People who know Feng Ge, Chief Executive Officer for Jiahui Health, a multisite private health system in Shanghai, know he always refers to health care as global. Medicine as a science is global — that’s why Jiahui works with NEJM and Massachusetts General Hospital. Secondly, health care is all about humanity, again making it global.
“I don’t have a whole lot of experience in health care to talk about. The people who spoke before me probably together have over 100 years of experience in health care. But the one thing that I learned in the last 9 years building Jiahui is that it’s really all about people,” says Ge.
“It’s really about humans. It doesn’t matter if you’re American or Chinese. We all want good health care, and this is what Jiahui is all about. Jiahui is about care, quality, the impact. We start with care. We end with impact, and quality is what we talk about — accountability, transparency.”
Related to that people-centric care, when it comes to technology, Ge emphasizes two words: trust and relationships.
The second thing Ge emphasizes is health care as a system business. An investor by training who has seen many types of businesses, Ge views health care as unique in that regard. “Health care is a systematic business more than any other business,” he says. And technology is important to help resolve this industry’s issues.
Shanghai is a sophisticated 25 million–person metropolis, and a typical tertiary public hospital there is incredibly overcrowded. “We don’t have a concrete data, but I estimate 70% of people shouldn’t be here,” Ge says, referring to his photo.
“I used to tell people in the U.S. that the only thing that looks like a Chinese public hospital, at least in the U.S., is Grand Central [in New York]. There’s no other institution that looks like a Chinese public hospital,” Ge explains.
Among the many problems in Chinese health care is rapid aging and the lack of qualified medical professionals to meet the rising demand of care for this population. Along with the lack of qualified professionals is a lack of trust, chronic underinvestment in health care and medicine, and fundamentally different economic incentives than elsewhere.
Tertiary public hospitals deliver about 95% of care in China, according to Ge. Why is that? Because “a tertiary hospital is too strong, too powerful, and too dominant,” he says. “They’re sucking all the care, primary, tertiary, secondary care — they’re all going there.” That’s why Jiahui is initially focusing on the other 5%.
As Ge mentioned earlier, Jiahui starts with care and ends with impact. They want to solve the technology and primary care issues but started with tertiary care because unlike their competitor — a single small, tertiary hospital — according to Ge, they are focused on confidence and trust.
“The third step is to earn trust,” says Ge. “The first step is to project trust.” With Jiahui’s modern medical facilities, they are trying to project that confidence and trust. “The reason we work with NEJM or we work at MGH is because we want to project that trust. That’s the beginning, but this is also the end.” Tertiary care in the U.S. is open, not a dominated monopoly, and so we can talk about primary care. But without tertiary care, people will still end up in a crowded system.
Jiahui’s goal is to create closure. “I call it a closed-end loop, that’s what we call the ecosystem. The systematic nature of health care gave us this opportunity,” says Ge.
And technology can help build the system. “We have a digital economic system, a mobile digital system. That’s a system that can help us circumvent the reality a little bit,” he says. The last 5 years saw an amazing digital transformation where everything changed, with communication, socialization, commerce, and service all integrated online.
“The best example, of course, is WeChat,” says Ge, displaying a screenshot of the platform. “It’s beautifully, simply designed.”
On the left side is the chat option — “we chat a lot; we spend more chatting than anything other than probably sleeping,” says Ge — so that you feel contact. The Discover option is social media. The Me, or “my profile” option, is what Ge calls “the supermarket, the closed-end loop.”
The top right of the app displays Tencent proprietary services. “Every service you can imagine is there already,” says Ge, whether getting your passport or paying your mobile bill. On the bottom side are third-party services for food delivery, purchasing movie tickets, calling a cab, etc. “You literally can live on WeChat without doing anything else,” he says. “We’re going to have to leverage this [virtual] ecosystem.” Jiahui has an advantage in integrating the IT system because they are new, and so they are able to provide tertiary care, ambulatory care, and digital at-home care.
Ge emphasizes a mobile ecosystem where we can engender trust and transform that trust into relationships. Jiahui built their own apps on WeChat — no need for separate apps anymore — and the great thing about them is starting with the chat, because of its frequency and closed-end ecosystem.
“So what we could do, trying to leverage it, is to make health care part of your daily life: a lot more convenient, a lot more effortless, a lot more natural,” Ge says. “Health care tends to be unnatural because you have to make an effort, going to a tertiary care facility. But this is the thing: we can do promotion, there are coupons, we can create this closed-end ecosystem, live off WeChat.”
Displaying Jiahui’s apps, Ge describes one (on the right) developed for an affiliate that delivers primary care. It’s a currently active app undergoing testing, where bots answer patients’ questions.
“We think about what we can in a couple years deliver, not only that we’re going to have a better [electronic medical record], but we want to develop a cloud-based EMR so we can implement it close to affiliates nationwide, and maybe in a couple years we can affiliate with 10,000 clinics nationwide,” he adds. “We can deliver clinical decision support. We can deliver second opinion through these channels.
“Another great thing about [building] trust and WeChat is the social element. Patients can talk about their experiences easily. That’s super-charged word-of-mouth, spreading our name. That’s another beauty of this ecosystem. This is what I call the future of relationship health care.”
The next element is artificial intelligence. “AI, telemedicine, we all talk about this; the fact that we have to use this to scale medical delivery is universal,” Ge says. “But in China, there’s a much stronger need and urgency to use it. We have to build a global network because we lack the capability. We don’t have enough doctors. We have to connect with California, Boston, New York, Houston, Rochester, Minnesota — all the relationships we have.
“The key issue I still have to come back to is trust. Why you can’t just do this online? Because people don’t trust you. We have to first build the trust, the second to be able to scale, but the beginning is always the trust.”
Lastly, Ge talks about delivering care to a patient’s home. Even though Jiahui doesn’t have all the capabilities that Kaiser Permanente has, for example, they do have density — a very populous Shanghai. Density makes care delivery more economically viable, enabling Ge to send a nurse to someone’s home, for example. Today, many health care services could be delivered at home.
“I believe that health care will do that,” says Ge. “But before we can do that, we have to deliver the trust, we have to deliver the capability, and that’s exactly what we’re doing. Jiahui is very proud and very lucky to be part of this massive transformation. We are in the process of building a hopefully effective and efficient system, but above all we cannot do this without learning from all of you, without the experiences, all the mistakes, and all the lessons.”
From the NEJM Catalyst event China’s Changing Health Care: Global Lessons at Scale, held at Jiahui Health in Shanghai, April 25, 2019.