How Oscar Health integrated case management and utilization management

Oscar Health CEO Mario Schlosser

Photo courtesy Oscar Health

Insurtech companies such as Oscar Health use technology to engage patients and offer risk-based, value-based care to engage providers in what is touted as a collaboration of savings, efficiency and better health outcomes.

While Oscar's first quarter earnings showed losses, membership has grown. Recent partnerships, such as the one formed between Oscar and integrated delivery network Health First point the way forward for the company's business model.

At AHIP's online annual Institute and Expo on Thursday, Oscar CEO and cofounder Mario Schlosser and Health First CEO and president Steven Johnson talked about their collaboration during "Leveraging the Power of Insurtech to Enable Patient and Provider Empowerment."

Health First in New York is using Oscar's technology platform to engage its 170,000 members. Oscar's technology has taken the Health First Health Plan and made it modern, Johnson said. They collaborated because, "there's no way to replicate the consumer-facing platform that Mario developed at Oscar."

In recent months Oscar has also partnered with Cigna in an aim to expand affordable coverage in Connecticut through Cigna + Oscar. 

Oscar bills itself as the first health insurance company built on a full stack technology platform.

WHY THIS MATTERS

What's needed in the healthcare ecosystem is more of a blending of payers and providers to align incentives and to have better integration, Johnson said. Most applications don't talk to one another. 

"Nothing in healthcare talks to anything in healthcare," Johnson said. "The loser is the expense due to lack of integration."

Shared savings agreements are better than nothing, but it's not an alignment of incentives, Johnson said.

Schlosser said that in the beginning his company built networks by seeking out health systems that wanted to take risk. 

Once that risk is shared, payers and providers can work on incentives such as wellness to engage members.

"You need an end-to-end perspective," Schlosser said. 

Thirty-five percent of members don't see a physician in a given year. If you don't have their ear or attention, they'll turn to Google when they get sick. 

When Oscar worked on formulary design, it wanted to know why members weren't filling their prescriptions and what could be done about it. 

"Incentives for members in the end make the biggest difference," Schlosser said.

Oscar promoted a switch to mail order drugs for convenience. But what really worked was telling them they'd save $10 by ordering by mail. Sometimes these small incentives get missed, he said. 

Oscar created a formulary in which insulin would only cost $3. Then provider engagement and benefit design had a chance to work together, he said.

"The key," said Schlosser, "is how to integrate case management and utilization management."

THE LARGER TREND

Oscar Health is one of the disruptors of the traditional health insurance model.

Insurtech is being driven by investors who see the health insurance industry as being ripe for innovation and disruption.

Another big player in the space is Livongo founder Glen Tullman, the CEO of Transcarent. The company is looking to overhaul the employer-self-insured market by creating a digital platform "overlay" to existing plans and by engaging patients through a chat app option.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com

For today's HIMSSCast, Oscar CEO Mario Schlosser joins host Jonah Comstock and Healthcare Finance News Managing Editor Susan Morse to tell his story and answer some questions about the company's latest moves. Along the way, we discuss telehealth, value-based care, and more.