At the beginning of 2014, mobile medical care began to heat up. At one time, hundreds of startup companies were established. There are three main categories of projects for patients:
The first category is the registration and medical service platform, the second category is the platform for seeking medical advice and combining medical e-commerce, and the third category is focused on vertical disease areas and chronic disease management.
According to the data of the Prospective Industry Research Institute, the total health expenditure in China has shown a rapid growth trend in recent years, rising from 1998 billion yuan in 2010 to 46.345 billion yuan in 2016. In 2010-2016, the compound growth rate is as high as 15%.
Among them, chronic disease expenditure accounts for about 70% of total health expenditure, and in 2016 it was about 3,244.15 billion yuan. If 10% of them can be converted into chronic disease management costs in the future, the market size will be 324.4 billion yuan, and the development potential is huge.
After the management of chronic disease has risen to the national strategy, how to effectively manage chronic disease has become an important topic in top-level design. The chronic disease management system is complex, covering the services from hospitals to pharmacies. The typical network of arterial network management combined with chronic disease management and Internet in recent years, trying to explore the development trend of chronic disease management from the digital path transformation. .
The digital turning point of chronic disease management - traditional chronic disease: hospital services, doctor management
The traditional chronic disease management model is based on the process of “diagnosis, treatment, rehabilitation, and follow-upâ€, involving patients, hospitals, and community health service centers. Hospitals and community medical service institutions are the main implementers of chronic disease management, and undertake many tasks such as prevention, health care, medical care, rehabilitation, and health education in chronic diseases.
Slow disease management service flow chart
In the traditional chronic disease link, the key to management is still relying on "people." However, due to the excessive concentration of quality medical resources to large medical institutions, grassroots medical institutions not only lack the talents of general practitioners and preventive health doctors who can afford chronic disease management, but also lack sufficient service facilities and medical equipment , and relevant policy support and financial investment. Obviously insufficient, the chronically ill patients have not fully trusted primary health care workers and primary health care institutions.
Take the largest diabetes in the population as an example. If you calculate 365 days a year, the total is 8760 hours. Under traditional Chinese medical conditions, diabetics may only have 6 hours a year to contact nurses, doctors, dieticians and other health workers. The next 8760 hours can only rely on patient self-management.
Slow disease management appeals solved by the Internet: scene family and decision accuracy
With the development of new generation information technology, the application of mobile APP and wearable devices in the field of chronic disease management is increasing. The development and popularization of next-generation information technologies such as mobile Internet, Internet of Things, cloud computing, and big data have injected new vitality into chronic disease management and innovated the chronic disease management model.
In the face of the pain point of traditional chronic disease management, the appeals that rely on the Internet to solve are: scene familyization and decision-making accuracy.
A sound management network is the hardware foundation for chronic disease management. At present, the construction effect of the regional health information platform has not been highlighted. The information on electronic health records and electronic medical records of chronically ill patients cannot be effectively transferred between different medical institutions, making it impossible for doctors to understand the patient's medical history.
In addition, there is no unified information software for the health records of Chinese residents, and the chronic disease monitoring network is not perfect. A national unified chronic disease prevention and treatment information platform has not yet been established. Doctors lack effective living habits and life behavior data (such as diet, exercise, and Behavioral habits, health psychology and other data), and the vital signs data of chronically monitored patients are not continuous and cannot be timely understood and monitored by doctors, making doctors' treatment of chronic diseases more popular and difficult to personalize and precise. The treatment plan.
Development factors affecting chronic disease management
How to carry out effective patient education and chronic disease management has become a common goal from the national top-level design to the grassroots service organizations. In the management of chronic diseases and the use of the Internet to achieve the synergy between patients and medical institutions, the following factors have become the key to affecting chronic diseases:
Graded diagnosis
As the most important part of the implementation of primary medical care in grading diagnosis and treatment, chronic disease management has adopted the “slow disease first†strategy from the central to local medical reform.
At the end of 2015, the National Health and Family Planning Commission issued the “Notice on Doing a Good Job in the Pilot Work of Hypertension and Diabetes†(hereinafter referred to as the “Noticeâ€), which clarified the key tasks of high-grade and diabetes graded diagnosis and treatment, and requested hypertension, diabetes, etc. Chronic disease prevalence, morbidity, visit rate and grading diagnosis and treatment technical programs, determine the number of patients suitable for the grading diagnosis and treatment service model, and assess the condition and basic conditions. Strengthen the construction of information systems, and establish electronic health records (including hypertension and diabetes disease information) for Unicom secondary and above hospitals and primary health care institutions for patients who are grading and diagnosing patients. And to clarify the functional positioning of medical institutions at all levels in chronic diseases.
