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1	
Disrup)ng	health	insurance?	
Na)onal	University	of	Singapore	
MT5016	-	Business	Models	for	High-
Tech	Products,	A/Prof.	J.	Funk	
Nov	2015	
Terence	Deļ¬€enu 						A0147215L	
Jessica	Maria	Teguh	 						A0056967L	
Loo	Jian-Ju	 	 						A0134495Y	
Sun	Jing	 	 						A0120104J
1. US Healthcare Insurance: The state of the industry
2. Oscar Health Insurance
3. Value Proposition
4. Customer Selection
5. Scope of Activities
6. Value Capture
7. Strategic Control
8. Recommendations & Conclusions
2
Outline
1.	US	Healthcare	
Insurance	
The	State	of	the	industry	
3
VALUE	
NETWORK	
4	
Traditional Health Insurance
Intermediate in the Healthcare Value Chain
Sources:	The	World	Financial	Review	ā€“	The	Business	of	Healthcare	Innova)on:		Convergence	in	The	
h]p://www.worldļ¬nancialreview.com/?p=1451/
VALUE	
NETWORK	
Traditional Health Insurance
Value Network
High Barriers to Entry
ā€¢ā€Æ Residents may not buy policies from insurers located
outside of their state.
McCarran-Ferguson Act
ā€¢ā€Æ Universal Access - Insurers must oļ¬€er and provide
health insurance for all applicants
ā€¢ā€Æ Rate Bands - Limits insurersā€™ range of policy premiums
Regulations
ā€¢ā€Æ Minimum amount of capital for the insurer to avoid
insolvency
Risk Based Capital
7
Opportunities: Obamacare
OBAMACARE: Obama
Administration's Aļ¬€ordable
Care Act (2010, eļ¬€ective
from 2014) shifted the
health insurance market
from a B2B focus to a B2C
ā€¢ā€Æ It gives consumers more
control over which plan they
choose
ā€¢ā€Æ It requires individuals to have
health insurance, or face
penalties, starting in 2014 and
increasing through 2016.
8	
Opportunities: Obamacare
ā€œCommon-sense insurance
market reforms should be
implemented to increase
competition and improve
options for consumers as well.
Such a truly competitive
marketplace would have the
power to keep health insurance
costs lower and quality higher.ā€
Alyene Senger, 2013 (Heritage
Foundation)
Competitive Pricing
depends on the number
of suppliers available.
South side of the U.S has
lack of health insurance
carriers in Obamacare
exchanges
Source: http://www.heritage.org/research/reports/2013/11/obamacare-insurance-exchanges-and-
the-lack-of-competition
Sources:	h]p://www.economist.com/news/business/21600147-a]empt-change-americas-most-arcane-industry-be]er-geek-guide-insurance		
h]p://www.usatoday.com/story/tech/2015/06/24/oscar-uses-tech-to-make-consumers-less-grouchy-about-health-care/29150055/		
9	
Opportunities
Sources	:	h]p://www.cdc.gov/nchs/data/nhis/earlyrelease/earlyrelease201506.pdf		
U.S. health care costs is 2X
more expensive compared to
other rich countries
Health Insurance cost keeps
increasing
ā€¢ā€Æ Results : 40% forego the
health insurance plan
Health Insurance Market Value
of $750B in 2015, expected to
grow annually by 1.8%
Opportunities
10
Private Insurance
2. Get Receipt Back
1. Go to Clinic
3. File Claims
4. Conļ¬rmation from the Clinic
5. Long process before approval
6. Payback to The
Insured (Very Long
Processes and
Time).. May Take
Months
ā—ā€Æ High complexity on health insurance claim process
Opportunities
2.	Oscar	Health	Insurance	
A	brief	overview	
12
Simple, Smart & Friendly
"We wanted to build a company that was like having a doctor in the family"
Oscar ADV: https://www.youtube.com/watch?v=WZJMk2HEU1s
ā€¢ā€Æ Technology-Based Healthcare Insurance
Company
ā€¢ā€Æ Launched in 2013 after ā€˜Obamacareā€™
ā€¢ā€Æ Founders: Josh Kushner, Kevin Nazemi
and Mario Schlosser (CEO), all from Harvard
ā€¢ā€Æ Current Markets in US: New York, New Jersey,
California, Texas
ā€¢ā€Æ Funding: ā€œBillion Dollar Startupā€
ā€¢ā€Æ Valuation: US$1.75B
14
The Company
Notable investors: General Catalyst, Goldman Sachs, Li Ka-Shing, Alphabet
ā€¢ā€Æ Revolutionize health insurance through technology, data
and design
Mission Statement
ā€¢ā€Æ Better plans, lower costs
ā€¢ā€Æ Better healthcare
ā€¢ā€Æ Better experience
What Oscar Oļ¬€ers
ā€¢ā€Æ Expand to become a national insurer and compete with
the established old big players
Vision
15
Mission, Oļ¬€er, Vision
Sources: www.hiOscar.com
http://www.npr.org/2014/01/03/259432738/this-is-not-your-parents-health-insurance
16	
Better Plans, Lower Costs
17
Better Healthcare: Network Eļ¬€ects
Using geofencing technology,
Oscar members can choose
amongst a list of available and
relevant doctors based on the
patientā€™s location.
