The National Medical Insurance Bureau opens up O2O medical insurance payment integration services, or spawns "super pharmacies"

Medical Network News on July 19 On July 16, the official website of the National Medical Insurance Administration issued the "Opinions of the National Medical Insurance Administration on Optimizing Convenient Services in the Field of Medical Insurance (Yibaofa [2021] No.
39)" (hereinafter referred to as the "Opinions").
In implementing the decisions and deployments of the Party Central Committee and the State Council on providing convenient and efficient medical security services for the people, we will further promote the reform of "delegation, management, and service" in the medical insurance field, and improve the level of medical insurance services
.
Focusing on the main task of optimizing convenient services in the medical insurance field, the promotion of "Internet + medical insurance services" has once again been supported by the official policy of the Medical Insurance Bureau
.
Among them, in reiterating that in accordance with the principle of online and offline fairness and the policy of medical insurance payment to accelerate the improvement of "Internet + medical insurance services", the National Medical Insurance Bureau officially proposed to actively explore information sharing to realize the integrated services of prescription circulation, online payment and settlement, and home delivery of medicines
.
The industry generally believes that "online order delivery" (referred to as "O2O model") is supported by medical insurance regulatory policies, which will inevitably bring new development opportunities to the out-of-hospital pharmaceutical retail market, especially when the "prescription drug online sales" policy becomes clearer Under the background, the demand for prescription drugs that drained from the hospital to the outside of the hospital is expected to be greatly released, which will promote the transformation and upgrading of the "fourth terminal" drug new retail
.

O2O is supported by medical insurance as a
"super pharmacy" or will be born.

With the promotion of medical insurance control fees in the hospital market and the normalization of large-volume purchases, more and more prescription drugs are moving from inside the hospital to outside the hospital
.
The online order-store delivery model has received more and more market attention since 2020 because of its advantages of "no-face diagnosis and treatment, contactless dispensing".
The epidemic prevention and control has also further accelerated the development of the new retail O2O industry and technological changes
.
Under the conditions of implementing drug quality traceability and ensuring online and offline consistency, the whole process of sales and distribution complying with drug quality and safety regulations, and the effective implementation of pharmaceutical services by licensed pharmacists, encourage the development of "Internet + medicine " and support the realization of "online online" in drug retail “Under the” integration is becoming the direction of industry supervision and market development in the new era
.
The "Opinions" clearly stated: Actively promote "Internet + medical services", follow the principle of online and offline fairness and medical insurance payment policies, improve protocol management and settlement procedures based on service characteristics, actively explore information sharing, and realize prescription circulation, online payment and settlement, Integrated service of home delivery of medicines
.
The medical insurance departments of all coordinating regions should accelerate the improvement of the management of the "Internet + medical service" medical insurance payment agreement in the region
.
In fact, prior to this, cities such as Yiwu, Jinhua, and Dalian, Liaoning, have explored the opening of "online order store delivery" medical insurance settlement.
The common people achieved this through the model of "mobile phone ordering, platform receiving, medical insurance payment, and drug delivery in pharmacies".
With the integration of online and offline medical insurance purchase scenarios without leaving home, "Internet + medical insurance services" have begun to be put into practice
.
Previously, market analysts pointed out that in the past, insured persons who went to designated pharmacies to purchase medicines had to hold a card to make payment by credit card.
With the outbreak of the new crown epidemic, in order to meet the needs of people for medication during the epidemic prevention and control period, to reduce the on-site medical treatment and purchase of medicines by patients during special periods Risks, the advancement of the work of "delivery in online order stores and pick up in online order stores", it is urgent to innovate online and offline medical insurance settlement and payment links
.
This time, the National Medical Insurance Bureau officially proposed to open up an integrated chain of “online order-in-store delivery” medical insurance payment for prescribing, payment, and delivery of medicines, so that O2O medical insurance payments are truly supported by top-level payment policies, and it is expected to be promoted quickly across the country in the future
.
In the past, the O2O model has broken the online and offline space constraints.
Now, with the support of the medical insurance policy and the channel’s online and offline integration promotion and operation, once the terminal service capabilities are released, the Internet platform technology will continue to expand the scope of single-store services, and single-storey pharmacies have become The "super pharmacies" with annual sales of over 100 million or even over 1 billion are not out of reach
.

