探索智慧医保管理新模式 国家医保局启动个人医保云建设试点

Core Viewpoint - The National Healthcare Security Administration (NHSA) has initiated a pilot program for the construction of a "Personal Medical Insurance Cloud" from February to December this year, aiming to develop a smart healthcare management model that covers the entire population, lifecycle, and various scenarios [1] Group 1: Pilot Program Details - The pilot program will be based on a unified national medical insurance information platform, focusing on building provincial (or municipal) personal medical insurance clouds [1] - The initiative aims to aggregate core data from designated medical institutions, including diagnosis, settlement, and usage of medical supplies [1] - The program will integrate data from wearable devices, home health monitoring equipment, and health examination institutions to enhance the connection between in-hospital medical settlement data and external health sensor data [1] Group 2: Data Utilization and Personal Profiles - Data analysis techniques will be employed to create multidimensional personal profiles for insured individuals, which will be dynamically updated [1] - Personal medical insurance profiles will include health records, past medical history, surgical history, allergy history, and health monitoring data, supporting health risk alerts and medical consultation references [1] - Financial profiles will integrate insurance contributions, medical expenses, and account transactions, providing cost analysis and medical insurance recommendations [1] Group 3: Service Features - The program will utilize a medical insurance code to provide real-time notifications and status queries for key medical service points such as registration, waiting, examinations, and settlements [1] - The medical insurance code will facilitate identity verification, business processing, and medical insurance settlements [1]