Geo-fencing (geofencing) is a feature in a
software program that uses the global
positioning system (GPS) or radio frequency
identiļ¬cation (RFID) to deļ¬ne geographical
boundaries.
More doctors =
More choice for
Insured + Greater
Convenience
More Insured =
More potential
customers for
doctors
18
Better Healthcare: Telemedicine
In Oscar, Telemedicine is a core value-added service
ā€¢ā€Æ Cut down Oscar expenses
ā€¢ā€Æ Beneļ¬cial for both parties, doctor and patient as below
Better Experience
	1. Short Claim Time due a digitalized process:
Claims are processed within 20 mins without troubling the
insured
2. Simple Sign-up Steps:
19
20
Better Experience
3. Billing made simple
ā—ā€Æ digitally printed/less paperwork
ā—ā€Æ more readable to the patients
ā—ā€Æ faster and more eļ¬ƒcient process for the
doctors to key in due to technology
Oscar Bill Statement
Traditional Bill Statement
21
Wearable Technology for monitoring
Incentive for being healthy and
active
ā€¢ā€Æ Oscar takes a calculated risk by giving cheaper
health insurance if the insured is living a healthy
lifestyle
ā€¢ā€Æ Rewards for staying active with a free wearable
tracking device
ā€¢ā€Æ Partnership with Misļ¬t Inc.: wearable given free
to the insured, to track and monitor the insuredā€™s
lifestyle
ā€¢ā€Æ Partnership with Amazon Inc.: to provide gift
cards in exchange for meeting health goals
Compe)tors	
Some	examples	
22
23	
Traditional Companies
24	
Competitors
Type	 Company	Example	 Main	Market	 Value	ProposiDon	
Tradi)onal	
B2B	(Main	proļ¬t	
from	employers)	
Nego)ate	lower	
prices	using	large	
scale	of	demand	
CO-OP	 Individual	 Non-proļ¬t	
Startup	 Individual	(Elderly)	 Data-driven	care	
Health	Sharing	
Program	
Individual	(Healthy)	
Lower	risk	
customers,	non-
proļ¬t
ā€¢ā€Æ Mostly Traditional
ā€“ UnitedHealth
Group, Fidelis Care
ā€¢ā€Æ Highly Competitive
ā€¢ā€Æ Market leaders
possess relatively
small market
shares
25
Competition in the NY state
Figure shows market share of the New York Health Insurance Industry in 2015
Source: http://info.nystateofhealth.ny.gov/sites/default/ļ¬les/2015%20NYSOH%20Open%20Enrollment%20Report.pdf
26	
Example: Average Pricing in NY, 2014
Market	
Share		
Company		
Catastrop
hic		
Bronze		 Silver		 Gold		 PlaDnum		
19%	
Health	
Republic		
$212.73		 $307.12		 $387.42		 $438.69		 $515.81		
17%	 Fidelis		 $189.86		 $323.75		 $409.66		 $501.60		 $606.03		
15%	 Metroplus		 $323.38		 $365.30		 $392.41		 $432.28		 $484.13		
14%	 Empire		 $186.20		 $391.97		 $456.39		 $544.32		 $645.52		
9%	 Emblem		 $202.83		 $342.88		 $396.87		 $474.68		 $570.85		
8%	 MVP		 $238.09		 $460.56		 $598.90		 $720.93		 $850.19		
3%	 Healthļ¬rst		 $317.38		 $379.41		 $444.40		 $519.47		 $615.54		
3%	 Oscar		 $217.95		 $341.95		 $422.41		 $489.98		 $570.42		
2%	 United		 $418.93		 $685.49		 $803.68		 $950.36		 $1,121.38		
Data	Source:	Informa)on	Source:	
h]p://www.capitalnewyork.com/ar)cle/city-hall/2014/09/8552029/tracking-premium-changes-new-yorks-health-exchange		
Oscar	pricing	is	compe))ve	and	some)mes	lower
Value Proposition
ā€¢ā€ÆSaves time and simpliļ¬es selection process by comparing 13,000+ plans
from 180+ carriers
Customer base
ā€¢ā€ÆIndividuals Market
Value Capture
ā€¢ā€ÆFee for service/Commission/Referral
Signed agreement with Federal Government to access the Federal
electronic data hub to automatically determine tax subsidy eligibility
and amount of subsidy
