Chief Executive Officer/Co-Founder
Oscar is a consumer-focused health insurer that uses technology, data, and personalized service to give members transparency into the health care system and guide them towards better, more affordable care. The Oscar member experience includes a concierge team, a free, 24/7 telemedicine service for members on the go, and a tightly integrated, curated network of first-rate physicians and hospitals. Plans for individuals and families will be available to Austin residents for 2018.
HTA - What inspired you to start Oscar Health?
The idea for Oscar evolved at a time when my cofounders and I were dealing with different medical needs in 2012. For me, my wife was pregnant with our first child, and I was trying to do my homework to prepare for how much we might incur in medical expenses. One of my other cofounders, Josh, was in the midst of deciphering his own medical costs after a sprained ankle landed him in the emergency room. Neither of us could believe how complicated it was to get a direct answer from our insurer, our doctors, or medical administrators on costs, quality of physicians, and how our benefits worked. What’s more, we had a hard time understanding the bills we did ultimately receive and why we were being charged as much as we were.
As we dove deeper into the dynamics of the U.S. health care system, we realized that our confusion and frustration were symptoms felt far and wide by most Americans. We looked for the common thread that pulled the needs of doctors and patients together. What we learned is that insurers are the only player that has a full, 360 degree view of a consumer’s health care experience through the claims they process. The challenge of coming up with a new health insurance model that put the consumer’s experience front-and-center became our inspiration for Oscar Health.
As we like to say, we didn’t start Oscar because we love health insurance. Quite the opposite really. We started Oscar because we saw a gap in the way consumers are treated, guided, and helped through their health journeys. Since our official launch in 2014, we have built a consumer-focused, technology-driven health insurance experience that makes it easy for members to navigate the complex health care system. We are now more than 600 employees strong, with dedicated, personalized concierge teams that handle thousands of member inquiries a week. Our engagement data shows us that our members are using Oscar tools, like our free, 24/7 Doctor on Call feature, 8x more than the industry average, proving that we are building something that is meaningful and in demand.
HTA - What has Oscar’s journey been like to get to where you are today?
We’ve always said that building the first technology-driven, member-centered health insurer is a bold, ambitious investment. One of the developments that I am most proud of is our ability to bring some of the core parts of our model in-house. Over the last five years, we’ve built from scratch our own provider networks, our own claims processing system, and, of course, our Concierge Team model. We have teams of engineers and designers who are focused on creating a product interface that is intuitive and user-friendly. With full ownership of these elements, it means that we don’t need to rely on other companies to deliver the Oscar experience. That is the case for almost no other entity or vendor in healthcare. By owning the entiretechnology stack, we are even better positioned to serve our members and to innovate in ways that keep their needs front-and-center.
HTA - Where is Oscar available and why are you expanding to Austin?
We originally launched Oscar in New York and grew to cover California and Texas. Now, as we look towards the 2018 enrollment period, we are one of only a few health insurers that is actually planning to expand. Aside from Texas, New York, and California, our coverage will include New Jersey, Tennessee, and Ohio. This expansion is a testament to our unique product and approach. We also know that our members are growing to trust us and, in turn, are recommending us to their friends and family. Our new membership data shows that 40% of our members learned about us due to word of mouth. We are more confident than ever that we are building something that Americans want.
In Texas, specifically, we are thrilled to be expanding to Austin. Texas has quickly become one of our favorite states to operate in, both in terms of the quality of our provider partners and the enthusiasm for the Oscar experience. Given Austin’s growing population and the high concentration of tech-savvy, entrepreneurs, it has been a city on our radar for some time. We are actually the only new insurer entering the Austin market for 2018.
HTA - Who are Oscar's ideal customers?
Oscar is an insurer that has the capability and the capacity to cover everyone, whether you buy insurance through your employer or on your own. Our expansion plans for 2018 demonstrate that we are already on our way to bringing Oscar to more people geographically. We hope to deliver an ideal member experience that is personalized, proactive, and helpful. No matter who you are or what your medical needs are, the Oscar Concierge Team, our products, and plans are there to help keep you healthy.
HTA - How does Oscar use partnerships to scale growth?
This year we’ve launched two meaningful partnerships that support Oscar’s expansion plans in 2018. The first is a joint venture with the world-renownedCleveland Clinic to bring co-branded health insurance plans to individuals in Northeast Ohio. This partnership is particularly exciting because it is the Cleveland Clinic’s first such entrance into the insurance market. All Cleveland Clinic | Oscar plans will include access to Cleveland Clinic’s network of over 3,500 full-time physicians and 14,000 nurses across 140 specialties and subspecialties, personalized, guided care from a combination of a Cleveland Clinic Care Team and an Oscar Concierge Team, plus free 24/7 access to telemedicine for care needs when our members are on the go. Through a deep integration of our systems, Cleveland Clinic and Oscar will be able to deliver accessible and to quality care through easy-to-use technology that is aligned on the same goal: putting members first.
Second, we launched a partnership with Humana, a leading health and well-being company, to bring health insurance plans to small businesses in Nashville, TN. Similarly to our expansion efforts in Austin, we chose Nashville because it is home to some of the most engaged health care consumers in the country and it is supported by a growing entrepreneur-driven community. These Humana + Oscar plans will combine our member focused approach with Humana’s strong provider relationships. We are confident that together we can reshape commercial health insurance in America into a simple, seamless, and consumer-focused experience.
HTA - There’s a lot of noise in Washington about health care reform. What form of health care policy does Oscar think works best?
We'd support anything that puts more power in the hands of the individual, from more transparency to encouraging greater health literacy. We take the long view at Oscar and what we see is that people want easy, affordable health insurance that guides them through a broken system. The current healthcare system evolved around the needs of middlemen, not around the needs of individuals. Any reform that creates a market where people can “vote with their feet”, and where certain standards of healthcare coverage are guaranteed, is a better market that will develop more innovative power. And Oscar is helping drive that positive change in each market we’re expanding to.
HTA - Where do you want Oscar Health to be in five years?
I would love for Oscar to predictably and reactively serve our members’ health care needs. This involves the ability to intervene when our members are interacting with the health care system by providing assistance at just the right points in time, ideally in real time or even proactively if we see something emerging.
Right now, Oscar is already using the data feeds we receive from our members and hospital partners to create algorithmically generated alerts. For example, when a patient enters an out of network emergency room, our Concierge Teams get a notification. By taking a greater role in our members well-being, we are able to make sure that they have the information they need while in the ER and, more importantly, that they get discharged with the right follow-up instructions so that they don’t end up back in the ER again. In five years from now, I expect Oscar to have the capability to more proactively work with doctors and nurses to intervene so that our members don’t end up in the ER at all, except in the most severe of cases.
I want Oscar to keep finding ways to help our members go through their daily routine knowing that they have their insurance company on their side, advocating for their health. This is the greatest thing about being an insurance company. From a business model perspective, we are very much aligned with the interests our members have as patients. We want them to be healthy well into the future, which is why we are developing tools and using data to proactively invest in their health today.
HTA - What is your favorite book?
There’s a great German book called, “Herr Lehmann,” written by Sven Regener, that I absolutely love. It’s about a man who lives in Berlin in the 1980s before the Berlin Wall comes down. It has been translated into English by John Brownjohn under the title, “Berlin Blues,” but the original in German is beautifully phrased in a way that makes it actually incredibly fun to read. It’s my favorite book and I read it once every three years.