Can “Health Management + Medical Insurance” Ecological Closed Loop Become A New Moat in The Medical Field?


Catalyzed by the epidemic, the growth space of the Internet medical industry has been further opened up, especially in the field of “health management + medical insurance”. Recently, there have been continuous “big moves”, high financing news has been released one after another, and JD Health, Ping An Good Doctor, etc. in the secondary market The stock price and market value have risen sharply, and capital is increasingly optimistic about the future market space.

According to other sources, the Internet insurance platform Waterdrop Company is in the midst of intensive preparations and will go to the United States for an IPO in the next quarter. The latest valuation has reached tens of billions of dollars. Almost at the same time, WeDoctor, an online healthcare solution provider, is in the process of “preparation” for the equity sale after completing the Pre-IPO financing, and will apply for a listing in Hong Kong in the near future.

It is not difficult to see that at present, the Internet medical industry is in a critical development stage of deep integration of various business links and forming a closed loop. The “online + offline” integrated service model is gradually becoming clear, and the “health management + medical insurance” industrial ecological chain is becoming increasingly clear. perfect. Under the two-wheel drive of policy guidance and market demand, the construction of a “new infrastructure” for health protection with digital technology is in an explosive growth trend.

However, every new market format will have its inevitable laws, so for the industry itself, what kind of internal driving force is driving its rapid development? Why do companies in the depths of this track choose to collectively “accelerate” at this time? And what are the characteristics of digital health companies represented by Ping An Health, Miao Health, and Water Drop Health that support them to become industry benchmarks? All kinds of questions are before us.

What is driving Internet medical “out of the circle”

After 10 years, the new medical reform centered on the “three-medicine linkage” has gradually entered the deep water area. In February 2020, the State Council issued the “Opinions on Deepening the Reform of the Medical Security System”, which further clarified the need to accelerate the establishment of a multi-level medical security system and promote the reform of payment methods and the reform of the medical service supply side.

Driven by policies, China’s medical treatment, medication and payment systems have been rapidly optimized and are moving towards a multi-level medical security system. Markets such as out-of-hospital prescriptions, online diagnosis and treatment, commercial health insurance, and health management have also entered rapid growth.

At the same time, some high-end technologies such as artificial intelligence, Internet of Things, and big data are rapidly penetrating the medical and health field. They are reshaping the user-centric medical security system and are beginning to try to transform cutting-edge technologies into clinically usable solutions. In 2018, the State Council issued the “Opinions on Promoting the Development of “Internet + Medical Health””, clearly expressing the need to encourage the development of “Internet +” medical services, improve “Internet +” drug supply guarantee services, and promote “Internet +” medical security settlement services .

It can be seen that with the development of the times, the medical field is more firmly moving towards better service quality, higher accessibility, and more transparent medical expenses. The combination of various data technologies and clinical practices has also moved from the skin to the deeper level. Interaction, ushered in the “golden age” of development with the new medical pattern of “health management + medical insurance”, and became the core driving force for economic growth.

Stones from Other Mountains: What are the commonalities of foreign benchmarking companies?

Although the new market model has gradually become clear, whether it can truly go out of the market requires authenticity verification. Looking at the world, the United States, thousands of miles away from us, has hatched many successful cases.

United Health Group was established in 1974 and is the largest commercial health insurance company in the United States. According to the 2020 financial report, the company’s annual revenue was US$257.1 billion, a year-on-year increase of 6.2%; operating profit was US$22.4 billion, a year-on-year increase of 13.8%; net profit was US$15.769 billion, a year-on-year increase of 10.7%.

Behind a series of brilliant data, how did United Health build an Internet “insurance empire”?

With big data, health information, and clinical expertise as its core competitiveness, United Health continues to extend the industry chain on the basis of its main insurance business, creating a one-stop integrated service, focusing on the two major categories of health insurance (United Healthcare) and health services (Optum) Core business modules, and these two sectors have a strong synergy.