27
Complementary Services
- Online Brokers
3.	Value	Proposi)on	
28
Economic
ā€¢ā€ÆLower
Insurance
Premium
ā€¢ā€ÆAļ¬€ordability
Functional
ā€¢ā€ÆUser
Experience
ā€¢ā€ÆFast
ā€¢ā€ÆNetwork
Psychological
ā€¢ā€ÆSimple
Process
ā€¢ā€ÆHealth
Coverage
Assurance
29
Customer Needs
Unserved & Articulated Need
Convenience
Cost
Oscar provides value to the insured:
ā—ā€Æ a simple technology interface for consumers
ā—ā€Æ unprecedented beneļ¬ts (e.g. three free doctor
visits, free generic prescriptions, a home nurse visit
after giving birth and telemedicine)
ā—ā€Æ a broad and deep provider network (40,000
physicians are in it so far) at prices comparable or
lower than the rest of the market
ā—ā€Æ transparency and a great customer service
30
Value Proposition
Oscar brings value to healthcare
providers:
ā—ā€Æ Save time by automating the claim
conļ¬rmation process
ā—ā€Æ Connect to a wide network of patients
ā—ā€Æ Allow diļ¬€erentiation through review
system in platform
31
Value Proposition
Customerā€“Centered Health Insurance: target on ā€œIndividualsā€ and
not only ā€œEmployersā€. This will allow Oscar to learn and know
individualsā€™ needs in-depth so as to serve them better
Bring Simplicity resulting in Higher Convenience and Lower Cost by
leveraging the telemedicine technology and predictive data analytics
intensively
(i.e oļ¬€er customized pricing plan by analyzing the wearables tracking result, not
merely on historical health records)
Integrated software platform to quickly and easily ļ¬nd a doctor,
indicate one's question and make an appointment or speak directly
to a doctor within 10 minutes of one's request
Oscar keeps track of the patientā€™s medical history so they can
access their past prescriptions, lab work, and oļ¬ƒce visits without the
hassle of making phone calls and completing lots of paperwork 32
Value Proposition
Leveraging technology and data to make insurance simple, intuitive and human compared to traditional competitors
Price	
Simplicity	
(Sign-Ups	&	
Billings)	 Customer		
Service	
Innova)veness	
Health	
Services	
Integra)on	
Middleman	/
Insurance	Agent	
Brand	Reputa)on	
Health	Tracking	
Doctor	Consulta)on	
Service	
Oscar	Health	
Insurance	TradiDonal	Health	
Insurance	
New	
Dimensions	
Oscar	
33	
Strategy Canvas
Data	
Analy)cs	
Oscar offers a better value proposition because it
integrates technology to make the health insurance
simple, friendly and human
34	
VP Recommendations
ā€¢ā€Æ What	Oscar	oļ¬€ers	can	disrup)ve.	Tradi)onal	health	insurance	
popularity	is	so	low	that	as	a	new	entrant,	Oscar	should	
diļ¬€eren)ate	themselves	as	a	customer-centric	insurer		
Superior	Value	ProposiDon	vs.	CompeDtors:	
Usability,	Speed,	Psychological	Friendliness	
ā€¢ā€Æ Simple,	easy	to	use	
ā€¢ā€Æ Share	data	between	doctors,	hospitals	and	pharmacies	
ā€¢ā€Æ Integrated	medical	history	
Uniļ¬ed	plaVorm	network	for	all	the	healthcare	
players	
ā€¢ā€Æ The	data	that	Oscar	own	is	one	of	their	most	important	assets.	
Partnering	with	the	right	companies	will	provide	beneļ¬ts	to	the	
development	of	new	products	from	both	sides	
Data	to	the	right	partners
4.	Customer	Selec)on	
35
36
Customer Selection
Lead Users
Millennials/
Generation &
Tech ā€“ Savvy
Individuals
(B2C)
New Families
New Jobs,
Freelancers
Not eligible for
ā€¢ā€Æ Medicaid
ā€¢ā€Æ Medicare
Target Speciļ¬c
Markets, starting
from NY & NJ
Why Oscar targets this customer segment?
