平安好医生携手头部HIS企业，推动商保直付迈入“原生集成”新时代

This article introduces a new native-integrated commercial insurance direct payment service co-launched by Ping An Good Doctor and leading Chinese healthcare information system (HIS) providers, which addresses the pain point of overly complicated traditional commercial insurance claims processes and delivers tangible convenience for general patients.

1. User experience of the new service: For Ping An medical insurance customers, all insurance processing can be completed with one-click settlement at the hospital checkout counter upon discharge. The entire process — including medical insurance reimbursement, commercial insurance deduction, and out-of-pocket payment settlement — is finished in one trip, eliminating the need to organize claims materials after discharge and make multiple trips to handle procedures, making the whole experience smooth and hassle-free.

2. Advantages over traditional claims models: The traditional model requires patients to file additional claims after discharge, and the entire process relies on manual document verification, which is time- and energy-consuming. The new model embeds commercial insurance functions into hospitals' existing systems to automatically process all procedures, requiring no extra actions from users.

3. Prospects for adoption: The partnership already covers medical institutions at all levels across China, and will be further expanded going forward, so that an increasing number of insured users can access this convenient service.

The medical-insurance collaboration sector is now entering a period of large-scale development, with new demands emerging from both the consumer side and the supply side, which provides clear direction for brands in health insurance and medical information technology.

1. Consumer trends: Users' demands for convenient commercial insurance claims processing are rising steadily, and the poor experience of cumbersome traditional post-discharge claims has become a prominent pain point. Users generally expect smoother settlement and claims services, and convenience has become one of the core competitive advantages for brands.

2. Partnership channel development: Ping An Good Doctor integrates the strengths of multiple leading HIS companies, and leverages their existing market coverage to rapidly expand its commercial insurance direct payment service network. This in-depth cross-industry cooperation model effectively reduces customer acquisition and implementation costs, and quickly expands brand influence.

3. Product development direction: The new native integration model solves long-standing industry pain points and delivers a win-win outcome for hospitals, users, and insurance institutions. It is a proven viable direction for commercial insurance service innovation, and worth investing in for brands.

This article sorts out the policy environment, market opportunities, and mature practices in the commercial insurance direct payment space, providing multi-dimensional reference for practitioners in health insurance and medical services.

1. Policy landscape: Starting from 2024, the national government and multiple local authorities have issued guiding policies that explicitly encourage commercial health insurance to integrate into routine medical scenarios, and support insurance firms and medical institutions to connect data systems and enable interlinked settlement. The entire industry has clear policy support for development.

2. Market opportunities: Following the nationwide rollout of DRG and DIP medical insurance payment reforms, public hospitals have an urgent need to expand commercial insurance payment channels to supplement their revenue. At the same time, consumer demand for convenient claims is strong. The industry is currently in an inflection point for large-scale implementation, with substantial growth opportunities available.

3. Replicable best practices: Ping An Good Doctor partnered with leading HIS companies to establish unified integration standards, eliminating the cumbersome "one hospital, one agreement" process of traditional models. This approach greatly shortens project implementation cycles and reduces communication costs, making the model highly replicable. Practitioners need to proactively address industry pain points including inconsistent interface standards and fragmented processes.

This article outlines new market demand and business opportunities brought by medical-insurance collaboration, offering insights for digital transformation for medical IT manufacturing and service factories.

1. Shifts in product demand: As commercial insurance direct payment enters a stage of large-scale development, the industry requires embedding direct payment functions directly into hospitals' core billing information systems. Demand for medical IT products that support unified standardized integration has grown sharply, with relevant demand coming from medical institutions of all levels and across all regions.

2. Clear business opportunities: Leading domestic HIS companies have already entered this new market through partnerships with Ping An Good Doctor, unlocking new growth by leveraging their existing regional or customer coverage advantages. Small and medium-sized providers can also match demand based on their own regional strengths to expand business volume.

3. Insights for digital transformation: Factories can optimize product design around the new demand for medical-insurance integration, build unified standardized integration interfaces, enable one-time integration that works for multiple insurance products, simplify implementation processes, and improve their products' market competitiveness to capitalize on the industry growth opportunity.

For service providers focused on medical information technology and medical-insurance collaboration, this article sorts out industry development trends, identifies core customer pain points, and outlines viable solution directions.

1. Industry development trends: Driven by policy support and market demand, medical-insurance integration has become an inevitable industry trend. Commercial insurance direct payment is shifting from the early stage of fragmented point-to-point integration to a new stage of standardized, large-scale development, and the native integration model will become the mainstream in the future.

2. Core customer pain points: The industry currently faces widespread issues including fragmented hospital systems, heavy manual review workloads, inconsistent insurance interface standards, and cumbersome implementation processes and high communication costs in traditional models. Cumbersome claims for patients and high risk-control difficulty for insurance providers are pain points across the entire value chain.

3. Viable solutions: Service providers can form in-depth partnerships with insurance platforms to jointly build unified settlement and data interoperability standards, and develop functions that are natively embedded into hospitals' core systems. This approach meets the needs of all stakeholders and opens up new room for business growth.

This article introduces innovative platform practices in the medical insurance service space, sorts out core market demand for platforms, and provides reference for operation and development of relevant medical and health, and insurance service platforms.

1. Core market demand: After medical insurance reform, public hospitals need to expand commercial insurance payment channels to supplement revenue; insured users expect more convenient claims services; insurance providers need to improve efficiency and strengthen risk control. All three sides require third-party platforms to build a unified integration network and establish unified service standards.

2. Innovative platform operation practices: Platforms can partner with leading HIS companies across the industry, integrate the regional and customer coverage advantages of different HIS providers to rapidly expand service networks, and establish unified standards covering the full process from identity verification, cost splitting to real-time settlement. This allows one-time hospital integration that works for multiple insurance products.

3. Risk mitigation insights: This model eliminates the cumbersome traditional "one hospital, one agreement" process, shortens project implementation cycles, and reduces operational and communication costs. Meanwhile, data is synchronized in real time through encrypted channels, helping platforms strengthen risk control and avoid the information opacity risk of traditional models.

This article presents the latest industry trends and innovative practices in medical-insurance collaboration amid China's efforts to build a multi-level medical security system, providing a fresh research case for scholars in related fields.

1. New industry trends: Against the background of national policy promotion and DRG/DIP medical insurance payment reform, medical-insurance collaborative services have entered a period of large-scale implementation, and commercial insurance direct payment models have been upgraded. The model has shifted from fragmented post-discharge reimbursement integration to a standardized native-integrated real-time settlement model, and the industry has entered a new stage of development.

2. Analysis of the innovative business model: The partnership between Ping An Good Doctor and leading HIS companies fully integrates the resource advantages of all parties: Ping An Good Doctor provides the commercial insurance service network and unified standards, while HIS providers deliver system support and customer coverage. This approach leverages each party's strengths to solve core industry pain points.

3. Research value: This model delivers a triple win for hospitals, patients, and insurance institutions, and provides a replicable practical example for integrating commercial health insurance into the medical service system. It has high reference value for research on China's medical payment reform and the construction of a multi-level medical security system.