Oscar Is Disrupting Health Care in a Hurricane
backchannel.com
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If you aren't attacking health insurance from an actuarial standpoint (reducing costs/lowering premiums) I find it really hard to believe businesses are going to move to your platform.
Eventually, Oscar is going to have to come off the VC teet and still pay all their expensive programmers and google VPs while staying price competitive.
Would have been a much better read if the article would have addressed how they plan to do this. My guess is using tech to make their members healthier and boost preventive care, thus lowering premiums.
That's the theory, anyway. It might work, because the health insurance industry is a mess and is just now finishing migrations to modern IT platforms. A well-funded upstart like Oscar could easily come in with a modern analytics core and undercut on administrative costs.
Many of these companies don't have people who know how to deal with the volume of data in a migration.
You pay less per year on average per person, but now your sick people live longer so you pay for more years. Now, private insurance may get around this assuming the sick person moves on to someone else's balance sheet, but for the health care system there is no real savings.
My thought is that Oscar is ultimately a platform play; not an insurance company.
My sister became diabetic after having her second child. Her kids are VERY active, her husband is often away for work, and she's a nurse. The biggest positive impact on her health? Getting a pump to regulate insulin dosage so that she didn't have to think about it anymore.
This is a positive thing. Meanwhile, my workplace has instituted one of those pedometers that tracks your activity and reduces your healthcare costs. People are worried not only about what it tracks, but what business it is of their employer to know how active they are outside of the office to begin with.
Hang on - tracks your activity out of work? Are you paid for the full 24 hours? No. So you're performing unpaid labour (walking) for them?
Might want to consider a union there.
The "hurt his ankle" as inspiration seems trite and contrived. Insurance companies profit by denying claims, increasing premiums and negotiating payment. Their profits should be regulated as a function of premiums and claims.
In the ACA space the most profitable plans will be those that most young people sign up for (usually with less benefits since they assume more risk).
> They let young people gamble but are a shell game
Given that I'm required to have insurance, how is this a gamble? I can easily cover $5k cash, and most years I never even go to the doctor. Why is this plan bad for me?
(I'm not suggesting it's great for _all_ young people, but I think a very large percent are better on them than other expensive gold plans).
i.e. you don't actually ever take money out of the HSA for medical expenses until you're older or really need it. You pay today's medical bills before the deductible via pay out of pocket.
Chaching.
But I still consider this for profit insurance system a big fat scam on the working poor to upper middle class.
How anyone with principles - fiscally conservative or liberal - can support carving out tax credits and subsidies, I don't understand.
It gets really tiresome how hard it is for some people to do anything but pattern-match every possible conversation to the same few narrow political conversations.
The (glaring) conflicts of interest exemplified by Kushner's role in the company -- just a small subset of the conflicts exhibited by the Trump-Kushner administration as a whole -- can hardly be dismissed as merely an "amusing media story".
Attempting to do so is a sign of, at the very least, rampant cognitive dissonance - if not pure and simple intellectual honesty.
His brother is actively involved in the administration's efforts to repeal the law that provides the foundation for the company that he founded. It's not cognitive dissonance; dismissing the question is the only thing he can do, from a PR perspective. It's not like he's going to say, "Yeah, the future is really uncertain for us, as a result of my brother's work."
I get that the situation could be a conflict-of-interest, but at the moment, if anything, the evidence suggests that the two brothers are working directly against each other here.
That's exactly what I mean: "from a PR perspective", the only thing he (thinks he) can do is shrug and say "it's all just a big non-story" -- which is an outright lie, of course.
I have a lot of respect for anyone trying to help in the healthcare sector, but IMO today has shown that all the well meaning Silicon Valley rhetoric and VC cash in the world means very little in a sector dominated by partisan politics.
If you want to fix healthcare the best thing you could do is run for office. Anything else is just window dressing.
Disrupting health insurance is easy. Move the numbers around, sign up different people, apply for whatever government programs ... it is an information and accountancy problem. Disruption of health care is clinics, vaccinations, treatments ... blood on the floor and actual hands on patients. That isn't easy.
Disclosure up-front: I work for Clover Health, which is a company people probably would put in the same bucket as Oscar. The biggest difference is we operate solely in the Medicare market (people who are eligible for Medicare can enroll in the traditional single-payer system, or a plan from a private insurer under contract to Medicare; in the latter case, Medicare pays a monthly premium to the insurer).
So we're an insurance company. Ho-hum. No big deal.
Except... it turns out that if you want to get people healthy and keep them healthy, being a provider of health care (i.e., nurse, doctor, clinic, etc.) may be the wrong business to get into. A provider sees only the particular slice of your health that they happen to deal with, which may not be much at all. The only entity in the whole system who sees everything is the entity that pays the bills, and that's the insurer.
And that opens up all kinds of opportunities, if you can break into the business. Medicare is interestingly set up to encourage this, since Medicare Advantage plans (that's what we are) get paid partly based on their rating on a five-star scale. The input to that scale is a set of about four dozen factors, many of which measure actions likely to improve or maintain health.
For example: someone who's on a lot of different prescriptions for various conditions faces risks as a result. Not just from uncaught interactions, but from things like the complexity of when and how often they need to take different medications. One of the ratings takes into account how many of those people have had a sit-down chat with someone who will help them go over and understand all of it and come up with a plan to stick to the required regimen. Which sounds like something so simple that it's almost silly, but non-adherence to prescribed medications is a huge problem that affects the health of a lot of people.
And beyond the factors that go into our star rating, there's a lot more low-hanging fruit to go after, and a lot of little and inexpensive things that you can do to help people get healthier and stay that way
Which is a major break from a lot of plans, especially in the Medicare space, because generally people treat the business of insurance as solved: you just hire some actuaries, work out from a given population what you expect the cost to be of covering them, and make sure you charge more than that. Very few companies are trying to get there from the other direction (figure out what the cost would be, then figure out what little things nobody has bothered to do that might have a big impact on that cost).
Meds is always a very complicated issue - add in seriously sick people and it becomes even more difficult. Pill pack companies that put the date and time on each pack seem to be the best way to manage it.
Second, it's worth pointing out that this is also the case in countries with fully nationalized single-payer systems: supplementary/third-party plans tend to still be available in such countries. For example, in Canada private supplemental insurance is a multi-billion-dollar industry.
Entrenched interests like existing private insurers, medical care providers and folks who never experienced single payer (and are convinced others are sucking off their teet) are doing everything in their power to prevent that.
The insurance company has its own view and maybe that's unique, but the paper trail isn't going to reveal everything. Isn't this view going to have distortions too?
but that doesn't make up for the limited network of crappiest doctors at the crappiest facilities - mount sinai beth isreal is NOT a network of quality doctors or a "quality" facility. and i had the most expensive platinum plan. i bet these oscar execs don't use the dr offices i used.
thank gaia i took a staff job with decent insurance.
Digression: I suppose a real "Uber of health insurance" would be an app with a map that shows doctors, ERs, walk-in clinics and other practitioners that lets you see someone immediately and also pay for it directly within the app.
...and that's a stupid idea - we already have walk-in clinics in Google Maps, and if I wasn't insured I wouldn't put a $5,000 ER invoice on my credit card without at least negotiating on it first.