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How Oscar Health’s CEO charts its path forward in a changing payer landscape

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Oscar Health CEO Mario Schlosser speaks on stage with Rock Health Research Director Megan Zweig.

When Oscar Health CEO Mario Schlosser was facing his own headaches navigating during the birth of his first child, he realized that insurance companies were the group that had the ability to view the entire the healthcare system end-to-end.

His solution? Create a new tech-enabled insurance company that has a better user experience for both its members as well as the providers it partners with.

Schlosser laid out what brought the New York-based company to where it is today, and how it plans to lean into some of the larger shifts in the healthcare system during an onstage interview at Rock Health 2018 Summit in San Francisco.

Oscar Health is one of a crop of heavy capitalized insurance startups looking to disrupt the traditional payer industry. The company raised $1.3 billion in funding, including a $375 million cash infusion from Google parent company Alphabet earlier this year leading to Oscar’s entrance to the Medicare Advantage market starting in 2020.

The company currently serves around 250,000 members in Ohio, Texas, New Jersey, Tennessee, California and New York through mainly individual health plans. It also offers small group health insurance plans in New York.

Oscar Health more seamless tech platform means that for 40 percent of first-time physician visits, the company is able to route members to doctors that drive 10 percent overall lower cost of care with 9 percent better member experience, according to Schlosser.

“If you multiply that out, this year that has probably taken out 0.5 percent of our medical-loss ratio,” he said.

While much of the attention on the company been on its user experience and care guidance programs for members. Schlosser said the company invested an equivalent amount in creating a seamless experience on the provider end, which is increasingly facing issues like burnout due to increased administrative burden. He stated that around 92 percent of the company’s claims are now automated.

In the company’s partnership with the Cleveland Clinic, Oscar has a 50-50 risk sharing agreement and removed prior authorization rules making it easier for doctors to get claims approved. Schlosser also touted tech tools given to physicians that make it easier to route care into specialists.

“As Oscar we can primarily focus on making your life as a physician easier through things like paying claims faster,” Schlosser said. “These are all things you can do when you have a better relationship between the physician, the provider and the insurance companies.

Somewhat ironically for a company so focused on its technology, the company has also launched a brick-and-mortar facility in Brooklyn that offers primary care and wellness services to function as an experimental private practice laboratory.

It was at that location that the company piloted the ability of its care guidance concierge teams to engage more directly with physicians and Schlosser said that  three-party messaging could potentially be a new feature rolled out across the insurer’s network.

One potential area of growth in the company is the behavioral health field, with the roll out of tele-mental health features and better guidance to specialized mental health services.

In developing a lot of the core technology infrastructure “building blocks” in-house, including a more seamless member experience, Schlosser said the company has made it easier for other clinically-focused digital health companies to plug into their system.

One other major point Schlosser made was that healthcare is becoming increasingly unbundled and individualized, an organizing thesis that rings especially true for a company that got its start on the individual insurance exchanges created by the ACA.

“I fully hope for society’s sake that the rest of the insurance market will individualized over time,” Schlosser said. “The more the system individualizes, the better it will be for all of us, the more competition there will be in the value chain and the more honesty and necessity there will be in tying what people pay out of pocket to getting better outcomes and lower costs.”

Picture: Kevin Truong, MedCity News

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