In 2016, the State Council issued the “Key Tasks for Deepening the Reform of the Medical and Health System in 2016†to speed up the pilot program of grading diagnosis and treatment. In accordance with the requirements of “primary diagnosis at the grassroots level, two-way referral, rapid division and treatment, and linkage between the upper and lower levelsâ€, the pilot areas of comprehensive medical reform pilot provinces and public hospitals will be accelerated, and the grading diagnosis and treatment will be accelerated, and pilot projects will be carried out in about 70% of the cities. .
In June 2016, the State Council's Medical Reform Office and the State Health Planning Commission jointly formulated the “Guiding Opinions on Promoting Family Doctors' Contracting Servicesâ€, stating that by 2020, we will strive to expand the family doctor contracting service to the entire population and basically realize family doctors. Full coverage of the contractual service system.
In June 2016, the General Office of the State Council issued the “Guiding Opinions on Promoting and Regulating the Development of Big Data Applications for Health Care â€, which basically realized that urban and rural residents have standardized electronic health records and fully functional health cards.
From the simple combing of the above policies, we can see that the slow patient group is the entry point, and the tools such as the Internet are used to promote graded diagnosis and treatment, redistribution of medical resources, and signing services through family doctors to regulate health big data and improve public health and health. The goal of management level is gradually becoming a reality through a comprehensive policy.
Medicare payment
According to the statistics of the National Health and Family Planning Commission, the incidence of chronic diseases in China has shown a rapid upward trend in recent years. According to the 2017 China Health and Family Planning Statistical Yearbook, the prevalence of chronic diseases has continued to increase. From 2003 to 2013, the prevalence rate has nearly doubled.
What followed was the increase in medical expenses. In 2014, the total national health expenditure reached 353.1 billion yuan, and the medical burden incurred by chronic diseases accounted for 70% of the total expenditure. The proportion of medical expenses caused by chronic diseases should not be underestimated. .
In June 2017, the State Council promulgated the "Guiding Opinions on Further Deepening the Reform of Payment Methods for Basic Medical Insurance." The introduction of this heavy "Opinions" will undoubtedly further accelerate the reform process of medical insurance payments.
The requirements show that for inpatient medical services, mainly according to the disease type, according to the disease diagnosis related group payment, long-term, chronic disease hospitalization medical services can be paid on a bed-day basis; for primary medical services, you can pay per capita, actively explore the per capita payment and chronic diseases Management is combined; for complex cases and outpatient expenses that are not suitable for packaging, you can pay for the project; explore payment methods that meet the characteristics of Chinese medicine services. It is necessary to strengthen the supervision of medical insurance on medical behavior, and shift the focus of supervision from medical cost control to medical expenses and medical quality.
According to the "2016 China Internet Chronic Disease Management Industry Insight Report" released by iResearch, the cost of reimbursement for the treatment of chronic disease in the total expenditure of the urban basic medical insurance fund is relatively high, so if you want to effectively control the total expenditure, For growth, it is necessary to effectively manage chronic diseases through the first consultation at the grassroots level, two-way referral, rapid division and treatment, and up-and-down linkage, thus indirectly reducing the cost of treatment for chronic diseases.
Internet + Medical Policy
For the grading diagnosis and treatment needs of chronic disease management, the “free lifting†of Internet + medical treatment has become the most timely “Dongfeng†in the market.
The government's attitude toward "Internet +" has changed from the original prohibition to encourage various attempts. By 2018, it officially issued a document as the State Council. "Internet + medical health" ushered in warm spring, and electronic prescriptions and online medical behaviors were gradually lifted. In markets involving the Internet, health and chronic disease management have lower barriers to entry, and SMEs are more likely to participate.
The problem of managing chronic disease patients in medical institutions lies in the discontinuity and fragmentation of data. Usually, patients may complete repeated tests in community health service centers or secondary hospitals, and they need to do repeated tests to monitor key indicators. The data between medical institutions at all levels has not been opened. And the hospital's chronic disease management outside the hospital is sceneless, which also causes data discontinuity. Therefore, the Internet and intelligent hardware play an important role in the entire process of chronic disease management.
Intelligent hardware becomes the entrance to data collection
The research trend of IoT technology applied to chronic disease management is generally from the information system focusing on IoT technology to the design of the slow disease management platform to the management mode. From the perspective of the model, it can be divided into government-led and multi-participation, hospital commissioned construction, enterprise leasing, and medical and enterprise joint construction.
