It remains to be seen whether Internet medical care can quickly enter a mature stage under the epidemic

There is no longer the rhetoric of “subverting medical care”, and there is no longer the debate of “moving, but not moving”. Internet medical care has gone quite quietly in the past three years. We did not expect that the “new crown epidemic” has become a stimulant to stimulate Internet medical care.

During the epidemic, many platforms have launched special consultation areas for the new coronavirus pneumonia, which have achieved a significant increase in the number of users and consultations. For example, on the WeChat “Payment” page, from the opening of the “New Coronary Pneumonia Epidemic Zone” on January 26, as of February 6, in just 10 days, the daily service exceeded 10 million users, and the daily interface calls for core services exceeded one billion.

In addition to Internet medical platforms, medical institutions have also launched specialized online consultation platforms during the epidemic to ease the pressure on outpatient clinics. For example, the online specialist consultation service of Peking Union Medical College Hospital was very popular as soon as it was launched.

In the period when 1.4 billion people are “fighting the epidemic at home”, the Internet diagnosis and treatment platform meets the medical needs in a “contactless” way; the Internet science popularization platform transmits medical information in a rational, vivid and clear way; Internet shopping The drug platform allows people who stay at home to get the necessary drugs at the first time; the Internet consultation platform opens a channel for remote case discussion among medical institutions. It is no exaggeration to say that Internet medical care is the “second battlefield” in the fight against the epidemic.

For this second battlefield, the government also gave policy support for the first time. On February 18, the Beijing Municipal Medical Security Bureau and the Beijing Municipal Health Commission jointly issued a document to formulate and announce the price of Internet follow-up items and medical insurance payment policies. On February 23, the Shanghai Municipal Bureau of Medical Insurance stated that designated medical institutions in Shanghai will have Internet diagnosis and treatment services to provide “Internet +” medical services for insured patients with common diseases and chronic diseases.

For a time, there was a lot of talk about the “new outlet” of Internet medical care. The question is, are these “wartime” special needs a new outlet? How will the Internet medical industry, which has experienced peaks and troughs, move towards a mature stage of development?

01 Internet medical treatment: out of the “Warring States Period”

As a former Internet medical practitioner, I have personally experienced the entire process of Internet medical care from budding, growing to “de-bubble” since 2011, and I have also witnessed all kinds of rhetoric, high spirits, and discouragement in that cycle. Therefore, in the face of the rapid heating of Internet medical care under the epidemic, I would like to start from the ups and downs of the last round of Internet medical care.

Because it is closely related to human life, this industry has been a bit more idealistic than other industries from the very beginning.

Almost every founder of Internet medical care will mention his family’s medical experience when talking about his original intention of starting a business: Wang Hang, founder of Good Doctor, started his business when his child was two years old, and Liao Jieyuan, founder of WeDoctor, started his business because of his nephew’s medical treatment experience. Zhang Rui, the founder of Chunyu, came from a family of doctors. He “witnessed the difficulties of doctors and the difficulties of patients since he was a child”… There are so many pain points in China’s medical industry, it seems that any point is a good “IDEA” for starting a business.

These pain points and ideals, with the rapid fermentation of the entire mobile Internet entrepreneurial tide, have brewed an era of “subversion of medical care”.

I still remember Zhang Rui from Dr. Chunyu standing on the coffee table with passion at a press conference. Not far away, is his dog. That was a very representative picture of the last Internet boom. At that time, Zhang Rui and the Internet medical care he represented brought such a shocking image of a youthful rebel to the traditional and conservative medical industry. In 2015, he had an encounter with Wang Shan, the then president of the Peking University People’s Hospital, at a venue. There was a heated debate on whether Internet medical care could “decentralize hospitals” and “is there a business model”.

A few years later, Zhang Rui passed away unexpectedly, and this picture is also particularly embarrassing.

Internet medical care really became popular in 2014. That year, Tencent entered the market with a large investment, leading the investment in WeDoctor, also known as “Registration Network”, with the highest record in the industry at that time; Ali through Alipay and Ali Health, two-way layout of Internet medical care.

The entry of the two Internet giants has fully opened the era of “big enclosure” of Internet medical care – BAT companies, various registration platforms, medical informatization companies, and start-up companies have entered the market; a large amount of funds, investment institutions, listed companies, Private bosses will pour into this industry in a short period of time; for patients, doctors, hospitals, medical insurance, and medicine, different companies have developed countless applications of different specialties, different stages, and different functions.

For a time, the product line of Internet medical care is extremely rich, and the competition between companies is also hearty. Of course, in addition to being driven by ideals and pain points, more entrants are looking for the seemingly infinite market of healthcare.

At the beginning of 2016, in a speech, I used the “Warring States Period of Medical Care” to describe the grand occasion at that time – “the competition for territory, competition for talents, the prevalence of wolf culture, the smell of gunpowder, and the smell of hormones everywhere”. I matched this sentence with a still from the popular TV series “The Legend of Mi Yue”.

