Do you have a holistic view of your
networks compared to competitors?
Do you understand your own network
differentiation or opportunities to meet market needs.
Can you strategically decide which providers to target
based on patient activity by line of business
or Most health plan executives cannot, at least
not at the level needed to truly make
an impact.
Quest analytics, the leader in provider network work
management solutions and services can help change that.
Their network performance benchmarking solution offers a comprehensive
view of data, crop payers and service areas,
empowering you with the information necessary to excel
in strategic network development,
competitive analysis, and contract negotiation to truly create
differentiated networks.
Discover how Quest Analytics can elevate your organization's
network performance at Quest analytics and dot com.
This is Laura D with the Becker Healthcare
podcast.
I'm thrilled today to be joined by Alyssa
Quan, Executive Vice President and Chief Insurance Officer
at Oscar Health. Us It's a pleasure to
have you on the podcast today.
Thank you for having me. It's pleasure to
be here. Now I'm really looking forward to
our discussion and learning more about some of
the cool things that you're doing at Oscar.
But before we dive in, can you tell
me a little bit more about yourself in
your background?
Discussion Sure. So
as as you noted,
I am the chief insurance officer at Oscar
Health.
I've been at Oscar
just over 3 years and in leading the
insurance
business there, you know, basically, we're focused on,
furthering our company's mission, just which is to
make a healthier life affordable and accessible for
all. So I spend a lot of my
time focusing on,
the things that are important, which is you
know, which markets we're in, what
segments of the markets we want serve how
our products can make sure that they meet
the needs of those markets and how we
can
keep them
affordable for for the folks in those those
markets. So
I'm excited about that. My overall background
is that I have been in the insurance
space for for over 3 decades.
I'm in act actuarial by training,
and so I've spent my entire career in
both domestic. And international insurance markets across commercial
and
and personal lines. So that's a little bit
about me.
Thick That's fantastic to hear. You know, and
it sounds like you've had some great experience
and and we're able to bring that to
Oscar her. What are some of the big
trends and headwind that you're following right now.
What's really top of mind for you?
I think for me there's sort of 3
major trends that we think... As a that
I think and and our team is certainly
focused on that are really sort of accelerating
within health care and and potential accelerating the
innovation
within health care.
The first of those is around the
consumer expectations, I think that that most people
in the country would agree that, health care
is becoming less and less affordable,
and therefore focusing I'm that that share of
wallet and the affordability of the care that
people really need in order to live a
healthier life is an important thing for everyone
to focus on.
The amount that the average family is paying
or that an employer is paying per employee
per year has really been on the rise,
And so,
I think focused by by the industry
and
the, you know,
political fear the... And really just, you know,
more generally the the population. On this is
something that that we're definitely focused on and
I think that that we need to to
continue
to do it in the future as well.
The second thing that I would say is,
you know, we're in the as we're in
the Aca space. So a lot of my
focus is very specific to to that space.
And as you're probably aware it's the faster
this growing segment in the U. S. From
an insurance, health insurance
perspective
with just almost 22000000 lives in the Aca
as of now. And, you know, now that
the Aca
has seen this amount of growth. It is
a very...
It's the largest single risk pool. You know,
in the Us bigger than any 1 employer
bigger than any, you know, particular date, and
that is creating greater stability for that market,
which is helping to lower cost trends relative
to other parts of the industry, etcetera.
And so now that it can reach the
size, which makes it a more permanent
structure, if you will,
in the healthcare space,
it really has the opportunity to
better serve the diverse populations that are within
that that market itself.
And so our focus in that as a
result is is what I would say is
probably the second.
Key trend that that I'm really focused on.
And then the third is around disruptive technology.
Right? Everybody is talking about Ai,
there's a lot of
opportunity for that to
help
lower administrative costs,
which will in turn make there's
healthcare care products more affordable
to potentially improve the overall experience within the
healthcare care system
for, for
individuals as well as providers, and others that
that are participating. So I think that's also
a... Probably, like, the third trend that as
an organization we're focused on, I'm personally,
like, less focused in the the the technology
space but Oscar is clearly a big.
A big player in that and is a
large focus for our organization.
Well, it's great to hear. You know, and
really fascinating to think about all the different...
Trends coming up right now, whether as... As
you mentioned the consumer expectations, some of the
different,
access and and then looking to it at
Ai and from your perspective as, someone who
is involved with those types of initiatives, how
are you thinking about growth for the future,
what is happening today and and what's possible
going forward?
That that I think is a great question.
You know, I think there's still room for
the Aca itself to grow. We still have
an uninsured population, a lot of the growth
that we've seen to get the market to
where it is today. Has come from that
uninsured space.
And and so, you know, I think there's
still room for that to to continue to
grow there. And I think that in order
to
move people out of that uninsured base and
into something like the Aca, it's important that
there are products out there that are,
attractive and actually meet their needs. Right?