The rapid development of big data and intelligent hardware, wearable devices and other important means in the treatment, monitoring, data collection, management, feedback and reminders of chronic diseases, especially in the fields of diabetes and cardiovascular diseases, for the primary health management, disease monitoring Provides great convenience. At present, personal health management methods are mostly for the primary functions of health monitoring, sports assistance, health information, health reminders, etc. provided by mobile APP, wristband, blood pressure meter, blood glucose meter and other software and hardware, and are still in the exploration stage.
Intelligent hardware-based data collection
For example, Fukang Medical has deployed more than 20,000 terminals for stroke prevention and treatment in six major terminal scenarios, covering 20 million people, including more than 2 million members and more than 17 million non-members. It is expected that the revenue will reach 1 in 2018. .500 million.
Enterprise combing: The core foundation of future chronic disease management still lies in data accumulation
The market for chronic disease management has basically formed an industry pattern with medical examination services, intelligent hardware manufacturers and medical device manufacturers as the entrance.
Schematic diagram of the classification of Internet chronic disease management enterprises (Source: iResearch, some revisions of the arterial network)
From the above picture, we believe that the main directions for companies using Internet technology to cut into the chronic disease field are data monitoring, chronic disease reminders and medical devices , including intelligent hardware, health cloud, big data, online consultation, patient community, telemedicine , Registered clinics, medical e-commerce and many other Internet models have become the best areas for Internet companies and offline medical institutions and health management institutions to form an integrated management system.
Among them, chronic disease medicine enterprises usually belong to the traditional category. R&D drugs need to have strong financial strength, and Internet companies are not easy to cut in, but the digital marketing of chronic disease drugs is indeed an innovative path after drug research and development and listing.
In addition, some people believe that the core foundation of future chronic disease management is still the accumulation of data. Therefore, digital transformation is an inevitable trend.
From the perspective of application mode, common Internet + chronic disease management applications at home and abroad mainly include single APP mode, "smart hardware + APP" mode, chronic disease informationization mode, O2O mode integrating online and offline resources, etc. The types of cooperation including Internet + chronic disease management and insurance are not listed in the table.
Note: In the column of CFDA, “√†stands for “Yesâ€, “X†stands for “Noâ€, “△†stands for No
Statistics on Internet chronic disease management enterprises that have obtained financing (Source: Arterial Network Database, State Administration of Markets, official website)
Chronic online platform: B-end focus on medical institutions, C-end with smart hardware
ToB: Serving medical institutions, using information technology as a breakthrough, building an Internet platform/cloud platform, connecting medical institutions and patients, and improving the efficiency of chronic disease management in hospitals or grassroots community health service centers.
Case
Ai Yisheng: GDS National Guide Artificial Intelligence Chronic Disease Management System
GDS National Guide Artificial Intelligence Chronic Disease Management System currently covers seven major diseases including hypertension, diabetes, dyslipidemia, coronary heart disease, cerebrovascular disease, gout, and cysteineemia. It consists of five modules, namely individual management and group management. Collaborative management, patient guidance and medical management. In the three major application scenarios of community hospitals, regional medical associations and urban chronic disease ecology, GDS system assists doctors, doctors assistants, guides patients; nurses around patients; supports deans, health planning committees and social security, and provides medical management platform For the medical, medical insurance and medicine to build a "three medical linkage" ecological environment, the provider of Baohe Pharmaceutical's operating platform; GDS supports community family doctors' contracted group management, and at the same time collaborate with specialist physicians, general practitioners, health managers, in grading It plays a role in the medical treatment.
Sugar Control Guard: Building Diabetes Management Information Platform through Cloud Technology
Controlling sugar guards to address the pain points of diabetes patients and experts, through the cloud technology to build a chronic disease management information platform. The doctors who control the sugar guards mainly docked the diabetes department, and adopted the business model of B+B2C to carry out daily diabetes management and remote consultation for patients, and also developed mobile terminals to realize the mobility of diabetes management.
ToC: Full-process chronic disease management service, with intelligent hardware becoming the entry-cut service for data collection
The key to the development of chronic disease management lies in the device itself. The chip and algorithm of the smart device, whether the obtained monitoring data can be used as the basis for clinical decision-making, is the core issue. As shown in the above figure, some of the intelligent hardware has been certified by the CFDA. The error rate of their data collection and clinical examination data is very small. The medical device-based chronic disease management mode lays equipment in different scenarios. Using data collection and cutting services, this is a big advantage for enterprises.