Just two years later, the situation took a turn for the worse.

On the one hand, some negative events happened. On October 5, 2016, Zhang Rui died unexpectedly, and the IPO road of Chunyu was forced to be interrupted; in February 2017, Baidu announced the abolition of the “Medical Division” with a team of 300 people; it is also reported that in 2017, as many as 1,000 Internet companies Medical-related businesses were deregistered.

On the other hand, in 2018, after allowing the Internet medical industry to explore itself for several years, the “Administrative Measures for Internet Diagnosis and Treatment (Trial)”, “Administrative Measures for Internet Hospitals (Trial)” and “Management Regulations for Telemedicine Services (Trial)” were issued at the same time. . This series of regulations not only fills the regulatory gap, but also defines the scope of Internet medical services. The once all-encompassing bold attempt has been narrowed down to the red line – these three services are inseparable from “medical institutions”.

For example, telemedicine refers to “the use of medical personnel registered by the institution between medical institutions to carry out remote consultation and remote diagnosis by using information technology such as the Internet”; Internet diagnosis and treatment activities refer to “the use of medical institutions registered by the institution by medical institutions. Personnel, using Internet technology to directly provide patients with some common diseases, chronic disease follow-up and family doctor contracting services”; Internet hospitals, either “as the second name of a physical medical institution” or “relying on the independent setting of physical medical institutions”.

Internet medical care is no longer a “subversive” role, it has been “incorporated” by traditional medical institutions to a large extent.

The Warring States era of Internet medical care has officially ended.

02 Contributed medical reform promoter

Does this end simply mean the failure of the industry? How to look at the Internet medical industry in the last cycle?

In 2014, I went to Silicon Valley to inspect the Internet medical industry, which is also in full swing. After returning, he summarized the development of Internet medical care in the United States into four stages: user-generated content, doctor-patient interaction, participation in medical reform, and data-driven decision-making.

At that time, the development of Internet medical care in the United States was between the third and fourth stages. During that period, the stars of Internet medical care in the United States included telemedicine company Teledoc, cloud Electronic medical record company Practice Fusion, and medical insurance cost control company Castlight, as well as companies such as Nant Health, which provided personalized diagnosis and treatment solutions by establishing a tumor sharing data platform.

China’s Internet medical industry falls between the second and third stages. There are two types of companies in the industry: one is the Internet light consultation and the Internet hospitals that have been combined with physical medical institutions since then; the other is all kinds of companies aiming to optimize the medical treatment process.

These Internet medical companies have explored to solve a series of problems in the medical system. From a macro perspective, including medical accessibility, insurance payment control, and rationality of medical resource allocation; from a micro perspective, including diagnosis and treatment procedures, Medical quality, medical personnel education, medical management, health education, etc. The result of the exploration is that in today’s medical industry, “Internetization” has become the standard – online appointment registration, online access to inspection results, online medical insurance payment, remote consultation between doctors, remote ward rounds, Internet technology And the medical system has been integrated without any trace.

In this sense, these Internet medical companies have contributed to the promotion of China’s medical reform.

But also in the third stage of “participation in medical reform”, there are great differences in the Internet medical industry between China and the United States.

The first difference is the format and scale of development.

When the well-known digital medical incubator “Rock Health” in the United States defines “digital medical care”, it clearly points out that it only includes those technology-driven health-related companies, whether these companies focus on medical management, medical services, or assistance. Introduction of innovative medical products to the market. Those hospitals and medical insurance companies that only use Internet medical technology cannot be counted as “digital medical” companies.

Under this definition, 6 digital healthcare companies in the US went public in 2019, including chronic disease management company Livongo, healthcare big data and quality improvement solutions provider Health Catalyst, healthcare IT service company Change Healthcare, patient appointment management company Phreesia, Smart Peloton, a home fitness equipment company, and Progyny, an assisted reproductive management company.

During the same period, if listed as the standard, the current Internet medical companies in China are only a few old medical informatization companies in A shares, as well as Ping An Good Doctor and Ali Health in Hong Kong shares. Among them, Ping An Good Doctor deeply relies on the insurance business of Ping An Group, and Ali Health has been listed before the transformation of Internet medical care.

The second difference is the return on investment ratio.

Judging from the situation of the five US digital medical companies listed in 2019, before the listing, the five companies received a total of $1.4 billion in investment. After the listing, their current total market value is $13 billion. That’s a nearly 1:10 ROI.

However, the current top medical Internet companies in China are much more expensive to grow, and the size of the top companies is also much larger. For example, since its establishment in 2010, WeDoctor has received a total investment of more than 9 billion yuan; on February 27, the market value of Ping An Good Doctor in Hong Kong stocks reached 82.9 billion yuan, and Ali Health was as high as 185.9 billion yuan.

