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in the field of healthcare, with the rapid development of artificial intelligence technology, ai-assisted diagnosis and treatment plan optimization are gradually becoming a reality. recently, the test report of the medgpt member version system of yilian deeply compared the original case records with the test analysis records, explored the application scenarios of medgpt in future medical cost control, and demonstrated the remarkable results of medgpt in treatment and medication plans. in particular, its ultra-high diagnostic accuracy and the comprehensive improvement of cost control capabilities brought about by the treatment and medication plans recommended by medgpt have brought new hope for medical insurance cost control, commercial insurance cost control, and the possibility of reducing personal medical expenses.

at present, the drg/dip payment 2.0 grouping scheme promoted by the national health insurance administration has been implemented. the reform goal is to guide medical institutions to transform to low-cost, high-efficiency, and high-quality "value-based medicine". commercial medical insurance companies can work with medical institutions to jointly promote the optimal allocation of medical resources and the improvement of medical service quality. medgpt provides doctors with many aspects of value in the context of medical insurance cost control, including improving the efficiency and accuracy of diagnosis and treatment, optimizing the allocation of medical resources, promoting communication between doctors and patients, and promoting medical technology innovation. these functions will also help national medical insurance and commercial insurance companies to better control the cost of medical services and achieve a win-win situation for medical care, patients, national medical insurance, and commercial insurance.

medgpt helps patients save 80% of medical expenses

this test collected real cases from 102 offline hospitals, involving 84 different diseases, of which 17 diseases had 2-3 different cases, ensuring the diversity and representativeness of the test data. testers recorded the prices of the modified diagnosis, treatment and medication plans, and calculated whether the treatment and medication plans were more expensive or less expensive.

in specific cases, medgpt can provide accurate diagnosis and reasonable treatment plans. for example, in a certain case, medgpt may formulate a treatment plan based on the patient's specific symptoms (such as frequent urination, dysuria, lower abdominal pain, etc.) and examination results (such as urinalysis), recommend the use of appropriate antibiotics and reasonable treatment costs, so as to achieve treatment effects and reduce the patient's financial burden.

similarly, in cases such as tonsillitis, medgpt can also develop personalized treatment plans based on the patient's specific conditions and test results. these plans not only take into account the diagnosis and treatment of the disease, but also take into account factors such as the patient's financial affordability and the side effects of the drugs, providing patients with more comprehensive and considerate medical services.

the test results showed that medgpt performed impressively in diagnosis. the accuracy rate was as high as 81% according to the disease, demonstrating the powerful ability of medgpt in disease identification.

the savings effect of using the drug regimen recommended by medgpt is particularly significant. among hundreds of cases, more than 80% of the cases used the drug regimen recommended by medgpt, and the price was nearly 80% lower than the actual offline cost, with an average saving rate of 79%, showing the great potential of medgpt in optimizing treatment plans and reducing the economic burden on patients.

in addition, the total offline price for treating a certain disease was 17,471 yuan, while the total price of using the medication regimen recommended by medgpt was 2,821 yuan. the use of medgpt helped patients save 14,650 yuan, and the total price accounted for only 16% of the offline total price. this data intuitively reflects the positive role of medgpt in medical insurance cost control or personal medical expenses savings.

at present, the cost-saving value and function of medgpt still need to be tested, but the cost-control value it has demonstrated is already amazing enough. this coincides with the current goal of the national medical insurance fund to promote drg/dip payment, and is similar to the goal of commercial insurance companies to control the claims ratio.

medgpt helps commercial insurance companies reduce their claims ratio

usually, the medical insurance of commercial insurance companies is reimbursed at a certain percentage after the residents' medical insurance is reimbursed. the specific reimbursement ratio and scope will vary according to the insurance terms and contractual agreements of the medical insurance. generally speaking, medical insurance will cover some items that are not reimbursed or reimbursed at a low ratio by residents' medical insurance, such as some high-end medical examinations, drug costs, hospitalization expenses, etc.

taking the above test as an example, the total offline price of treating a certain disease is 17,471 yuan. assume that a patient purchases outpatient insurance from a certain insurance company with a reimbursement rate of 80%. basic medical insurance can reimburse 60% (medical insurance reimbursement rates vary from place to place). in the absence of a deductible, basic medical insurance pays 10,483 yuan, and the individual pays 6,988 yuan. after the commercial insurance company reimburses 5,591 yuan for outpatient insurance, the individual needs to pay 1,397 yuan.

according to the treatment and medication regimen recommended by medgpt, the total cost is 2,821 yuan, which can save patients an average of 79% of the cost. basic medical insurance only needs to pay 1,692 yuan, commercial insurance companies only need to pay 903 yuan, and individuals only need to pay 226 yuan.