Case
Ji Kang Medical: cutting into the chronic disease management service with the terminal products as the entrance
In the 6 scenes of township hospitals, village clinics, community clinics, pharmacies, community service centers and community service stations, Fukang Medical has laid more than 20,000 terminals for stroke prevention and treatment, covering 20 million people, including members. More than 2 million, non-members more than 17 million, is expected to reach 150 million in 2018.
Wanda Remote: Smart Hardware - Patient - Medical Institution
Wanda Remote uses the “Resident Health Management Information Platform†as the main tool to integrate emerging information technologies such as “cloud technology, Internet of Things, and mobile Internet†into the community's basic public health management system and the resident health self-management system. Linked to the joint project and regional health information platform, improve the residents' health records, and established the overall service process of “resident pre-inspection, platform warning, clinical reference, doctor managementâ€, and launched a “full-course health†perfect intelligent health service model. Wanda's remote chronic disease management information system, in addition to providing chronic disease management services for the elderly, can also provide health management service packages, medical examination services and genetic testing to adults and children based on the information system platform, enriching Wanda's remote health. Manage business content.
Chronic disease management + insurance: HMO mode for slow disease insurance
From the perspective of a slow-growing start-up enterprise, it has opened up insurance and broke the traditional insurance of traditional financial management and light security. In addition to expanding service functions, it attracts more users, and more importantly, it can truly provide medical care for its own users. Insurance, reducing the economic burden for users and reducing medical costs, not only meets the requirements of the national health insurance policy, but also truly reflects the valuable value of Internet participation in chronic disease management.
From the perspective of commercial insurance companies, cooperation with Internet medical companies can develop new types of insurance and attract more insurance users. On the other hand, they can better control insurance fees and reduce the risk of policyholders. At the same time, it can also add certain social value to its own brand.
There are two main modes of combination of commercial insurance and chronic disease management: one is the combination of drug sales and commercial medical insurance, and is involved in the field of chronic disease management; the second is the combination of medical information technology companies and commercial insurance organizations to improve commercial insurance for insured persons. The level of health management.
Case
"Glucose Drum": Pocket Sugar Doctor + Taiping Insurance
At the end of 2015, Pocket Sugar Medical and China Taiping Insurance launched Diabetes Complication Insurance, Taiping Diabetes Complication, also known as “Glucose Drumâ€. As the Internet chronic disease management service platform, Pocket Sugar Medical is the only chronic disease management customized service provider of this insurance product, which realizes the unified management of China Taiping Insurance users. All insurance users will enjoy the high-quality blood sugar management services provided by Pocket Sugar, optimize their own blood glucose management, and thus reduce the incidence of complications.
In terms of cooperation, Taiping Diabetes Commitment Insurance only chooses to connect with a diabetes management platform. Pocket Sugar Medical has a complete service system for diabetes management platform. The multi-faceted customized service system provided by Pocket Sugar Medical is a three-dimensional complete service system with APP as the core, WeChat service number, call center and offline clinic. It can provide seamless integration of online and offline for policyholders. Customized medical service experience.
Listed medical companies are involved in the path of chronic disease management
14 listed medical companies involved in chronic disease management (incomplete statistics)
Previously, the arterial network had organized 14 listed medical companies involved in the path of chronic disease management, and summarized the four major directions:
1. Fixed: getting a lot of money
2. Self-built full-length chronic disease management service system and platform
3. Participation in mobile medical, wearable device related companies, participating in specialist hospitals
4. Establish an investment company to make investment plans
The characteristics of Internet tools are rapid dissemination and replication. The business of listed medical companies is relatively traditional. Therefore, the network has cut into the field of chronic disease management. First, it has extended its own business line and increased profitability. Second, the market is in great demand. At the heart of medical services is patients and doctors, medical institutions, and a type of tool that can bind these three together. Whether it is for pharmaceutical companies, equipment companies or information enterprises, the characteristics and core needs of chronic diseases are the driving force for these enterprises to open up new businesses and help them reach the target market quickly.
In The Innovator's Prescription, there is a view that although chronic diseases bring huge costs and pains, few of today's medical business models optimize the process of determining the diagnosis and treatment options, and they are basically unable to Improve the compliance of patients with chronic diseases and guide their business model of adherence to treatment.
Based on this, through our observation, the core of the current Internet + chronic disease management still lies in the following three aspects:
1. Intelligent hardware intervention, the main role is monitoring, the core of which is to simplify labor costs and improve management efficiency through multi-dimensional data collection;
2. The patient compliance of chronic disease management is less likely to rely on the Internet, and data monitoring requires subsequent services to form a closed loop;
3. The acquisition of accurate user traffic and the creation of the value chain of chronic diseases still require human services, and the core of doctors cannot be separated from each other.
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