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An ecosystem to overhaul China’s health care



An ecosystem to overhaul China’s health care

Like many countries, China has a health care problem. Changing demographics and lifestyles mean demand for health care is outstripping growth in medical resources and its cost is rising faster than the insurance premium.

With 250 million people over the age of 60, the world’s most populous country is ageing. Diseases associated with more affluent societies, such as cardiovascular conditions and diabetes, are on the rise. China has 400 million chronic disease patients whose treatment costs 70% of total health care resources. And there is a shortage of medical professionals—China needs an additional 700,000 general practitioners and 10 million nursing staff. In 2019, the country spent 6 trillion RMB ($928 billion) on health care, a figure that’s expected to reach 16 trillion RMB in 2030

But an uneven distribution of resources and their inefficient use mean the cost of providing health care services is unnecessarily high: China’s top hospitals are overwhelmed with patients, but many of them have mild conditions and don’t need to be in a health care facility at all. Of all hospitalized patients, 23% are in top tier hospitals, which account for only 0.3% of the total number of hospitals. And patient data is fragmented among thousands of local clinics and hospitals, making diagnosis, treatment, and effective public health policy implementation more complicated. This inefficient structure leads to wildly disparate service levels and costs in health care, which makes it difficult for insurers to provide standardized coverage.

The government acknowledges these challenges and the need to reform the health care system. President Xi Jinping has put public health at the core of the country’s policy-making programme, emphasizing health in government policy-making agenda. The national goal of “Healthy China 2030” focuses on disease prevention and a comprehensive overhaul of the health care system.

The big question, though, is how to connect all the stakeholders in China’s sprawling health care system in a way that reduces costs, improves public health outcomes and makes health care more insurable? For Ping An, trying to impact one segment or another is not the answer. The solution must involve a whole ecosystem involving the government, patients, providers, payors, and technology in dynamic interaction which enables all to function to their full potential.  

Beyond digitization

It is no surprise that the efficiencies offered by digitalization hold the potential to transform the health care provision in China. But given the scale, complexity, and importance of the challenge, Ping An believes that improving outcomes for all stakeholders has to go further than bringing more health care delivery online or connecting different data sources.

Instead, there needs to be a transformation that achieves “horizontal” and “vertical” integration. Payors, providers, and patients need to be more connected to improve efficiency, and payors also need to be able to communicate their needs to providers, helping to determine the cost and level of health care services. Only a high level of integration can ensure that a health care ecosystem will be sustainable. That is why Ping An’s health care ecosystem strategy—and the role of its 12 distinct entities in the sector—are built on this holistic online and offline approach.

Source: Ping An

Technology is at the heart of this strategy. Building an effective digital infrastructure for better health care in China involves leveraging a high level of professionalism developed working in the Chinese health care market, as well as substantial investment in cloud, artificial intelligence (AI) and data management systems: fields in which Ping An is a recognized leader. Underlining its commitment to innovation, Ping An invests 1% of its annual revenue in research and development for healthtech and fintech technologies.

Making it work

This leadership in technology is the key to Ping An’s ecosystem strategy—and to better outcomes for all participants, including the company itself. Reimbursements paid by private commercial health care insurers only account for 6% of China’s health care spending at the moment. That means insurers, in this capacity alone, can exert little influence over the cost and service level of the health care provision. As a result, insurers’ potential to contribute to China’s health care system is limited.

Ping An’s technology and services change this equation. The value of Ping An’s technology to the government in monitoring and improving public health—not to mention its benefits to medical professionals—allows the company to access public health care institutions. That means Ping An can help institutions to improve operations, manage costs, and deliver better and more affordable service to patients, making health care more insurable.

Built on a vast database of diseases, medical products, treatments, medical resources and patient information, Ping An Smart Healthcare is at the heart of this “vertical integration.” It provides tools to manage public health care, empower providers, and improve medical resource accessibility and patients’ disease outcomes.

