— From Insurance Product Alignment to a Shared-Risk Alliance
Introduction: Why Traditional Cooperation Models Fall Short
Historically, hospital-insurer collaborations have focused on product sales and risk transfer, where insurers provide coverage and hospitals offer patient access. However, in real clinical settings, such loosely structured partnerships often encounter problems:
- Limited awareness among medical staff, with results dependent on individual initiative;
- Lack of closed-loop workflows, preventing insurers from accessing accurate patient data and claim evidence;
- Delays in claims processing leading to poor patient experience and diminished hospital credibility;
- Hospitals bearing legal and compensation pressures while insurers are excluded from risk governance.
Meaningful cooperation must evolve beyond co-promotion to joint service development, shared risk, and mutual benefit. Yihuibao has developed a scenario-based collaboration model that creates lasting value for hospitals, doctors, and patients.
I. Department-Based Collaboration Model: Clear Roles and Incentives
Instead of top-down hospital-level deployments, insurance services are most effective when rooted in clinical workflows, especially in high-risk specialties like surgery, anesthesia, and ICU. Yihuibao promotes a 'departmental granularity' approach:
- Embedded Workflow Design: Incorporating insurance education, enrollment reminders, intraoperative records, and postoperative monitoring into routine care, forming a pre-op to post-op loop.
- Assigned Liaison Roles: Designated insurance liaisons or nurses in each participating department improve accountability and execution.
- Incentive Mechanism: Regular feedback and rewards based on enrollment rate, claims satisfaction, and payout control encourage active participation.
II. Three-Party Coordination: Information Sharing and Operational Synergy
Effective insurance services require seamless collaboration among hospitals, insurers, and patients. Yihuibao facilitates joint management via a tripartite framework:
- Hospital Side: The medical affairs department leads a risk management task force including surgery, nursing, and IT departments.
- Insurance Side: A project manager or onsite specialist serves as the main point of contact for enrollment support, issue tracking, and claims assistance.
- Platform Side: Yihuibao’s digital system acts as a neutral data hub for claims tracking, reporting, and analytics, ensuring transparency and workflow standardization.
III. Shared Value Framework: From Traffic Partnership to Value Co-Creation
Traditional incentives like referral bonuses or policy commissions are limited in long-term impact. Yihuibao applies a value-based incentive framework:
- Departmental Profit Sharing: Departments that reduce hospital liability through insurance participation receive shared revenue for training or operations.
- Performance-Based Rewards: Claims efficiency, satisfaction, and enrollment rates drive departmental bonuses and behavioral alignment.
- Strategic Use of Funds: Hospitals are encouraged to reinvest insurance revenue into patient education, pre-op counseling systems, and dispute mitigation mechanisms.
IV. Visualized Data to Sustain and Optimize Partnerships
Long-term cooperation relies on measurability and adaptability. Yihuibao equips hospitals with tools to monitor and evaluate partnership effectiveness:
- Real-time metrics on enrollment, reporting, claim closure time, and patient feedback;
- Radar-chart evaluations for departmental comparisons and targeted resource allocation;
- Management dashboards and quarterly review meetings to identify and resolve process bottlenecks.
Conclusion: Integrating Insurance into the Core of Healthcare Systems
If insurance remains an external service, its value will always be limited. Yihuibao believes that optimal healthcare insurance must become intrinsic to hospital systems—aligned with clinical pathways, integrated with management, and embedded in risk strategies. We aim to transform insurance from a financial product into a healthcare solution and evolve hospital partnerships from transactional to strategic and sustainable.