Oscar Health, founded, in 2012, originally set out to develop and sell tech products to established health insurance companies. When that plan did not work, Oscar Health’s founders took the millions of dollars raised from investors and started a health insurance company centered around its custom tech. Six years later, and with a recent $375 million investment from Google’s parent company, Alphabet, Oscar is doubling down on being an health insurance technology company. Or, are they a technology company that sells health insurance? And is Silicon Valley-style tech the missing component in health care reform?

Improving Services And Saving Lives

Oscar’s social media branding approach to health care and real-time data decision tools are a welcome contrast to the everything-but-the-kitchen-sink websites of other health insurers. A system that uses real-time prior authorization for surgeries is a huge improvement over faxing forms and waiting days or weeks for a response from the insurer before you can schedule an appointment. An insurance company that pays claims in real-time, while you’re still at the doctor’s office, is much better than waiting for a bill from the doctor and then waiting for the insurer to pay its portion before you know what you owe.

Innovative technology is good for the health care industry and the trash-talking bros at Oscar (these guys can't get through an interview without a negative comment about their competitors’ antiquated legacy systems) are producing tech that improves the health care experience and has the potential to save lives.

We know that the technology doctors and hospitals use to diagnose and treat patients can save lives, but so can having immediate access to real-time data. A recently reported story on Forbes Online about an Australian cancer patient, Mettaloka Halwala, illustrates how faxing forms can result in medical errors. In Mettaloka’s case, it was a death sentence. Less serious, but still frustrating, administrative errors occur in health care every day. Since 2014, Blue Shield in Los Angeles’s enrollment system, the one used for individual health plan purchasers, has been on the fritz. The enrollment system unexpectedly terminates policies of individuals whose premiums were paid. Customers spend hours on the phone trying to get their insurance coverage reinstated, all while skipping medical appointments and delaying prescription drug refills for days, weeks, and months. Blue Shield in LA’s continual system problems for the most basic of services is one of the worst examples of a major health care industry customer service failure due to inadequate technology.

Big Data, Innovative Tech, And The Human Condition

The rollout of the Affordable Care Act (aka Obamacare) had its technology challenges. But the Act achieved its primary purpose of providing affordable health insurance coverage to the millions of people without coverage. A glitch-free enrollment system, impervious to attack by political rivals, would have been a good start for Obamacare supporters and enrollees, but, what’s more important—affordable coverage or a streamlined health plan enrollment system? The guys at Oscar might think that they are providing both, but are they? Using data analytics, predictive modeling, and artificial intelligence may eventually lead to administrative savings in health care, but other factors can replace those costs. Continue Reading...

Tags: Oscar Health, obamacare, health care technology, Social determinants of health

Employers may be wary of their health insurance partners but they share in an opposition to single-payer health insurance.

You would think that large employers would say to heck with the health insurance and health care status quo. You would think that they have had enough of the annual negotiation performances played by brokers, consultants, and health insurance representatives. You would think this, but you would be wrong. Large employers are generally opponents of a single-payer (e.g., Medicare For All) system that would replace their private group insurance plans. They may not enjoy participating in the ritual pretense of controlling health insurance costs, but they find it preferable to the alternative—losing control of a powerful financial tool.

There are several reasons why big companies and the health care industry do not support Medicare for All or single-payer health insurance.

Large organizations that are not part of the health care industry oppose single-payer because they would no longer be able to use health insurance as a recruitment/retainment tool, or as way of manipulating the total compensation their employees receive. These organizations may also benefit financially from health care industry stocks. And you've got to figure that large corporations don’t want to upset each other because the shoe could easily be on the other foot, so it is best to have each other’s backs.

Health care organizations have even more at stake in the single payer debate. According to a Kaiser Family Foundation report, health care employment accounted for about 9% of all employment in the U.S., in 2017. The industry, with the exception of some groups like Physicians for a National Health Plan (PNHP) and a few others, vehemently opposes single-payer health insurance. The Healthcare Leadership Council, a health care industry lobbying group, lists insurers, hospitals, drug makers, medical device manufacturers, pharmacies, health product distributors, and information technology companies as part of the health care industry. Add to that the thousands of companies and freelancers that support these organizations... The bottom line is that the health care industry employs millions of people, and makes tons of money for Wall Street—a gig they would like to keep.

Small Employers Will Save Us

Health care reform isn’t over. Everyone agrees that health care costs is THE problem we must resolve, and that the solutions proposed by insurers and adopted by private sector organizations large organizations are band aids. So far the reforms taken to make health care more affordable and available involve transferring costs from one group to another. Large organizations can play this shell game better and longer than smaller companies because insurers realize from time to time they have to let the big guys win (or think that they've won). Small employers on the other hand do not have this kind of clout, and usually follow the lead of larger organizations when it comes to plan design, financing, and other health insurance reforms. Continue Reading...

Tags: Medicare For All, Single-payer