Medical Policy Intelligence & Compliance Platform
Large Research-based Tertiary Hospital Group
A policy and compliance base for multi-campus medical groups, providing deep AI interpretation of medical insurance (DRG/DIP), health, and drug regulations to achieve closed-loop management from policy issuance to clinical execution.
Project Results
Technical Highlights
Omni-channel Monitoring
Covers health commissions, medical insurance, and drug administrations across national and 31 provincial sources
LLM Deep Interpretation
Based on vertical medical LLM, generating automated policy summaries, impact assessments, and landing suggestions
DRG/DIP Specialization
Focuses on medical insurance reform with dedicated payment policy analysis and execution deviation assessment
Business Impact Loop
Policies mapped to business lines for full-lifecycle management from interpretation to feedback
Client Background
This large tertiary hospital group operates multiple campuses and requires real-time alignment with national and local health, insurance, and drug policies. With the deepening of Medical Insurance Reform (DRG/DIP), traditional manual modes based on paper documents and word-of-mouth can no longer handle the multi-regional, high-frequency, and complex regulatory environment.
Technology Stack
From Challenges to Solutions
System Architecture Design
Real-time multi-channel policy monitoring and semantic indexing, covering national and provincial data sources
LLM-based policy interpretation and knowledge graph construction for precise impact prediction
Compliance alerts and task distribution closed-loop for DRG/DIP and department operations
Phased Implementation
Group Data Foundation
Connected all-channel regulatory data sources, accumulated 100k+ historical policy data, and established a unified semantic search base
AI Interpretation Engine
Trained medical policy-specific LLM, constructed DRG/DIP policy graphs, and achieved automated multi-campus impact matching
Compliance Loop Integration
Launched compliance dashboards and task distribution modules for standardized policy response across the entire group
Group Data Foundation
Connected all-channel regulatory data sources, accumulated 100k+ historical policy data, and established a unified semantic search base
AI Interpretation Engine
Trained medical policy-specific LLM, constructed DRG/DIP policy graphs, and achieved automated multi-campus impact matching
Compliance Loop Integration
Launched compliance dashboards and task distribution modules for standardized policy response across the entire group
Client Testimonial
“As a medical group, we fear deviations in policy execution most. Now, the system tells us how different campuses and departments should adjust the moment a new regulation is released, greatly reducing our operational risk.”