By Carrie Ghose – Staff reporter, Columbus
Business First
Oct 25, 2018, 11:51am EDT Updated 2 hours ago
Google-backed,
technology-driven insurer Oscar Health will offer individual plans in Central
Ohio for 2019 with Mount Carmel Health System as its sole network of hospitals
and physicians.
Columbus
is one of six new markets in 2019, bringing the New York City-based insurer to
14 major metropolitan areas in nine states. Oscar has been selling co-branded
plans with the Cleveland Clinic this year.
“Oscar
has a tremendous consumer engagement tool,” said Dr. Richard Streck, Mount
Carmel’s chief clinical operations officer. “It’s a way to leverage technology
to make sure patients get the right care in the right setting at the right
time.”
In each
new market, the company looks for a health system that embraces technology and
emphasizes population health, said Kyle Estep, Oscar's market leader in Ohio and
other inland states. He did not say whether the company talked with other
Central Ohio health systems.
“They
(Mount Carmel) share a consumer-focused vision
like we do,” Estep said. “Hopefully we can exceed expectations of
what a health insurance company can be.”
CEO Mario Schlosser and venture
capitalist Josh Kushner founded Oscar in 2012 to create
digital-first, data-driven health plans for the federal health insurance
exchange under the Affordable Care Act. Today it's believed to be valued at $3
billion, according to Bloomberg, after a $375 million investment
this summerfrom Google parent Alphabet Inc. to speed expansion into
new markets.
Narrow
networks – Estep prefers the term “curated” – have become more common under the
ACA, he said, because they allow lower premiums, and that’s the top priority
for individuals shopping for insurance.
Oscar
sold $42 million in premiums in the state the first six months of 2018, its
first year in five northeast Ohio counties, according to filings with the Ohio
Department of Insurance. Startup insurers typically expect losses in their
first years, but Oscar has a $1.8 million underwriting gain in Ohio through the
first half of the year.
“With
Oscar, we developed a formula that worked,” Estep said.
For a
sense of scale: Anthem Blue Cross and Blue Shield in Ohio had $1.3 billion in
health insurance premiums statewide in that period, which doesn't include its
Medicare Advantage plans and other lines of business. Anthem is re-entering the
ACA exchange in Ohio for 2019 after sitting this year out. Its plans also used
Mount Carmel as sole provider.
There
are nearly 40,000 enrollees in exchange plans this year in Franklin, Delaware,
Licking and Fairfield counties, where Oscar will be selling policies, according to the
federal Centers for Medicare and Medicaid Services.
Startup
insurers haven't fared well in Ohio: Both a pre-Obamacare physician-founded
company and a nonprofit co-op created under the
ACA folded.
In the
first years of Obamacare, insurers struggled with figuring out an entirely new
market, Estep said, but Oscar has achieved stability.
Oscar
has requested premium increases ranging from 3 percent to 23 percent for its
different Cleveland plan designs, according to federal filings.
The
parent, legally named Mulberry Health Inc., is licensed as Oscar Insurance
Corp. of Ohio for the Cleveland plans.
The
Cleveland Clinic/Oscar co-branded plans are a unique model, Estep said. Mount
Carmel is not co-branding, and Oscar is licensing a separate subsidiary in the
state, Oscar Buckeye State Insurance Corp. (We'll see whether Ohio State
University comes after it for trademark
infringement.)
Columbus
already is a hotbed for VC-backed digital insurers: Root Insurance for
auto, valued at $1 billion, and
Beam Dental for employer-sponsored dental coverage.
Before
Oscar, Estep was a consultant to the industry, and saw insurers routinely
struggle with getting patients to stay engaged with wellness programs. They’d
send mailers.
Members
communicate with Oscar via its app – for example they’re paid $1 for meeting
footstep goals – which offers 24/7 telemedicine service and has a “concierge”
service available by message or phone that helps find a regular doctor or
explain benefits. Better coordination of care keeps claims down, the company
says.
“With
relatively minor types of illnesses, those can be handled (via messaging) just
over the app,” Streck said. “There is a tremendous ability for members to
assess and rate the interactions they’re having with their provider, … not only
on the technical quality of care, but also on the relationship.”
After a
few years in a market, Oscar might introduce employer health plans for
businesses with fewer than 100 employees. It's also exploring Medicare
Advantage.
Mount
Carmel owns MediGold, a Medicare Advantage plan, but Estep said any decisions
on Medicare are several years off.
No comments:
Post a Comment