　　The hospital market is shuffling the
　　"fourth terminal" and rapidly upgrading
the terminal scene of the Chinese pharmaceutical retail market has experienced the evolution from physical pharmacies, to "B2C+ physical pharmacies", to "O2O+B2C+ physical pharmacies", this kind of market ecological change Guided terminal traffic to redistribute
.
As an important part of the "fourth terminal" of the pharmaceutical market, O2O is becoming the general trend of new pharmaceutical retail and an important path choice for the transformation and upgrading of physical retail
.
According to data from Mi Nei.
com, drug sales in China's three major terminals and six major markets will reach 1,643.
7 billion yuan in 2020, a year-on-year negative growth of 8.
5%
.
Retail pharmacy terminals were the least affected by the epidemic among the three terminals and recovered quickly
.
Data show that the retail pharmacy terminal market will reach 433 billion yuan in sales in 2020, a year-on-year increase of 3.
2%
.
Retail pharmacies include two major markets, physical pharmacies and online pharmacies.
Among them, online pharmacy sales reached 24.
3 billion yuan in 2020, a year-on-year increase of 75.
6%
.
At the same time, with the gradual tightening of medical insurance supervision in the hospital market, the hospital prescription drug market is also undergoing a reshuffle
.
On July 15, the "Notice of the National Medical Security Administration on Printing and Distributing DIP Medical Insurance Management Procedures (for Trial Implementation)" was published online, requiring provincial-level agencies to guide the coordinated areas to formulate appropriate Coordinate the regional DIP handling management procedures, steadily promote the implementation of the regulations, monitor and evaluate the operation of the handling operations, and announce the beginning of the DIP payment method reform
.
Prior to this, DRG payment has been piloted in 30 cities across the country
.
A person in charge of a local medical insurance department that has launched DIP-related pilots said that the analysis function of the intelligent monitoring system for disease scores can clearly show the degree of dispersion between case data and the city average, and quickly find abnormalities and conduct further data mining analysis and processing.

.
At the same time, you can quickly identify unreasonable diagnosis and treatment behaviors through special warnings such as disease cost deviation indicators, or use big data features to realize warnings of violations such as high sets of groups
.
In fact, by improving the medical insurance payment mechanism and benefit control mechanism, the endogenous motivation of medical institutions to regulate behavior, control costs, and rationally admit and refer patients is stimulated to guide the rational allocation of medical resources and orderly treatment of patients, represented by chronic diseases.
The trend of prescription drugs gradually flowing to the out-of-hospital market has been irreversible
.
In the context of favorable policies and the expansion of market scale, pharmaceutical e-commerce continues to be favored by capital
.
On June 8, the pharmaceutical e-commerce Dingdang Kuaiyao received a strategic investment, led by Aobo Capital, Hongwei Capital, and TPG Asia Fund, with a financing amount of US$220 million; more than ten days later, Dingdang Kuaiyao's subsidiary Dingdang Health Technology Group The limited company submits a listing application to the Hong Kong Stock Exchange.
If it is successfully listed, Dingdang Kuaiyao will become another major Internet health company after Alibaba Health, Ping An Health, and JD Health
.
On June 9th, Chengdu Quanyuantang Pharmacy Chain Co.
, Ltd.
submitted its listing application and plans to be listed on the Hong Kong main board.
This IPO was co-sponsored by Citigroup Global Markets Asia Co.
, Ltd.
and Haitong International Capital Co.
, Ltd.
, and KPMG acted as the joint sponsor.
Auditor and reporting accountant, Frost & Sullivan (Beijing) Consulting Co.
, Ltd.
Shanghai Branch served as industry consultant
.
Since 2020, the impact of the epidemic has been superimposed, the separation of medicines, the outflow of prescriptions from hospitals have significantly accelerated, and the out-of-hospital market of prescription drugs has continued to expand
.
The epidemic has given medical e-commerce and Internet medical services a real "trial", and they are becoming an important part of China's medical circulation and medical service system.
The online "fourth terminal" market is rapidly upgrading and continues to gain consumers and capital markets.
Attention and recognition
.