ā€¢ā€Æ Healthy people ā†’ Lower Risk & Lower Cost
37	
Customer Selection
Many	did	not	take	insurance	at	all	(around	
$45	million)	
Most	come	from	the	Young	(18-34	y.o)	
	 Sources:	
h]p://www.usnews.com/news/health-care-index/ar)cles/2015/05/07/us-news-health-care-index	
h]p://www.aecura.de/Comparison-private-health-insurance/Problems.html		
Source: http://dupress.com/articles/the-future-of-health-care-insurance-whats-ahead/
38	
Customer Selection
Size	of	Individual	Market	increasing	amer	Obamacare	
Source: http://kff.org/private-insurance/issue-brief/data-note-how-has-the-individual-insurance-market-grown-under-the-affordable-care-act/
39	
Customer Selection
40	
CS Recommendations
ā—ā€Æ Quickly expand in states with high population density
to increase the customer base, supported by a large
network of doctors
ā—ā€Æ Luxury plans for rich people promising premium
treatment and fastest response while keeping the
easy and technology-focused user experience
Once the US individuals market is conquered, adapt sales
division and attack:
ā—ā€Æ Groups
ā—ā€Æ Employers: According to S&P Capital IQ, by 2020, 90% of employees
with employer-sponsored insurance are expected to shift to individual
coverage. The easy access to health insurance exchanges following the
Affordable Care Act (or ACA) is expected to lead to employers paying a
stipend for employees to pay for health insurance rather than sponsoring
the plan themselves.
5.	Scope	of	Ac)vi)es	
41	
Agenda
Integrated Services
Health
Insurance
Technology
Tele-
medicine
VISION
42
Integration
In Vertically Disintegrated Industry
ā€¢ā€Æ Oscar does not hire the medical practitioners,
like doctors. Oscar partners with them to
obtain lower costs
ā€¢ā€Æ Oscar does not produce and does not own the
wearables
VALUE	
NETWORK	Oscar Value Network
Customers, Collaborators, Suppliers
More	Integrated	
Services	between	
Healthcare	&	Health	
Insurance
VALUE	
NETWORK	Value Network Traditional Insurance vs Oscar
Customers, Collaborators, Suppliers
44
VALUE
NETWOR
K
Oscar Value Chain
Health Plan Core Processes
Finance, Legal, Compliance/Regulatory, Quality/Audit, Human Resources, 3rd Party
Wearables Technologies
Support Functions
ā–Ŗā€Æ Product
ā–Ŗā€Æ Sales
ā–Ŗā€Æ Marketing
ā–Ŗā€Æ Actuarial
ā–Ŗā€Æ Underwriting
Health Plan Functions
ā–Ŗā€Æ Network
ā–Ŗā€Æ Care management
ā–Ŗā€Æ Medical Informatics
ā–Ŗā€Æ Telemedicine
ā–Ŗā€Æ Enrollment
ā–Ŗā€Æ Billing
ā–Ŗā€Æ Beneļ¬ts
ā–Ŗā€Æ Claims
ā–Ŗā€Æ Service
Establish & Manage
Customer
Relationships
Market & Promote
Products
Perform Pricing &
Risk Management
Develop & Manage
Products
Perform Care
Management
Develop & Maintain
Provider Network
Data Analytics and
Reporting
Provide
Customer
Service
Manage
Membership &
Accounting
Manage Beneļ¬ts &
Claims
T
E
C
H
N
O
L
O
G
Y
Technology & Data Analytics
ā€¢ā€Æ software platform plays an essential role in Oscarā€™s activities because itā€™s
the main enabler of all the functions of the plan, from the data to the
customer relationships to the providers network
Marketing & Communication
ā€¢ā€Æ the design is crucial to customer growth and engagement
Customer Services
ā€¢ā€Æ membership, accounting, claims, relationships, services
Provider Networks
ā€¢ā€Æ developing and maintaining them is a strategic activity that cannot be
underestimated
Products Development and Risk Management
46
Scope of Activities
ā€¢ā€Æ Sales/Brokers:	can	s)ll	rely	on	tradi)onal	brokers	
to	a]ract	other	customers	
ā€¢ā€Æ Finance	
ā€¢ā€Æ Legal	
ā€¢ā€Æ Human	Resources	
ā€¢ā€Æ Wearables	and	Internet	of	Things	
ā€¢ā€Æ Health	EducaDon	
ā€¢ā€Æ Rural	unserved	areas	acDviDes	
47	
Collateral Activities
ā€¢ā€Æ Managed Care Organizations to access their