For example, Ping An Smart Healthcare’s intelligent image analysis system enables doctors to shorten diagnosis times from 15 minutes to 15 seconds. The integrated data analysis package, AskBob, aims to be the “Bloomberg for doctors.” Already, AskBob is used by as many as 710,000 doctors, covers around 3,000 diseases, and its AI capabilities in diagnosing and treating cardiovascular disease are comparable to that of human doctors.  In a competition at the Great Wall International Congress of Cardiology last year, AskBob scored 97.7 points compared to 93.9 points for a team of doctors from top tier hospitals.

In collaboration with China’s National Clinical Research Centre for Metabolic Diseases, Ping An Smart Healthcare has developed an advanced type 2 diabetes management tool powered by its underlying AI technology and database resources. The tool has been deployed in the center and more than 600 hospitals nationwide, serving more than 100,000 patients and delivering a 30% improvement in patients’ compliance rate.

Across the spectrum

Ping An Good Doctor and Smart Healthcare work together to create a robust product and service cost model, driving synergies by drawing providers and social health insurers into the system. If Ping An Smart Healthcare is the vertical thread connecting government and medical institutions with the delivery of health care to patients, Ping An Good Doctor is crucial to the group’s efforts to connect patients, providers and payors through the “horizontal” axis of its ecosystem strategy. Ping An Good Doctor provides online consultations with AI-assisted medical teams and integrates seamlessly with offline medical services within the ecosystem. Users can search for basic information for free, with consultations and treatments available at a cost. 

The adoption of telemedicine soared during the pandemic. By 30 December 2020, Ping An Good Doctor had 373 million total users, with a monthly average of 72.6 million users, and some 903,000 daily enquiries. Ping An Good Doctor has an in-house medical team of more 2,200 members and a network of more than 20,000 domestic medical experts and 300 renowned doctors across China.

But while these numbers are impressive and should continue to grow, currently only 3% of all medical consultations are conducted online in China—a smaller proportion than in the United States. To be truly transformative, the ecosystem must address the substantial proportion of consultations that still take place offline.

The ecosystem’s network of offline health care providers is therefore highly important. Ping An Good Doctor partners with 151,000 pharmacies, 49,000 clinics, more than 3,700 hospitals, and over 2,000 medical examination centers to provide services such as hospital referrals, appointments, and inpatient arrangements. Ping An Good Doctor also works with 1,000 prominent international doctors and the world’s top ten hospitals to ensure handy and accurate medical services for users.

Paying the bill

The benefits of this ecosystem strategy to government, patients, and providers are clear. But covering the cost of improved health care in China involves payors—and that’s where the opportunity lies for Ping An to commercialize its strategy. Insurance products are integrated throughout the Ping An health care ecosystem. Ping An HealthKonnect provides payors such as social health insurers and companies with anti-fraud and health care resource management models that reduce overtreatment, fraud, and abuse. The group’s recent Ping An Doctor Home proposition, which offers private family medical services online, includes up to 1 million RMB of insurance coverage against any injury or loss of time or property caused by the platform.

In total, the Ping An Group already provides health care services to 210 million individual financial services customers and four million corporate clients. However, transformation of China’s health care system is a long-term investment into Ping An’s own future: a healthier health care system allows the company to acquire new financial services customers as well as to retain and grow spending with the group by existing financial services customers.

The facts reinforce this business case. In recent years, 15% to 20% of Ping An’s new financial services customers have come from this growing health care ecosystem. Financial services customers who also have health care services use, on average, three Ping An financial services products, whereas a financial services customer without health care services uses only two of the group’s products. The average assets under management (AUM) of customers using both financial and health care services is $10,000, versus $5,600 for those who only use financial services.

Lessons for the world

Confucius said that “when it is obvious that the goals cannot be reached, don’t adjust the goals; adjust the action steps.” Ping An’s ecosystem strategy reflects a willingness to think differently about how to solve a longstanding problem, deliver on the “Healthy China 2030” goal, and may offer a useful example to other countries.