the treatment and medication plan recommended by medgpt saves basic medical insurance 8,791 yuan, commercial insurance companies 4,688 yuan, and individuals 1,171 yuan.

generally speaking, the price of outpatient insurance ranges from a few hundred yuan to thousands of yuan. assuming that the outpatient insurance purchased by the patient costs 1,200 yuan, without the help of medgpt, the commercial insurance company would have lost at least 4,391 yuan, excluding the cost of acquiring the customer. with the help of medgpt, the insurance company successfully turned losses into profits for this customer.

in the future, medgpt will be able to achieve more functions than this.

medgpt can analyze a large amount of medical records, diagnostic reports and patient histories to help insurance companies more accurately assess the health risks of each policyholder. through deep learning and natural language processing technology, medgpt can identify potential health problems and risk factors, thereby helping insurance companies formulate more reasonable premiums and insurance terms.

medgpt can automate routine tasks in claim processing, such as document review and preliminary assessment, to improve the efficiency and accuracy of claim processing. faster claims processing not only improves customer satisfaction, but also reduces claims costs caused by delays or errors.

by interacting with policyholders, medgpt can provide personalized health advice and guidance to help policyholders prevent diseases and manage chronic diseases, thereby reducing future health risks. this not only helps reduce the claim ratio, but also enhances the insurance company's brand image and customer loyalty.

based on the information acquisition and reasoning capabilities of generative ai, medgpt can conduct in-depth analysis of historical claims data, discover claims trends and patterns, and provide data support for insurance companies to develop more effective risk management strategies. predictive models based on data analysis can help insurance companies predict future claims, so that they can prepare in advance and reduce claims pressure.

medgpt helps doctors, patients and insurance companies achieve win-win results

since commercial insurance companies make compensation based on the out-of-pocket portion outside of basic medical insurance payments, drg/dip payments not only save basic medical insurance funds, but also play a decisive role in reducing commercial insurance and personal medical expenses.

under the drg/dip payment model, the goal of controlling medical insurance costs has invisibly put pressure on hospitals and clinicians. therefore, clinicians need technical "plug-ins", and patients also need to better understand the value of drg/dip for their own disease and health diagnosis and treatment. the new medical insurance payment method will inevitably bring challenges to the old payment system, and patients' medical experience will also undergo tremendous changes.

in order to control costs, medical insurance policies may restrict or exclude certain high-cost or non-essential medical items and services, which may result in patients facing limited choices when seeking medical treatment, affecting their treatment experience and satisfaction. some patients are also worried that medical insurance cost control will cause medical institutions to reduce service quality in order to reduce costs, such as reducing examination items, shortening hospital stays, etc., thus affecting treatment effects and recovery progress.

communication between doctors and patients has always been a difficult problem for medical institutions. doctors face a large number of patients waiting in line for medical treatment every day, and it is impossible for them to give detailed diagnosis, treatment and payment suggestions to each patient.

in the context of drg payment, communication between doctors and patients may be even more important. doctors need to explain to patients the basis for selecting treatment options, cost conditions, and medical insurance policies, and patients also need to participate more actively in the treatment decision-making process and jointly find the most cost-effective treatment options.

in the process of medical insurance cost control, enhancing the transparency of patients' medical treatment is an important part. medgpt can provide patients with a clearer understanding of their condition, treatment plan and possible expenses by providing detailed treatment plan descriptions and cost forecasts. this helps patients make more informed medical decisions and avoid increased medical expenses due to information asymmetry.

doctors can use medgpt's intelligent analysis results to explain the condition, treatment plan and cost to patients more intuitively, enhancing patients' trust and satisfaction. at the same time, patients can also ask questions and give feedback to doctors through the platform provided by medgpt, forming a better doctor-patient interaction relationship.

for patients, high medical expenses have always been a heavy burden. while reducing the payments from basic medical insurance funds, drg/dip payers will also significantly reduce individual payment costs, and commercial insurance companies will also benefit greatly from this.

in this round of testing, due to the use of medgpt, more than 80% of the cases achieved significant cost savings, which is of great significance for alleviating the economic pressure of patients and improving their satisfaction with medical treatment. in the future, as medgpt technology continues to mature and become more popular, more patients will benefit from this innovative achievement. at the same time, the national medical insurance fund and commercial insurance companies will also reduce the overall compensation rate. the saved national medical insurance fund and commercial insurance funds will greatly increase the coverage of more diseases and a wider range of people, and achieve better social welfare protection as a whole.