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.

People are more than their health care data—they have all kinds of stuff going on in their lives and sometimes their lives are messy. People with the greatest health care needs may not have the time or sometimes the inclination to engage and become smarter health care consumers. And for the occasional health care user, there isn’t enough frequent contact with insurers and doctors to become proficient in navigating America’s insane health care system.

The legacy health insurance companies Oscar so likes to mock know the difficulty of building relationships with health care consumers. The sleek, social media-driven disease management programs, nurse hotlines, price transparency tools, and wellness programs Oscar offers to engage its members are ancillary benefits its rival started when the Oscar guys were still in grade school. These programs, although still marketed by all insurers, historically have low utilization. Established health insurers, hospitals, and doctors familiar with the limits of engagement through technology have turned their attention to addressing the social issues that lead to poor health outcomes, like poverty housing, food deserts, and loneliness.

Conclusion

Oscar Health is ahead of the curve in its use of real-time data to make payment decisions and its creation of a new claims infrastructure and predictive models, but the rest of the health care industry knows something Oscar does not—the health care business is not an island unto itself. There are many social factors that impact health status, medical care adherence, and health care costs. Technology has yet to prove it can address the social determinants of health and significantly lower health care costs.

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