Some of the unique characteristics of China’s system, especially an open approach towards data-sharing and the role of government in health care, unquestionably help to make Ping An’s ecosystem strategy viable. However, the health care challenges China faces are not unique. Indeed, data fragmentation, inefficiency, high cost, and a shortage of medical professionals afflict health care systems around the world. Undoubtedly, all governments would want to use technology to better monitor and protect public health, especially since the outbreak of covid-19.

Each country will make its own decisions on how patient data can be gathered, aggregated and shared, and the role of government in health care will of course vary in every country. But it is clear that achieving better outcomes for patients, providers, payors, and governments—as Ping An’s health care ecosystem strategy aims to do in China—must in some way harness the power of data and AI to create efficiencies and standardize the cost and level of medical services.

This content was produced by Ping An. It was not written by MIT Technology Review’s editorial staff.


The hunter-gatherer groups at the heart of a microbiome gold rush



The hunter-gatherer groups at the heart of a microbiome gold rush

The first step to finding out is to catalogue what microbes we might have lost. To get as close to ancient microbiomes as possible, microbiologists have begun studying multiple Indigenous groups. Two have received the most attention: the Yanomami of the Amazon rainforest and the Hadza, in northern Tanzania. 

Researchers have made some startling discoveries already. A study by Sonnenburg and his colleagues, published in July, found that the gut microbiomes of the Hadza appear to include bugs that aren’t seen elsewhere—around 20% of the microbe genomes identified had not been recorded in a global catalogue of over 200,000 such genomes. The researchers found 8.4 million protein families in the guts of the 167 Hadza people they studied. Over half of them had not previously been identified in the human gut.

Plenty of other studies published in the last decade or so have helped build a picture of how the diets and lifestyles of hunter-gatherer societies influence the microbiome, and scientists have speculated on what this means for those living in more industrialized societies. But these revelations have come at a price.

A changing way of life

The Hadza people hunt wild animals and forage for fruit and honey. “We still live the ancient way of life, with arrows and old knives,” says Mangola, who works with the Olanakwe Community Fund to support education and economic projects for the Hadza. Hunters seek out food in the bush, which might include baboons, vervet monkeys, guinea fowl, kudu, porcupines, or dik-dik. Gatherers collect fruits, vegetables, and honey.

Mangola, who has met with multiple scientists over the years and participated in many research projects, has witnessed firsthand the impact of such research on his community. Much of it has been positive. But not all researchers act thoughtfully and ethically, he says, and some have exploited or harmed the community.

One enduring problem, says Mangola, is that scientists have tended to come and study the Hadza without properly explaining their research or their results. They arrive from Europe or the US, accompanied by guides, and collect feces, blood, hair, and other biological samples. Often, the people giving up these samples don’t know what they will be used for, says Mangola. Scientists get their results and publish them without returning to share them. “You tell the world [what you’ve discovered]—why can’t you come back to Tanzania to tell the Hadza?” asks Mangola. “It would bring meaning and excitement to the community,” he says.

Some scientists have talked about the Hadza as if they were living fossils, says Alyssa Crittenden, a nutritional anthropologist and biologist at the University of Nevada in Las Vegas, who has been studying and working with the Hadza for the last two decades.

The Hadza have been described as being “locked in time,” she adds, but characterizations like that don’t reflect reality. She has made many trips to Tanzania and seen for herself how life has changed. Tourists flock to the region. Roads have been built. Charities have helped the Hadza secure land rights. Mangola went abroad for his education: he has a law degree and a master’s from the Indigenous Peoples Law and Policy program at the University of Arizona.

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The Download: a microbiome gold rush, and Eric Schmidt’s election misinformation plan



The Download: a microbiome gold rush, and Eric Schmidt’s election misinformation plan

Over the last couple of decades, scientists have come to realize just how important the microbes that crawl all over us are to our health. But some believe our microbiomes are in crisis—casualties of an increasingly sanitized way of life. Disturbances in the collections of microbes we host have been associated with a whole host of diseases, ranging from arthritis to Alzheimer’s.