　　National Medical Security Administration
　　Opinions on optimizing convenient services in the field of medical insurance The people's governments of
provinces, autonomous regions, and municipalities directly under the Central Government, ministries and commissions of the State Council, and directly affiliated institutions: To implement the decision and deployment of the Party Central Committee and the State Council on providing convenient and efficient medical security services for the people, We will further promote the reform of "delegating management and service" in the field of medical insurance and improve the level of medical insurance services.
With the consent of the State Council, the following opinions are hereby provided on optimizing convenient services in the field of medical insurance
.

　　1.
General requirements
(1) Guiding ideology
.
Guided by Xi Jinping Thought on Socialism with Chinese Characteristics for a New Era, fully implement the spirit of the 19th National Congress of the Communist Party of China and the 2nd, 3rd, 4th and 5th Plenary Sessions of the 19th National Congress of the Communist Party of China.
“Service” reform, enhance service awareness, innovate management methods, strengthen capacity building, create an efficient and convenient medical insurance service system, and continue to improve the people’s sense of gain, happiness, and security
.
(2) Basic principles
.
Adhere to demand-oriented, focus on the people's medical and medical insurance needs, make up for shortcomings, plug loopholes, strengths and weaknesses, and provide more intimate and heart-warming services
.
Insist on convenience and efficiency, promote the deep integration of service innovation and information technology such as the Internet and big data, and promote flat, efficient, and intelligent handling of services, so that more data will run, and the masses will run less errands
.
Adhere to unified standards, strengthen management service rules and management service capacity building, promote the standardization and standardization of medical insurance services, and continuously improve service efficiency
.
(3) Work objectives
.
Before the end of 2022, accelerate the promotion of the standardization, standardization and facilitation of medical insurance services, implement the "maximum run once" reform of medical insurance services, and achieve "cross-provincial administration" of high-frequency medical insurance services to effectively improve the level of medical insurance services
.
On this basis, gradually establish a medical insurance management service system that is guided by humanity, guaranteed by the rule of law, based on standardization, and supported by information technology, and realizes the integration of national basic medical insurance, critical illness insurance, medical assistance and other medical insurance services
.

　　2.
Main tasks
(4) Promote the standardization of medical insurance services
.
Promote the management of the list of medical insurance handling service items.
By the end of 2021, realize the "six unifications" of the national medical insurance handling service item names, item codes, handling materials, handling time limits, handling links, and service standards, and adjust and update them in due course
.
Medical insurance departments at all levels must resolutely cancel the processing links and materials other than the requirements of laws, regulations and national policies in accordance with the "four most" requirements of the best service quality, the least required materials, the shortest time limit, and the simplest handling process.

