— A Systematic Approach to Embedding Insurance Services into Medical Care
Introduction: 'Product Standards' Are No Longer Sufficient to Support the Value Delivery of Medical Insurance
As medical care becomes more refined, digitalized, and patient-centric, traditional insurance models focused solely on 'products' can no longer meet the expectations of hospitals or patients. To make insurance truly 'usable and payable,' we must shift from isolated product offerings to deeply embedded service experiences throughout the medical journey. Scenario-based medical insurance is not just about covering a specific event—it follows the entire patient journey, from pre-diagnosis to surgery, recovery, and communication, building a full-service insurance framework centered around the patient experience.
I. Identify Service Touchpoints Around Key Medical Milestones
Scenario-based service standards must be built not on internal insurance procedures but on the actual medical workflow. Yihuibao defines five core service touchpoints:
1. Preoperative Communication: Doctors guide patients, supported by ward posters and animated risk education, to recognize potential complications and complete coverage.
2. Intraoperative Event Monitoring: Through hospital information systems or reporting platforms, intraoperative complications and anomalies are recorded as initial evidence for future claims.
3. Postoperative Complication Reporting: A formal system for documenting complications triggers insurance activation when criteria are met.
4. Claims Handling and Coordination: Onsite or remote insurance personnel assist with data collection, family communication, and claim validation.
5. Case Closure and Feedback: Closed-case analysis generates insights on departmental risk profiles and claim trends.
II. Collaborative Mechanism Across Multiple Stakeholders
Traditional insurance services rely too heavily on individual agents or call centers, which cannot meet the needs of information-intensive, multi-party hospital environments. Yihuibao promotes a tri-party mechanism:
- Hospital: Led by the medical affairs department, with support from nursing and clinical teams, to report incidents and provide documentation.
- Insurer: Project managers and claim specialists—onsite or on-call—ensure timely case handling.
- Platform: Technology backbone enabling real-time workflow tracking, data integration, animations, and claim analytics.
This institutionalized structure ensures timely service delivery and avoids a 'product without service' mismatch.
III. Evaluate Based on Patient Experience to Drive Process Optimization
Scenario-based insurance is essentially an extension of healthcare service. Its success is not measured by the number of policies sold or claim amounts but by the patient's sense of trust and benefit. Yihuibao uses a '3 Sentiments & 5 Metrics' evaluation model:
- Three Sentiments: Risk awareness, protection awareness, trust perception.
- Five Metrics: Promotion reach rate, doctor recommendation rate, patient satisfaction, claims satisfaction, and public sentiment positivity.
Hospitals are encouraged to set performance targets and track them dynamically, enabling a full-circle process from education to post-claim care.
IV. Data-Driven Foundations Enable Standardization and Scalability
Data is the backbone of service standardization. Yihuibao’s system is embedded with end-to-end analytics covering:
- Insurance Data: Patient profiles, policy distribution, recommendation conversion rates.
- Claims Data: Case classification, payout ranges, claim cycle duration.
- Operational Metrics: Service response times, delay points, departmental participation.
- Risk Alerts: AI-driven claim trend analysis triggering departmental risk warnings.
These insights feed continuous improvement and serve as a replicable blueprint for new hospital partners.
Conclusion: Make Service Standards a New Pillar of Trust in Healthcare
In medical settings, insurance should not only serve as a reimbursement mechanism, but as an institutional bridge of trust. To build insurance services that are impactful, usable, and payable, we need more than policy documents—we need scenario-centered service standards. Yihuibao will continue to enhance its service evaluation models, optimize workflows, and expand technical toolkits, helping hospitals raise patient satisfaction and build a collaborative, trustworthy healthcare ecosystem.