Behind these two differences are actually different growth soils for Internet medical care under two different medical systems.

The U.S. medical system is decentralized and diverse in terms of medical service provision and medical insurance payment. Doctors, hospitals, public hospitals, private hospitals, family doctors, specialist doctors, commercial insurance companies, federal insurance companies, managed medical institutions… a lot of different The role of the division of labor and cooperation has given birth to a rich format of Internet medical care. In addition, the HIPPA Act, a well-established regulation in telemedicine, has also provided good practice for the industry’s development over the years.

In contrast, the main body of China’s medical industry is much simpler. In terms of medical service supply, although the number of private medical institutions has greatly increased, according to the latest statistics, public hospitals account for more than 80% of the total number of patients and admissions; in terms of medical insurance, commercial medical insurance has developed rapidly, but At present, the payment from commercial health insurance still only accounts for 1/10 of the social security payment.

In other words, in order to innovate in China’s medical industry, companies either need to directly face “Big Mac”-style customers, or they need to compete directly with these “Big Mac”-style entities. The cost of the education market is high, and the negotiation There is little room for innovation, and the threshold for innovation is extremely high.

This can also explain why China’s Internet medical companies are particularly “burning money”, and why after one cycle, only a large number of players are still active.

03Three roles expected to climb quickly

In fact, from a long-term perspective, the rise and fall of the Internet medical industry in just a few years just fell on the “Gartner Technology Hype Cycle”. This industry has gone through the “technology birth period”, “high expectations period”, “bubble disillusionment period”, is going through a “slow climbing period”, may be about to enter a “steady growth period”, and may experience one or two fluctuations will really mature.

In the past few days, the news that the Internet diagnosis and treatment hotline has been included in medical insurance has once again made the industry boil. It is foreseeable that under the stimulus of the epidemic, there will be more favorable policies. But who can seize the opportunity, and what kind of enterprise can quickly go through the “slow climbing period”? In my opinion, there are three roles that might be better positioned to take advantage of this opportunity.

One is the winner-take-all traffic giant.

Since 2018, the concentration trend of the Internet medical industry has become more and more obvious. A notable feature of leading companies is that they are backed by various resource traffic portals. This traffic comes from several sources. For example, in addition to online users, Ping An Good Doctor’s traffic is also the insurance customers of Ping An Insurance; physical medical institutions, as a necessary entity for Internet hospitals, are the most important patient traffic portals; BAT, JD.com, Meituan and other platforms have accumulated A large number of data-based user portals have certain advantages to convert them into users in the medical and health segments; medical information companies that have been deeply involved in the medical industry for decades have deeply penetrated into the medical industry through software. , is an important industry entrance for medical institutions and doctors.

The second is a pragmatic and low-key invisible champion.

Although the Internet medical industry is no longer noisy, the pain points of the medical industry still exist. These pain points still need to be improved through medical reform and technological solutions. This epidemic has once again exposed many problems in the public health and medical system. For example, the role of the “medical gatekeeper” before the hospital is still missing. Can some innovative solutions be made through technical solutions? With the advent of aging, how to better serve the health care and care needs of the elderly? How to better integrate various medical and health institutions and applications to form a patient-centered integrated medical model? How to change from focusing on individual health to focusing on population health? Faced with this series of problems, industry “assistants” who have in-depth research on the medical and health system and are persistent and low-key are expected to become the “hidden champions” among them.

The third is a new round of industry disruptors.

SARS in 2003 promoted the reconstruction of the medical system and greatly promoted the rapid development of industries such as pharmaceuticals, medical devices, and medical services. The main engine that promotes the development of the industry is the “expansion” of the market, that is, the expansion of medical insurance coverage, the increase of financial investment in medical software and hardware, and the substantial increase in medical purchasing power. After the epidemic, “innovation” is expected to become a new engine for the reshaping of the medical system and the development of the industry. The epidemic has accelerated the comprehensive application of new technologies such as big data, artificial intelligence, and robotics in the medical industry, and fostered demand for health education, telemedicine, home diagnosis and treatment, and home fitness. In the future, can Internet medical care be deeply integrated with these technologies to create a new round of industry disruptors?

It is worth mentioning that these optimistic projections are not quickly becoming a reality. In the past, an industry cycle has taught you the most, is the word “patience”. The “stimulant” of the epidemic will not become a new outlet. Compared with “in full swing”, “long flow” is the main rhythm of the future of this industry.

Of course, just as the speed of the spread of diseases can be reduced due to people’s efforts or larger because of people’s neglect, whether the Internet medical industry can quickly enter a mature stage also depends on the joint efforts of various roles. Whether the government and society will comprehensively reflect after the epidemic, sort out the problems in this system with a real and pragmatic attitude, and encourage various innovative solutions is the key to determining the speed of industrial development.