.
Standardize and reduce the discretionary power of medical insurance payment, improve diversified payment methods, and actively promote payment by disease diagnosis-related grouping, total budget based on regional points, and payment by disease points
.
Guarantee the basic medical needs of the insured persons and avoid the surprise "control expenses" of medical institutions at the end of the year
.
Promote medical insurance reimbursement integrated package services to ensure that the masses can handle medical insurance reimbursement as the main line, implement process reengineering, realize one-time notification, one-form application, and one-window processing, and effectively solve the problems of complicated medical insurance reimbursement application materials and complicated procedures
.
(5) Deepen the reform of "maximum run once" for medical insurance services
.
Promote the “comprehensive teller system” at the service window of medical insurance handling, so as to realize one-window acceptance regardless of insurance types and matters at the front desk, and separate handling at the back office
.
Encourage grassroots medical insurance management services to be stationed in the government service comprehensive hall, strengthen the business connection with human resources and social security, the People's Bank of China, taxation and other departments, and facilitate the "one-stop" joint operation of insurance registration and payment for the masses
.
Explore the implementation of basic medical insurance, critical illness insurance, medical assistance, and commercial insurance settlement in a single settlement, at most once
.
(6) Promote "Internet + Medical Insurance Services"
.
Optimize medical services.
Insured people can choose to use social security cards (including electronic social security cards) and medical insurance electronic vouchers to purchase medicines
.
Relying on the national integrated government service platform, promote the online handling of medical insurance handling services, and realize "handheld handling" and "online handling"
.
Actively promote "Internet + medical services", follow the principle of online and offline fairness and medical insurance payment policies, improve protocol management and settlement processes based on service characteristics, actively explore information sharing, and realize integrated services of prescription circulation, online payment and settlement, and home delivery of medicines
.
The medical insurance departments of all coordinating regions shall speed up the improvement of the management of the "Internet + medical service" medical insurance payment agreement in the region
.
Unblock medical insurance consultation service channels, strengthen the construction of intelligent knowledge bases, and provide the masses with professional medical insurance hotline services with timely response, effective consultation and high resolution rate
.
Actively explore the "video office" of medical insurance services
.
(7) Optimize the transfer and continuation of medical insurance relationship and settlement of medical treatment in different places
.
To adapt to the needs of population mobility and employment conversion, improve the policy for the transfer and continuation of the medical insurance relationship, actively promote the transfer and continuation of the basic medical insurance relationship across the coordination area, and realize the "cross-provincial operation" of the transfer and continuation of the basic medical insurance relationship
.
Through the national integrated government service platform, the basic medical insurance relationship transfer and continuation service "online" and "nearest" are promoted, and the processing time limit does not exceed 20 working days
.
Accelerate the direct settlement of basic medical insurance across provinces for medical treatment in different places, realize national unified medical records for medical treatment in different places, and expand the scope of direct settlement for medical treatment in different places
.
By the end of 2021, more than 60% of the counties in all provinces will have at least one inter-provincial networked medical institution for general outpatient expenses, and each coordinating area will basically achieve direct settlement of ordinary outpatient expenses across provinces; before the end of 2022, each county will have at least one designated medical institution Institutions can provide cross-provincial direct settlement services for medical expenses, including outpatient expenses
.
Strengthen the data sharing between medical insurance and financial and taxation departments, establish and improve the national medical expense electronic bill library, and realize the docking with the medical insurance system and hospitals
.
Gradually realize the online and offline integration of inpatient and outpatient expenses for medical settlement services in different places
.
(8) Promote medical insurance management services to be handled nearby
.
Vigorously promote the sinking of medical insurance handling services, give full play to the role of townships (streets) as regional centers serving urban and rural residents, and decentralize services such as insurance registration and payment, information inquiry and change, remote medical treatment filing, and sporadic (manual) reimbursement initial review.
) First-level processing, and encourage the coordinating areas with conditions to be delegated to the village (community) level for processing
.
Encourage the decentralization of matters closely related to the medical treatment process, such as the identification of chronic diseases in outpatient clinics and the enrollment of newborns, to designated medical institutions for handling
.
Expand self-service functions, and set up self-service areas in designated designated medical institutions to facilitate people's inquiry and basic medical insurance handling services
.
(9) Optimize the agreement management of designated medical institutions
.
Publicize the application conditions of designated medical institutions, implement list management of the required materials, and clarify the circumstances of non-acceptance, and no "glass doors" for social medical institutions, etc.
, are treated equally
.
Coordinating regional agencies should promptly accept medical institutions and retail pharmaciesThe fixed-point application is submitted and the evaluation is organized, and if a consensus is reached through consultation, the two parties voluntarily sign a service agreement
.
(10) Improve the medical insurance management service system
.
Accelerate the establishment of a unified national medical insurance management service system to achieve full coverage of provinces, cities, counties, towns (sub-districts), and villages (communities)
.
Strengthen the service capacity building of grassroots medical insurance management offices, and promote the integration of medical insurance management services into county and rural public services
.
Relying on township (street) service stations to improve the service system of grassroots medical insurance management
.
Encourage the development of commercial health insurance, enrich insurance products, introduce third-party forces such as information technology service agencies, commercial insurance agencies, and social service agencies to participate in medical insurance management services, improve medical insurance actuarial standards, and establish performance evaluation and survival of the fittest adjustment mechanisms
.
(11) Strengthen the data support of medical insurance services
.
In accordance with the goal of building a unified national medical insurance information platform, relying on a nationally unified technical system and structure, accelerate the implementation of medical insurance information platforms in various regions, and interconnect with the national integrated government service platform
.
Fully implement the landing application of 15 information business coding standards, realize the "one code connection" of the national medical insurance system and various business links, and gradually realize the integration, deep mining and online application of medical insurance data
.
Improve medical insurance integrated management, convenient services, intelligent supervision and scientific decision-making capabilities, and improve the modernization of medical insurance governance capabilities
.
Strengthen the data management of insured participation in key groups such as employees in new forms of employment, such as flexible employees, newborns, orphans, children who are actually unsupported, etc.
, to prevent "missing insurance" and "breaking insurance"
.
Using the national integrated government service platform as the data sharing hub, establish a data sharing exchange between the medical insurance department and the education, public security, civil affairs, human resources and social security, health, veteran affairs, taxation, market supervision, rural revitalization, and disabled people’s federations.
System, strengthen the comparison and dynamic maintenance of personnel information, and make the basic data of insurance participation
.
(12) Create a demonstration window for medical insurance handling services
.
Strengthen the standardization of service windows for medical insurance management, improve infrastructure and equipment, unify service standards, and fully implement the one-time notification system, the first inquiry responsibility system, and the time-limited settlement system
.
Implement the "good and bad reviews" system, strengthen the use of results, start pioneering and strive for excellence, strengthen the construction of service windows for medical insurance management, and carry out experiential evaluations and surveys on public satisfaction
.
Accelerate the full coverage of service standardization windows for medical insurance agencies at and above counties and districts across the country to provide the masses with a better working environment and working experience
.
(13) Combating fraud and insurance fraud in the medical insurance field
.
Strengthen the whole-process supervision of medical insurance funds, improve laws and regulations , and severely crack down on fraudulent insurance activities such as induction of hospitalization, false expense receipts, and excessive diagnosis and treatment in accordance with the law, and protect the "life-saving money" of the people
.
Relying on the unified national medical insurance information platform, accelerate the application of the medical insurance intelligent supervision subsystem, and fully connect with the medical institution information system
.
In view of the characteristics of fraud and insurance fraud in the medical insurance field, improve the intelligent monitoring knowledge base and review rule database, strengthen the guidance and review of the clinical diagnosis and treatment behaviors of designated medical institutions, strengthen the supervision before and during the event, and use big data to screen for abnormal medical expenses after the event.
Deal with it in a timely manner
.
Encourage places where conditions permit to promote the use of face recognition technology, so that insured persons can "brush their face" for medical treatment and hospitalization, and eliminate "fake patients"; doctors "face-brush + positioning" double authentication, and eliminate "fake doctors"
.

