At the recent America's Health Insurance Plans Institute 2014 meeting in Seattle, most of the buzz among insurance executives focused on physicians and hospitals providing care that costs too much for the quality of care received. Then a presenter turned the tables on the health plans, asking them to look in the mirror at their own inefficiency. Enter Oscar Health Plan.
When the new start-up health plan's co-founder Kevin Nazemi completed his presentation, panel moderator Susan Dentzer asked the room how many people would prefer to have Oscar health insurance rather than their own health plan. Most of the room (and keep in mind this is a roomful of insurance executives) raised their hands.
As the Affordable Care Act pushes the health insurance industry further toward consumerism where players compete on a more level playing field, innovation in the industry could come quicker than many expect. And plans such as Oscar could be among the forces leading the market to push the envelope on transparency and consumer-friendliness. Oscar has the ability to be the catalyst that forces the insurance industry to innovate, to post prices, to be easy to understand and to become consumer-friendly. The carrier is offered on the state insurance exchange in New York, and enrolled about 16,000 during open enrollment. Based on Nazemi's description of Oscar's employees dressed in hoodies, sitting at one big table, this insurance company sounds like Facebook and Instagram meeting health insurance.
Other than employee dress codes, what makes Oscar different? The carrier offers a simple, easy-to-understand website that gives patients 24/7 access to a physician through telemedicine company, TeleDoc. A physician will call a member back within an hour, but on average Oscar officials say calls are returned in seven minutes. All members receive free, unlimited calls with physicians. The hope is that those phone calls can lead to diagnosis of minor illnesses, bypassing an expensive office visits. Prescriptions can be sent to the pharmacy for common ailments. Oscar pays physicians $40 per call.
Depending on the plan, Oscar offers members a certain number of free physician visits each year and free generic drugs. And its website is simple and easy-to-understand: Most patients are unfamiliar with what gastroenterologists or endocrinologists do, so Oscar allows members to search for a providers by simply describing what is ailing them. For instance, an entry of I need sleep or my tummy hurts leads the member to primary-care physicians, a specialist, an urgent care center or the emergency room. Each category gives members a description of what's likely to happen at each place, and a price range based on the patient's out-of-pocket costs. Then, once a patient chooses a category, they can choose a physician based on cost, how many patients they've seen in their age group and location displaying all of this information on a map.
The price transparency aspect is probably the most innovative part of what makes Oscar different. If Oscar is successful in the marketplace, it could force health insurance companies to provide pricing information and transparency to customers to compete. So keep a close watch on Oscar it could be the catalyst that changes the insurance industry.
Follow Jenny Kerr on Twitter @ JennyKerrDRG