And so that's something that, you know, I
think we should
you know, we certainly as oscar and I
think that our our competitors should should also
be thinking about
as we as we move forward. Forward. I
think the other thing that, you know, I'm
sure you've you've heard our Ceo talk about
it
that we think
will be key to continuing to grow the
individual market is
is ic.
And, you know,
this is a
a long term opportunity, I would say to
serve a broader set of customers.
And what is it, you know, for for
those listing that might not be familiar what
what an acre does is that it allows
an employer of any size to reimburse their...
Employees for health insurance premiums
and that they can then go and purchase
an individual plan
on the Aca
and that employee then has that full choice
of which plan is best for them, which
network, which,
formula
does the plan, you know, meet of a
specific health need that this individual
is trying to deal with, etcetera. And that's
independent of their employer,
and there are... You know, there's ways that
these can be structured such that they maintain
some of the the tech the facts or
advantages that, you know, come with a typical
employer plan.
And so we see this as a, you
know, a the there's pros for the employer
as well as as the employee.
But
this is a really good way. I think
to think about growth as we move forward.
So if we think about the size of
the Ach aca today, Right? So it's just
under 22 22000000 people, the small
medium sized businesses, so those that are
let's call it under 1000
employees.
There's 75000000
dollars to people in that today. So even
if a a portion of those,
you know, take advantage of this type of
this this opportunity through aircraft, there's substantial
opportunity in order to continue to grow that
singular risk pool,
which will you know, really help provide even
additional stability if you will, which then allows
those that participate in that market to continue
to provide,
innovative plans as well at that are affordable
and attractive
to more and more people. And so I
think it's just
that when I think about gross for future,
I see that as, like a really, you
know, really great opportunity and 1 that, you
know, has a has a very long runway.
That's that's a, I think a key area
focus for for me and for the team
right now. Yeah. That sounds great. You know,
And certainly.
Exciting that there are are such awesome some
opportunities for collaboration and
you know, really a way to move health
care forward and and ensure that access to
care that we've been talking about? And along
those lines, I'm wondering, could you tell me
about a project or initiative
from the last year or so at Oscar
that's really yielded the best results?
Yeah. So,
I guess the thing that I would would
choose to sort of tell you about is
if I... First off, if I guess so
that, I take a step back, and I
think about,
you know, why oscar was founded and it
was to, you know, help... To, make the
system
clearer to people easier to navigate to really
kind of help people meet their their health
their needs what we tend to do is
think about the individual we're very member focused.
I'm sure you've heard that about us. And
in thinking about that member, we're often looking
to try to kinda solve issues that they
might be having
within that healthcare care ecosystem. And so
with that in mind, 1 of the things
that we focused on was
the
Hispanic and Latin
population, which is the fastest growing segment in
the Aca, and it actually represents about a
third of Oscars membership
And so we were looking at ways to
see whether or not we could really improve
their experience within
the system.
And,
we developed something which we call Ola oscar,
and it's
it's a culturally authentic,
kind of personalized
experience
for these members.
And, you know,
really what it does is it helps us
provide them or help, I guess, we provide
them with
AAA
culturally authentic experience that's in their own language
that serves up
providers or other elements of the
of the health care system that, better meet
their cultural needs,
and allows them to, you know, feel that
they're hurt or that they have the opportunity
to engage with someone who,
better understands, their culture, their,
health care needs, etcetera.
And what we found in in doing this
is that,
our Spanish speaking. I mean, has a real
impact on
retention,
as well as,
our net promoter score, which we've found both
of those things to be higher with our
overall Spanish speaking population than we have with
our non Spanish speaking population,
And we've also found that this program has
assisted with the the N mps with our
brokers because our Spanish speaking brokers.
They have, like, a
about a 30 percent higher satisfaction level than
our non Spanish speaking.
And I think there's just a lot of
benefit to the... The tools and the experience
that was provided. That's most importantly, in a
language that they all understand, but that's that's
more
the culturally aware for them. And so we've
been really excited about this. We've
launched in in limited markets
so far until we're really looking to scale
this to even more markets to address more
of this population,
and then to see whether or not you
know, we have a possibility to replicate this
kind of experience for other,
you know,
different cultural cohorts if you will, in the
future. So we're really excited about it, and
it's an area that we're we're gonna continue
to focus. And I think, you know, that's
1 of the things that we... Or we
kind pride ourselves on
is to do something that's innovative and to
really try to continue with our very member
centric focused.
Which is aligned with our mission. So...
That's fantastic here. Alyssa that
I really appreciate you being here today. This
has been a such a fun conversation, and
I look forward connect with you again soon.
I really appreciate you having me, and
I appreciate you allowing me to take part
in this this series. So thanks for your
time.