Some might not be completely gone, though. Scientists believe many might still be hiding inside the intestines of people who don’t live in the polluted, processed environment that most of the rest of us share. They’ve been studying the feces of people like the Yanomami, an Indigenous group in the Amazon, who appear to still have some of the microbes that other people have lost. 

But there is a major catch: we don’t know whether those in hunter-gatherer societies really do have “healthier” microbiomes—and if they do, whether the benefits could be shared with others. At the same time, members of the communities being studied are concerned about the risk of what’s called biopiracy—taking natural resources from poorer countries for the benefit of wealthier ones. Read the full story.

—Jessica Hamzelou

Eric Schmidt has a 6-point plan for fighting election misinformation

—by Eric Schmidt, formerly the CEO of Google, and current cofounder of philanthropic initiative Schmidt Futures

The coming year will be one of seismic political shifts. Over 4 billion people will head to the polls in countries including the United States, Taiwan, India, and Indonesia, making 2024 the biggest election year in history.

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Navigating a shifting customer-engagement landscape with generative AI



Navigating a shifting customer-engagement landscape with generative AI

A strategic imperative

Generative AI’s ability to harness customer data in a highly sophisticated manner means enterprises are accelerating plans to invest in and leverage the technology’s capabilities. In a study titled “The Future of Enterprise Data & AI,” Corinium Intelligence and WNS Triange surveyed 100 global C-suite leaders and decision-makers specializing in AI, analytics, and data. Seventy-six percent of the respondents said that their organizations are already using or planning to use generative AI.

According to McKinsey, while generative AI will affect most business functions, “four of them will likely account for 75% of the total annual value it can deliver.” Among these are marketing and sales and customer operations. Yet, despite the technology’s benefits, many leaders are unsure about the right approach to take and mindful of the risks associated with large investments.

Mapping out a generative AI pathway

One of the first challenges organizations need to overcome is senior leadership alignment. “You need the necessary strategy; you need the ability to have the necessary buy-in of people,” says Ayer. “You need to make sure that you’ve got the right use case and business case for each one of them.” In other words, a clearly defined roadmap and precise business objectives are as crucial as understanding whether a process is amenable to the use of generative AI.

The implementation of a generative AI strategy can take time. According to Ayer, business leaders should maintain a realistic perspective on the duration required for formulating a strategy, conduct necessary training across various teams and functions, and identify the areas of value addition. And for any generative AI deployment to work seamlessly, the right data ecosystems must be in place.

Ayer cites WNS Triange’s collaboration with an insurer to create a claims process by leveraging generative AI. Thanks to the new technology, the insurer can immediately assess the severity of a vehicle’s damage from an accident and make a claims recommendation based on the unstructured data provided by the client. “Because this can be immediately assessed by a surveyor and they can reach a recommendation quickly, this instantly improves the insurer’s ability to satisfy their policyholders and reduce the claims processing time,” Ayer explains.

All that, however, would not be possible without data on past claims history, repair costs, transaction data, and other necessary data sets to extract clear value from generative AI analysis. “Be very clear about data sufficiency. Don’t jump into a program where eventually you realize you don’t have the necessary data,” Ayer says.

The benefits of third-party experience

Enterprises are increasingly aware that they must embrace generative AI, but knowing where to begin is another thing. “You start off wanting to make sure you don’t repeat mistakes other people have made,” says Ayer. An external provider can help organizations avoid those mistakes and leverage best practices and frameworks for testing and defining explainability and benchmarks for return on investment (ROI).

Using pre-built solutions by external partners can expedite time to market and increase a generative AI program’s value. These solutions can harness pre-built industry-specific generative AI platforms to accelerate deployment. “Generative AI programs can be extremely complicated,” Ayer points out. “There are a lot of infrastructure requirements, touch points with customers, and internal regulations. Organizations will also have to consider using pre-built solutions to accelerate speed to value. Third-party service providers bring the expertise of having an integrated approach to all these elements.”

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