Chongqing - The 2024 National Intelligent Healthcare Security Contest concluded on November 5 in Chongqing Liangjiang New Area. The winning projects featured advanced technologies, including large models and AI, to tackle challenges in China's healthcare insurance operations.
During on-site interviews, the case from PICC Property and Casualty Company Limited (PICC P&C), the "Medicare Smart Assistant," uses large model-enhanced retrieval technology combined with healthcare insurance policy data to provide accurate Q&A services and information retrieval.
Users can interact with the Assistant via text, voice, or images to quickly receive professional responses, helping resolve various healthcare insurance-related issues.
The Assistant is used in three key scenarios: public consulting, inquiry services, and regulatory efficiency. Tailored to each scenario's specific needs, it offers effective and timely solutions through intelligent interaction.
Yang Yi, representative for PICC P&C's case, explained that the most common public concerns about healthcare insurance are medical expenses and the reasonableness of reimbursements.
It is reported that healthcare insurance policies in China are often written in highly technical language, making them difficult for the general public to quickly understand. Public concerns, such as those mentioned above, are challenging to address by independently searching through policy documents.
Yang noted that, to address this issue, the Assistant combines a specialized database with a large model to interpret colloquial inquiries from the public and deliver answers in accessible language, making healthcare policy explanations more user-friendly.
Moreover, the Assistant is equipped with image recognition capabilities, enabling it to process images such as medical expense statements. On-site staff demonstrated the Assistant's ability to parse anonymized statement images, with the solution accurately identifying the reimbursable amount, thereby providing enhanced convenience for insurance inquiries.
In healthcare fund oversight, the Assistant effectively supports flying inspections, a form of surprise audit. Yang explained that during these inspections, medical review experts often need to reference policy documents to confirm the basis for identifying violations.
However, the vast number of such documents and the complicated details trouble their research. The Assistant offers experts convenient access to policy document retrieval through data integration, streamlining the process.
The Assistant also proves valuable in the inquiry services. Addressing the limited resources and insufficient policy understanding at grassroots healthcare service centers, service staff can use the solution for self-directed queries to obtain accurate policy information before responding to public inquiries, ensuring answers align with the latest standards.
Additionally, Yang noted that the Assistant serves as a training tool, significantly reducing training and maintenance costs for healthcare personnel at local service centers.
At the awards ceremony, Zhang Ke, director general and secretary of the Leading Party Group of the National Healthcare Security Administration, stated that the next step will involve providing support for these outstanding projects and teams in terms of results transformation, incubation, and practical implementation, further promoting the adoption and application of smart healthcare insurance technologies.