On the whole, although United Health is a commercial health insurance company, it does not only focus on insurance itself, but covers various core sections of insurance, such as payment, drug purchase, and medical treatment. The formed full-chain service model not only enables United Health to have powerful cost control methods, but also further improves the medical experience of the majority of users.

In addition to the insurance field, there are also successful cases in other fields.

Kaiser Permanente is currently the largest private non-profit medical institution in the United States. According to the 2020 financial report, Kaiser Permanente achieved annual operating income of 88.7 billion U.S. dollars, an increase of approximately 5% from the previous year’s 84.5 billion U.S. dollars. However, this is not the most exciting part of Caesars Medical, and what really makes the company shine is its unique “HMO” operating model.

The “HMO” operating model refers to a system that provides comprehensive medical services to people who actively participate in insurance in a specific area after a fixed prepaid fee is collected. As the originator of the “HMO” operating model, the core characteristics of the Caesars Medical business model are its insurance and medical integrated organizational structure and a pay-per-person system. In the closed system of insurance companies, hospitals, and doctor groups, Caesars Medical has realized the efficient operation of self-financing, and provided the medical institutions with the motivation of cost control through the prepayment system.

Whether it is United Health, which focuses on the insurance field, or Caesars Medical, which focuses on medical services, they have chosen a user service-centric ecological closed loop in their business system, and each core link in the user experience process is included in the service category. And set up relevant agencies or functional departments for direct management, thus forming an integrated service model.

But this is not the only element that promotes the development of Internet medical companies.

Livongo is a technology company with the digital management of chronic diseases. It took diabetes solutions as the starting point. From establishment to listing, Livongo only took a short period of five years, which can be regarded as a “growth model” in the digital health field in the United States.

Livongo positioned its solution in the new medical field, proposed the concept of Applied Health Signals, and built an AI+AI system to support the provision of its own solutions. The AI ​​here is not the hot domestic artificial intelligence. “AI+AI” refers to collection (Aggregate), interpretation (Interpret), application (Apply), and iteration (Iterate).

It is not difficult to find that although the three companies focus on different digital health sectors, they can still find the common ground between them, that is, focusing on technological innovation and building a closed-loop service. These two characteristics are also important for companies to achieve major breakthroughs and become industry leaders. Endogenous power.

Focusing on the domestic market, how are high-quality companies making efforts?

Relying on the liberalization development path in the United States, many successful cases have been born, proving the feasibility of the new operating model of “Internet + medical health”. However, different environments will give birth to different health management models, and China and the United States, which have large differences in the field of medical and health care, will inevitably adopt different “styles” on the development path of “Internet + medical health”.

Under the trend of differentiation, how do domestic leading companies deploy? From the upgrade of insurance strategy to Ping An Health focusing on “medical + health”, from mutual assistance for major illnesses to health insurance and then to health management, and from health management to reversely empowering the wonderful health of commercial health insurance, these three representative companies have started from Different angles and different entry points will gradually build a closed-loop ecology.

On January 27, 2021, China’s leading Internet healthcare service platform, Ping An Health Medical Technology Co., Ltd. (stock code: 1833.HK), announced that with the overall upgrade of the company’s strategy, the “Ping An Good Doctor” APP was officially renamed “Ping An health”.

The name change mainly includes two meanings. The first is to leverage the national policy to focus on the three directions of channels, services, and capabilities to create a full life cycle health management service covering prevention, treatment, and rehabilitation for users; the second is to strengthen and safety The collaboration of the group’s medical and health ecosystem is committed to providing high-quality “medical + health” services to citizens.

Like Ping An Health, Waterdrop also focuses on the comprehensive creation of an integrated service model. In an interview in 2019, Shen Peng, the founder and CE0 of Waterdrop Company, told, “In the future, Waterdrop will become a platform company in the health field. It will conduct in-depth collaboration with suppliers in the large health field to allow C-end users Enjoy better diagnosis and treatment at a lower cost.”

