Core Insights - The "2025 Inclusion·Bund Conference" was held in Shanghai, showcasing innovative practices in the medical payment sector by Megxin Health [1] - Megxin Health's flagship product, the "One Code Direct Payment Integrated Machine," gained significant attention for its innovative payment model, allowing users to experience direct payment services for medical treatment and medication [1] Group 1: Service Offerings - The "One Code Direct Payment" platform offers a "pay after treatment, no upfront costs" service, enabling users to quickly obtain payment authorization before treatment and generate a unique payment QR code [1] - In the medication scenario, users with specific insurance policies can purchase high-cost medications without upfront payment, only covering the out-of-pocket expenses after insurance claims [1] - The service has achieved extensive coverage, partnering with over 20,000 medical institutions, including public hospitals and private medical facilities, with full coverage of general departments in top-tier hospitals nationwide [1] Group 2: Technological Support - The efficient operation of the One Code Direct Payment platform is supported by the AI claims assistant, ClaimMaster, which provides comprehensive technical support for the claims process [2] - ClaimMaster automates the classification and extraction of key information from uploaded documents, analyzes patient treatment paths, and generates dynamic three-dimensional treatment maps [2] - The AI can quickly translate complex insurance terms into understandable language and automatically calculate claim amounts based on user-specific medical situations, reducing disputes over policy interpretation [2]

Core Viewpoint - The article emphasizes the transition of AI in healthcare from a focus on large model parameters to practical applications that solve real-world problems, particularly in the medical payment sector [2][3][4]. Industry Trends - The World Artificial Intelligence Conference (WAIC) highlighted "AI + Healthcare" as a central theme, indicating that the industry is moving towards integrating AI into real medical scenarios rather than merely competing on model performance [2][3]. - The healthcare system faces a structural dilemma known as the "medical impossible triangle," where high-quality service, broad coverage, and low costs are difficult to achieve simultaneously. AI and big data are seen as potential solutions to break this triangle and enhance healthcare accessibility [2]. Company Insights - Megxin Health, a multi-payment platform based in Shanghai, is leveraging AI to reconstruct the medical payment ecosystem, aiming to integrate the value chain of medicine, pharmaceuticals, and insurance [2][8]. - As of June 30, Megxin Health reported serving over 1.6 million patients with a total medical payment amount (GPV) of 39.7 billion yuan, collaborating with over 90 insurance companies and more than 140 pharmaceutical companies, including 90 of the top 20 global pharmaceutical firms [8]. AI Integration and Development - The article discusses the evolution of AI in healthcare from single-point breakthroughs to system integration, with a focus on creating a commercial closed loop rather than just improving algorithm performance [5][6]. - Megxin Health's AI central platform, named "mind42.ai," is designed to facilitate the integration of medical, pharmaceutical, and insurance sectors, enhancing decision-making efficiency and automating core processes [9][11]. Challenges and Solutions - The medical payment landscape is complex, requiring high precision in decision-making due to the financial implications for patients and insurance companies. AI's role is to enhance this precision through collaborative efforts of multiple AI agents [13][14]. - The article highlights the need for AI to understand medical logic and insurance calculations, which traditional methods struggle to achieve. Megxin Health's AI agent cluster aims to address this by creating a collaborative network for efficient task completion [14][16]. Future Prospects - The future of AI in healthcare payment is expected to evolve towards intelligent risk management and actuarial-driven processes, reshaping the logic of risk pricing in health insurance [19]. - Megxin Health is committed to ensuring the fairness and transparency of AI decision-making processes, addressing concerns about algorithmic bias and data privacy [20]. Conclusion - The essence of medical payment should be to safeguard patients' dignity rather than create barriers. The success of AI in this domain will be measured not just by efficiency but by its ability to alleviate anxiety for families facing health challenges [21].

Core Insights - The World Artificial Intelligence Conference (WAIC) in Shanghai highlighted the shift of AI's main battleground from large model parameter competition to practical applications in industries, particularly in healthcare [2][3] - The focus of discussions has moved towards how AI can empower real-world scenarios in diagnosis, payment, and new drug development, aiming for a commercial closed loop [2][3] - The "impossible triangle" in healthcare—high-quality service, broad coverage, and low cost—may be addressed through the maturity of AI and big data capabilities, enabling better healthcare access [2][3] Industry Trends - The integration of AI in healthcare is evolving from isolated breakthroughs to systematic integration, with a focus on digitalization and intelligence [3][4] - The competition has shifted from algorithm performance to data acquisition and compliance, emphasizing partnerships with major hospitals for high-quality data [4][5] - AI's role in healthcare payment systems is becoming crucial, as it is seen as a key to validating AI's business model and creating a value closed loop [4][5] Company Developments - Megxin Health, a Shanghai-based technology platform, is leveraging AI to reconstruct the healthcare payment ecosystem, aiming to integrate the value chain of medicine, pharmaceuticals, and insurance [2][6] - As of June 30, Megxin Health reported serving over 1.6 million patients with a total medical payment amount (GPV) of 39.7 billion yuan, collaborating with over 90 insurance companies and 140 pharmaceutical firms [6][7] - The company is developing an AI central platform named "mind42.ai" to facilitate the integration of medical, pharmaceutical, and insurance ecosystems [6][7] AI Implementation - Megxin Health is focusing on automating the claims process through AI agents, significantly reducing the time required for claims processing from about one day to as little as 10 minutes [13][14] - The AI agent cluster is designed to cover the entire decision-making process in healthcare payments, enhancing efficiency and accuracy [10][11] - The company aims to extend its AI capabilities to more scenarios, including health management for chronic disease patients and patient management for pharmaceutical companies [14][15] Future Outlook - The evolution of AI in healthcare payments is expected to transition from process automation to intelligent risk control and actuarial-driven approaches [15][16] - Megxin Health envisions becoming a participant in setting new industry standards for payment processes and claims regulations, leveraging technology to optimize healthcare resource allocation [15][16] - The integration of AI in insurance pricing and claims decisions raises concerns about data transparency and algorithmic bias, prompting Megxin Health to implement rigorous data quality and decision-making transparency measures [16][17]