
Oscar Is Disrupting Health Care in a Hurricane - rbanffy
https://backchannel.com/oscar-is-disrupting-health-care-in-a-hurricane-65480bfed940
======
rcarrigan87
The article heavily focused on Oscar's user experience and customer service
strengths, but buying health insurance really comes down to getting the most
coverage at the lowest price.

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.

~~~
exelius
The thought is that, especially with expensive chronic illnesses like diabetes
or heart disease, getting the patient to stick to their treatment plan has a
dramatic effect on costs. Fewer hospital visits means drastically lower costs,
and having even a marginal shift in utilization of routine maintenance
regimens can move the needle on costs.

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.

~~~
Retric
Research does not really back that up.

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.

~~~
wbl
Your per annum costs determine premiums, plus the person can work longer.

~~~
koolba
On the whole, not the individual as there's no discrimination on the health of
the customer. It's entirely possible for an insurer to end up with a bad pool
through attrition of healthy people.

------
kafkaesq
_When pushed, Joel Klein portrays the fraternal drama as a non-issue. “We will
follow all of the rules,” he says. He admits that this unique situation might
be so hazy as to preclude bright boundaries, but is nonetheless certain that
the Kushner distraction is non-material to Oscar’s fate—rather, he
characterizes it as an “amusing media story.”_

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.

~~~
chimeracoder
> 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.

~~~
kafkaesq
_It 's not cognitive dissonance; dismissing the question is the only thing he
can do, from a PR perspective._

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.

------
untog
Feels odd to see this posted today (it was written in January).

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.

------
sandworm101
Health Insurance /= Health care.

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.

~~~
ubernostrum
It depends.

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).

~~~
sandworm101
So you are the best and most advanced of all buggy whip manufacturers. The
idea of a for-profit insurance company providing health care, and all the
silly games that entails, will one day stop. The rest of the western world
seems to be ticking along without you. I see it in the eyes of Americans that
have moved to canada: The utter relief of never having to talk to a health
insurance company again.

~~~
ubernostrum
First of all, it's worth pointing out again that we operate under the Medicare
program. Medicare, in the US, is primarily a single-payer socialized system
supported by taxes (but only people over the age of 65, or with certain
disabilities/conditions, are eligible to enroll in it), but private insurers
are able to operate under contract to Medicare. In that case, Medicare pays a
premium to the insurer. The insurer can charge an additional premium to the
member as well, and generally these plans come in tiers which make tradeoffs
like premium versus deductible.

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.

~~~
mtanski
Ideally we too would have a Medicare for all default with private supplemental
insurance if you opt into it.

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.

------
bettyx1138
i used oscar for the past 3 years in NYC as a self-employed freelancer. yes,
oscar has great customer service.

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.

------
bernardlunn
Read this for a more analytical take from a year ago;
[https://dailyfintech.com/2016/03/03/oscar-tries-to-
untangle-...](https://dailyfintech.com/2016/03/03/oscar-tries-to-untangle-the-
giant-hairball-called-american-healthcare-insurtech/)

------
Animats
What they're really doing is cherry-picking. Their market, as someone pointed
out, is "young people with no claims". This dumps the high-cost patients on
some other payer.

------
yueq
Just FYI. Oscar's founder Joshua Kushner is Jared Kushner's brother. Yes,
President Trump is its founder's in-law.

~~~
dbattaglia
The article mentioned that several times.

------
latenightcoding
Stopped reading at "Uber of health insurance"

~~~
DaiPlusPlus
I kept on reading, but I instantly knew this was a vanity piece for the
company. The analogy is just so wrong so it's indicative of lazy article
writing.

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.