　　3.
Strengthen organizational security
(14) Strengthen organizational leadership
.
All regions and relevant departments should fully understand the importance of promoting the reform of "delegation, regulation, and service" in the medical insurance field, actively coordinate and cooperate, strengthen information sharing, mechanism linkage, and form a joint force
.
Medical insurance departments in various regions should refine and decompose tasks, layer responsibilities, and ensure that they are implemented
.
(15) Optimize resource guarantee
.
All regions should optimize the resource allocation of medical insurance agencies according to the actual situation, and strengthen the guarantee of the technology, equipment, funds and other aspects required for the performance of their duties.

.
Reasonably allocate the handling force that matches the number of designated medical institutions, the number of insured persons and work responsibilities, promote the professionalization and standardization of the medical insurance handling team, and comprehensively improve the service level of medical insurance handling, serving towns (sub-districts) and villages (communities) Undertake decentralized business and provide necessary working conditions and business guidance
.
(16) Active publicity and guidance
.
All regions should promptly summarize and evaluate the effective practices of convenient services in the medical insurance field, advocate simplification of procedures, improve efficiency, facilitate the insured people to enjoy medical insurance services, and build a medical insurance service brand
.
Increase publicity, actively respond to social concerns, broadly build social consensus, and create a good atmosphere for convenient services in the medical insurance field
.