Medical payments in the United States have gone through three stages. FFS (pay by service) is the earliest form and the normal mode of domestic medical payment. Later, the second phase of the HMO (Health Maintenance Organization) emerged due to the excessive profit-seeking pressure from the medical institutions to the US insurance system. Based on insurance institutions, HMO provides preventive management of members' health through annual or monthly subscriptions. In this mode, no matter what kind of treatment the doctor takes, the main purpose is to control the cost of treatment, avoid waste and over-treatment. However, due to the closure of the HMO system and the sensitivity to medical expenses, patients often do not receive effective treatment at the beginning of the disease, so the disease is dragged into a serious illness. In order to improve the shortcomings of the HMO model, the third phase of the ACO model was born under the leadership of US President Barack Obama. Different from HMO, the ACO model uses health management organizations and medical organizations as a close collaboration on the basis of fees. It not only helps members to develop health management plans, but also actively intervenes in member health through accurate medical treatment . Under this system, medical institutions, members, and insurance institutions can maximize profits. Therefore, the ACO model has become the main direction of the future medical system construction. However, due to the different soil environment, it is not easy to develop the US ACO model in China. How to solve the problems of the payer and the service party, how to integrate the resources of all parties, how to improve the basic medical level and other issues is a real dilemma. If the micro-medicine wants to successfully establish an ACO system, this series of problems is a few mountains that have to be passed. With many questions, the arterial network visited the micro-medicine. In the interview with the senior doctors, the arterial network gradually learned the whole picture of the “Chinese-style ACO†of the micro-medicine, and a series of “cracking methods†created by them in the face of various problems. The first problem: the inequality between the payer and the service party In the US ACO system, the payer is in a strong position relative to the medical service provider. China, on the other hand, is the opposite. Due to the weakness of Chinese insurance payers, the abuse of medical services and the over-expenditure of medical insurance expenses have been exhausted. Commercial insurance companies are wary of entering the medical market and want to make a difference, but they are losing one. Many local reforms are difficult to implement and have a certain relationship with commercial insurance. American ACO is a highly market-oriented business model. Insurance companies, hospitals, and doctors all operate around the market. The United States can build this system, and the core lies in the support of the data platform. In order to effectively connect the medical and insurance data platforms, the most important point is to need a comprehensive platform that can achieve accurate data analysis, through the platform to achieve fraud prevention and control fees. Therefore, American companies can collaborate with each other on the basis of business contracts and data support. Subject to the restrictions of the medical system, domestic companies cannot simply copy and copy the American model if they want to develop the ACO model. If you copy it all by yourself, you will inevitably encounter many problems, and the probability of success is almost zero. Micro-medicine is based on the American ACO model, combined with its own advantages in the field of Internet medical treatment, with a new mode of operation to achieve the same effect. Micro-medicine is building a Unicom platform for the interconnection and open sharing of medical and insurance data. Through data sharing, information asymmetry due to missing or opaque data will be fundamentally resolved. The most worrying behavior of commercial insurance companies will be reduced, and the ability to control medical expenses will be significantly enhanced. This is a very big touch for insurance companies. In addition, the US ACO model is based on the establishment of traditional medical institutions, and micro-medicine attempts to form its own characteristics through Internet medical treatment. From the perspective of industry layout in the past five years, micro-medicine has made achievements in hospital process optimization, Internet grading diagnosis and treatment, Internet hospitals and team medical care. The use of Internet technology to revolutionize the drawbacks of traditional medicine, but does not reject and exclude traditional medical methods. This is a set of operational treasures accumulated and summarized by micro-medicine.
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