Oscar Health is making a big bet on personalized care that people traditionally spend as much as $40,000 on

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Brennan Weiss

Updated Thu, Dec 14, 2017, 9:17 PM

Oscar

Oscar Health, the $2.7 billion health insurance startup, wants to have all of its members using concierge medical care in 2018.
The plan to create 'Concierge for All' relies on teams of nurses and other healthcare professionals who work with Oscar to help you navigate everything from insurance benefits to questions about your health.
It's something people often spend tens of thousands of dollars on every year in addition to their traditional insurance.

Oscar Health, the health insurance startup, is giving all of its members access to a team of healthcare professionals they can turn to for help navigating their healthcare.

The service is what's known as concierge care, and it might seem like a foreign concept to most Americans who struggle navigating the often complex and frustrating healthcare market. But such personalized care often comes at a high cost. Some 'boutique' or high-end concierge services can cost as much as $40,000 a year per family, on top of the insurance premiums that family pays.

Oscar is trying to change that. The $2.7 billion health-insurance startup is making a big push to make concierge care the centerpiece of their members' healthcare experience, with all its members using it.

Here's how it works

Oscar members are assigned a personalized concierge team of one nurse and three clinicians with specialized knowledge of the patient's local healthcare networks. The idea is that teams with localized knowledge will be better informed when making recommendations and referrals.
Those healthcare professionals can answer any questions you have about your insurance benefits, or about that strange bump on your neck, help the member get a prescription or a referral to a specialist.
While Oscar members don't physically meet with their teams, they can contact them over the phone or through secure messaging on the company's mobile app.
Concierge nurses will also be able to initiate contact with their patients with the help of clinical dashboards, which collect claims records and other data about the patients' medical history to give nurses more context on a person's health than what they might otherwise learn from electronic health records.

Oscar Health

"One of the things that we are able to do because we have a lot of data is to flag to care teams the suspected conditions that members may have in our clinical dashboard and say 'hey, you really should go in and see a doctor. We think you might have something and you should get some medication for it,'" Chelsea Cooper, Oscar's Senior Vice President of Member & Strategy Operations, told Business Insider. "And that’s something we’re able to do because we’re a tech company."

Since launching its concierge services in full earlier this year, Oscar says 70% of its roughly 90,000 members have interacted with a concierge team, although those who engaged had an average of only three interactions. The company says concierge care has even helped its members save money on out-of-network costs.

Now Oscar is trying to universalize the service with a "Concierge for All" campaign to encourage 100% of its members to start using it next year.

"We think healthcare is very personal and that these changes really matter," Cooper said. "You want to know the [concierge team] so that you can trust them and take their recommendations about which doctor to go to and whether you should go to the ER or an urgent care facility. We try to build that connection."

Surviving as the market shifts

Bradley C. Bower/APThe future of American healthcare has taken on new dimensions over the last year as President Donald Trump and Republicans in Congress attempt to repeal Obamacare. But Oscar keeps pushing forward.

Earlier this year, Oscar announced it would start offering health insurance plans alongside the Cleveland Clinic in Ohio for the first time. In 2018, it plans to expand coverage from three states to six.

Despite its optimism, Oscar is not immune to the financial challenges of the turbulent healthcare market.

Last month, Oscar reported a $96 million third quarter loss across the three states where it currently sells coverage, according to Forbes. Although it was an improvement from the same quarter in 2016, it was in line with a continuing losses the company has experienced since its founding in 2012.

But Oscar's chief technology officer Alan Warren told Business Insider in June that such challenges, including the political debate over healthcare in Washington, will ultimately do little to deter the company from carrying out its mission. When the Trump administration slashed Obamacare advertising funding by 90% earlier this year, for example, Oscar ratcheted up its own advertising campaign in New York just in time for the most recent open enrollment period, which ends on Friday.

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