.8% of consumers say it is necessary to configure commercial health insurance, different income levels, different ages, different life circles of the population for insurance protection needs, interaction and service types are also different, which also truly reflects the current growing consumer demand for diversified multi-level health protection, commercial health insurance for specific groups of people to provide specific products and customized services innovation ability to put forward higher requirements.
supply side: the value of health insurance is insufficient China's commercial health insurance after more than 30 years of development results, in 2019 health insurance premium income reached 706.6 billion yuan, the annual compound growth rate of more than 28% in the past decade.
But at the same time, China's commercial health insurance in the development process has also encountered a series of challenges, health insurance, especially medical insurance is a very test of enterprise fine operation of the insurance, risk pricing needs a lot of data support.
because of the current lack of medical data docking and sharing mechanism, actuarial database can not be expanded, so on the one hand inhibited the product innovation of health insurance, on the other hand, also makes the phenomenon of product homogenization serious.
To huimin insurance products, for example, should be "one city, one policy", according to the health of residents in different regions to price, but driven by the market white-hot competition, in order to seize the market as soon as possible, not only the terms are very similar, pricing lack of adequate health insurance data support.
At the same time, while the basic medical insurance forms a wide coverage and guarantees the basic supply, the development of commercial health insurance lags behind, does not fully exert its market flexibility, and its position in the industrial chain is relatively weak, and has not yet been able to use the advantages of its payers to link up the medical and health industry chain.
In management, many insurance companies are also difficult to get out of the "pan-life insurance" operation inertia, product structure single, channel development and use of high cost, low level of specialization, wind control means lag, high profitability and other issues have not been well resolved.
Breaking the way: Repositioning the advantages of health insurance payment role From a long-term perspective, commercial health insurance needs to reposition the advantages of its medical health industry chain payment role, through a series of users, medicine, medicine, health management and other multi-stakeholders, to build a medical health ecological value chain, the formation of things Closed-loop health services for pre-prevention, in-service diagnosis and treatment, and after-the-fact management, while exploring new business development models through differentiated positioning with basic medical insurance, fully relying on big data technology to optimize industry operations, finding new profit margins, changing passive payments and relying on the traditional three-way single profit model.
in the breadth, to build an all-channel, all-people, full life cycle of health insurance product supply system.
in depth, relying on the social security directory to establish a supply and demand linkage, risk control of the dynamic business insurance directory.
, the risk cost of transforming basic procurement into integration symbient, balancing and reconstructing the safeguard boundary.
in the wind control, series of medical resources and commercial insurance supply, innovative payment model, the establishment of a risk-sharing mechanism.
to achieve these transformational developments, an important support is health care big data.
In the past, the degree of information and digitalization has not reached a great rich, interconnected time, mainly by manual means to carry information, with the deepening of medical reform and the level of medical insurance information technology continues to improve, social data connectivity is possible, which gives commercial health insurance the opportunity to get out of the existing empirical logic, really Starting from customer protection needs, establish a precise and customized full life cycle insurance guarantee supply for different users, based on data to break through the existing health insurance-based operating bottlenecks, from "health insurance" to "health insurance", to build a new health management and medical payment ecological supply system.
In product innovation, the White Paper is based on a customized model of specialized and sophisticated small group health insurance products such as age-breaking products, urban customized products, single-disease vertical domain products and special occupational customization products.
In service innovation, establish a digital portrait of users, pre-risk management, implementation of accurate pricing, remodel the two-core business process, carry out data engineering, build intelligent operation, connect the medical and health system, integrate product innovation, promote online services, apply medical technology, layout core capabilities, build health care closed loop.
In marketing innovation, according to the current trend of online, digital and socialized crowd, with the help of private traffic into a specific circle layer, based on data and technology analysis of their population health risk characteristics, to provide them with customized products, and supporting health management services deeply embedded in the user's circle scene, in order to enhance user satisfaction and satisfaction at the same time, complete the expansion and transformation of the customer group, to achieve win-win results for both sides.
Recommendations: Standardized application, urgent sharing The White Paper suggests that the governance and application of big data should be promoted to the strategic development height of business health insurance enterprises, which requires the enterprise's high-level macro-plan architecture, from the bottom of the data governance to business value transformation, from the construction of big data platform to foster data intelligence and medical management personnel, and gradually establish a truly customer-centric business model, so as to achieve the transformation of business health insurance model.
The cognitive management transformation of enterprise leadership and the level of "digital commerce", the cultivation of "medical management" and "data operation" talents, the customer-centric value orientation driven by big data and the long-term sustainable data ecological governance will be the four basic supports for insurance enterprises to realize transformation and transformation in the future.
Based on the practical problems and challenges that business health insurance currently faces in the sharing of big data in health care, the White Paper argues that, first of all, health care big data applications face the challenges of using compliance, data security and privacy definition, user data attribution and use norms are not clearly defined, and the industry expects relevant national and government departments to promote the use of data compliance norms or guidance documents, guide health industry entities to better carry out data sharing and cooperation, and further stimulate data value and promote high-quality industry development.
Second, health care data subjects, resources scattered, different quality, facing the high cost of data docking and processing, business application difficulties and other issues, the industry looks forward to the upstream data sources and data users, led by the industry joint organization to build a data information sharing platform, play a joint role in jointly developing application standards, establish efficient channels for data sharing applications, improve the efficiency of industrial cooperation.