How Oscar Guides Its Members Through The Health System

posted by Mario Schlosser

on June 6, 2016

We started Oscar because we wanted to build a health insurer that was designed from the ground up around the consumer’s needs.

Our core belief at Oscar is market forces require change happens now – from unsustainable year-over-year cost increases, to high deductibles that necessitate health care consumers become consumers. By making Oscar our members’ guide through the health care system, we can improve our members’ experiences while also improving our bottom line.

Here are a few examples of how we do that.

Signing up. Our enrollment process is simple and fast because we designed it with the user in mind. Not only do our members regularly enroll in under 10 minutes, but those members that enroll through our tools (as opposed to through brokers or exchanges) show a  30+ percent  increased probability of getting matched up with a plan that optimizes for their expected health care behavior. That means, from day one, we’re helping the member engage with the healthcare system in the easiest way possible.

Operations. Once you’re a member, we deliver an exceptional experience (in part) because of our operational tightness and the ways we use technology to empower that tightness. For example, we get real-time pings whenever our members are sent to the emergency room. We then do an automated lookup to find that member’s main doctor (based on their previous claims) and send the doctor a fax (entirely automated), letting her know that her patient was just admitted to the ER. When the doctor calls a unique number listed on the fax, the member’s mobile phone rings, and we seamlessly reimburse the doctor for this direct member outreach. This simple feature requires us to own and control everything from our claims system, to payments operations, to real-time data infrastructure, to a messaging infrastructure.

Member engagement and trust. Building trust with members is critical. It helps ensure they come to Oscar when they need to navigate health care decisions. This improves the member experience and enables us to direct them to high-quality, efficient care.

Our front lines in building trust are our high-touch member services, which help our members navigate the complexity of the health care system. We flipped the traditional service model (call centers characterized by one-off interactions) on its head by routing any member communication back to the member’s four-person concierge team. Each team is comprised of three service guides and one nurse, and that team is responsible for their panel of members.

Technology tracks whether members were happy or unhappy in their last interaction with us, algorithms scan call notes for flags we need to be aware of (such as, member is at risk of using out-of-network care), and the concierge teams are able to visualize a member’s entire interaction history with health care (from calls, to drugs, to lab tests, to televisit clinical notes). This allows us to manage member relationships with necessary continuity – both from a service and clinical perspective.

We currently have unprecedented levels of member engagement. For instance, on a rolling timeframe as short as one week, we interact with a quarter of our members – truly serving as our members’ entry point to health care. Modern digital products help us engage with our members, allowing them to find the right care, speak to a telemedicine provider, book an appointment, and see their entire medical history online.

One of the core elements of this product offering is a sophisticated care router, which helps members find appropriate care through an intuitive search platform. Seventy percent of members searching for a doctor click on one of the top five doctors we sourced. And our members trust the help we provide them with: Thirty percent of online searches lead to appointments with one of those top five doctors.

Mario Schlosser is CEO of Oscar.