Medical Policy Intelligence & Compliance Platform
Large Research-based Tertiary Hospital Group
This multi-campus medical group adopted FIM One as its policy and compliance base, using deep AI interpretation of medical insurance (DRG/DIP), health, and drug regulations to close the loop from policy issuance to clinical execution.
Business Impact
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
Customer Context
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 Pain Points to Adoption
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
The group connected all-channel regulatory data sources, loaded 100k+ historical policy records, and established a unified semantic search base
AI Interpretation Engine
The group tuned the medical policy-specific LLM, ran DRG/DIP policy graphs, and validated automated multi-campus impact matching
Compliance Loop Integration
The group rolled out compliance dashboards and task distribution modules for standardized policy response across the entire organization
Group Data Foundation
The group connected all-channel regulatory data sources, loaded 100k+ historical policy records, and established a unified semantic search base
AI Interpretation Engine
The group tuned the medical policy-specific LLM, ran DRG/DIP policy graphs, and validated automated multi-campus impact matching
Compliance Loop Integration
The group rolled out compliance dashboards and task distribution modules for standardized policy response across the entire organization
Customer Voice
“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.”