In 2020, Waterdrop began to explore the “Internet + medical and health” operation model. While providing users with more and more efficient insurance protection services, it also accelerated the exploration of medical and health services that can be combined with health insurance based on user needs. In addition, Water Drop also launched a new project to explore the “risk + medicine” model, named “Water Drop Good Medicine Payment”, to provide drug welfare services to healthy and sick people.

Driven by the market environment, Ping An Health and Water Drop have taken a distinctive path in line with their own development, but this is not a “standard answer” and there are still other paths to choose from. As the leading digital precision health management platform in China, Miao Health starts from health management, connects medicine, medicine, and insurance, and deeply explores the value of big data on health behaviors and precision health management.

MyoHealth attaches great importance to digital technology innovation. It uses the Internet of Things and smart hardware to obtain user health data in multiple dimensions, breaks up the information barrier between the device interface and the data platform, and combines professional medical research and artificial intelligence algorithms to calculate the health behavior index (M value). ) And the comprehensive health score (H value) intuitively give the user’s portrait, conduct continuous full-scene data tracking and analysis of the user, output a “thousand-thousand-thousand-face” health management plan, and uniformly form a powerful health management digital center , To drive the link and application of health management with multiple industries and multiple scenarios, including the empowerment of insurance scenarios, corporate scenarios, healthy communities and healthy cities.

In order to open up the space for insurance companies to control fees and realize the full-process convenience of health management services, Miao Health continues to deploy in the insurance field and has established cooperation with more than 80 domestic insurance institutions to help insurance companies make up for their shortcomings in health management service capabilities. Focusing on the construction of “Healthy China”, MiaoHealth also cooperates with real estate, hospitals, and the government to jointly promote the AIoT upgraded version of the Canadian Health Management Center (China) stores in major cities to achieve “on-site + off-site” full-scene health Management services; in corporate scenarios, provide employees (and members served) with overall health plan solutions, and improve post-inspection services, insurance protection and other links.

On the whole, whether it is Ping An Health, which is already on the market, the water droplets that are about to be listed, or Miao Health, which has grown extremely fast in recent years, three companies in different fields are actively exploring different development paths of “Internet + medical health”. And set it up as a future development strategy, and continue to focus on deployment in various business sectors.

The first entrant is first, who can become the enterprise of the times

Since the beginning of 2020, stimulated by the new crown pneumonia epidemic, the digitalization of medical and health services has accelerated unprecedentedly, and healthy digital infrastructure has been placed in an unprecedentedly important position. The country has intensively issued digital and new infrastructure-related policies to release a series of benefits for the development of the industry. Add new power.

In particular, the further opening of the medical insurance policy will introduce “super payers” for new services and new formats of “Internet + medical health”. In 2019, the total national medical insurance expenditure is about 2 trillion yuan. As a payer for Internet medical services, part of this will strongly promote the development of the industry and further have a positive impact on the choice of patients’ medical treatment.

On another level, “speeding up the construction of new infrastructure such as 5G networks and data centers” has become the government’s future strategic goal. Since then, “new infrastructure” has once again become a buzzword in China’s economy.

At present, authoritative experts in many fields have pointed out that due to policy guidance and market demand, the closed-loop medical ecology with “health management + medical insurance” will become an important part of the “new infrastructure” and also the health management market in China. Whether it can usher in a new round of development boom is the key.

“There are no successful companies, only the companies of the times”, this is a saying often put on the lips of Haier Group Chairman and CEO Zhang Ruimin. So for the entire medical field, facing the current new business model, who can seize the opportunity and explore a development path that better integrates with the business, who can seize the opportunity and become a unicorn in this field enterprise.

Therefore, under the trend of my country’s digital health management, companies that create real value must be pioneer companies that dare to seize opportunities, continue to iterate, and keep up with the progress of the times.


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