network of providers. Healthix (NY), Qualcore (NJ)
ā€¢ā€Æ Technology Infrastructure: Amazon Web Services
can save cost through a pay per use model
ā€¢ā€Æ Selected Providers : CVS Caremark for pharmacy,
Value Options for behavioral health/substance abuse,
Davis Vision for pediatric vision and Healthplex for
pediatric dental
ā€¢ā€Æ Recognized Hospitals: e.g. UCLA in California
ā€¢ā€Æ Wearables companies for biometrics informations:
Misļ¬t
48	
Current Partnerships
49	
Recommended Partnerships
Google:
ā€¢ā€ÆAlphabet invested in Oscarā€™s capital. This investment will lead Oscar to have
better deal in using Google Cloud Platform at better prices as compared with
Amazon (Amazon Web Services)
ā€¢ā€ÆChance to leverage Google Analytics for better web analytics
ā€¢ā€ÆMore digital devices: by having its own health insurer, Google has a
platform from which it can distribute drugs and devices (products from the
alliances with Dexcom (DXCM) and Novartis (glucose monitor lenses))
Apple:
ā€¢ā€ÆiPhone iOS is one of the major players of the smartphones market
ā€¢ā€ÆPartnership with major players will enforce Oscar recognition
featured in the Apple Store
integrated in the Appleā€™s Healthkit Platform
ā€¢ā€ÆApple too will beneļ¬t from a synergy between the two companies.
50	
Recommended Partnerships
GE	Healthcare:	
ā—ā€Æ GE sells and maintain big machines for hospitals, collecting data
including monitoring and diagnostics and operations intelligence.
Combining these data with Oscar would help improving clinical,
ļ¬nancial and operational outcomes for the healthcare industry.
ā—ā€Æ Contractual agreement with healthcare providers based on
services, quality of treatment, and prices.
Selected	Network	and	Providers:	
UniversiDes	and	Research	centers,	Pharma	Companies:	
ā—ā€Æ Providing data for the development of science and new
products to get more revenue and increase the base and the
brand reputation
6.	Value	Capture	
51
52	
$2.7 trillion in expenditures on Health Plans
$580.0 B
$286.7 B $952.6 B
$1172 B
$305.1B
$305.1B
Individuals
Government
Employers Health Plans Providers
ā–Ŗā€Æ Health plans consume 15.2% of the
$1172 billion that flow through
insurance providersā€™ doors (2012).
ā–Ŗā€Æ As cost pressures in the US
healthcare system continue to
rise, the pressure to reduce this
spending will continue to
intensify.
Source CMS
Healthcare Money Flow
53
Value Capture (Current)
Subscription
Gift Card
Data
Uncovered
Covered
Government
Providers (Doctors,
Hospitals, Pharmacies...)
Individuals
Visits,Assistance,
Prescriptions
Subsidies
ACA
Matchmaking
Lower Risks
Discounts on scale
54	
Value Capture (Current)
ā—ā€Æ From the Insured
Main Revenue: Subscription Fee Model Monthly Premium
In future : Personalized pricing plan depends on the customerā€™s risk.
Healthier person gets lower premium fee
	
	
ā—ā€Æ From Oscarā€™s Data
Identify Risk ā†’ Lower Cost ā†’ Oļ¬€er lower price
Oscar could determine that an unexpected sedentary period in a
personā€™s life, maternity, depression or even just an out of pattern
resting heart rate recorded from the userā€™s ļ¬tness tracker is more
than suļ¬ƒcient to triple a personā€™s health insuranceĀ costs.
In future : Sale of data to pharmaceutical or advertising companies
ā—ā€Æ From Healthcare Providers
Discounts for scale of demand
55
Value Capture (Future)
Subscription
Gift Card
Data
Uncovered
Government
Providers (Doctors,
Hospitals, Pharmacies...)
Individuals
&
Employers
Subsidies
Research
Matchmaking
Covered
Visits,Assistance,
Prescriptions
Advertising
Discounts on scale
Wellness
Programs
56
Value Capture (Future)
ā—ā€Æ Data play the biggest role
Partnering with Google (and Apple) to become an
integrated platform for all the players of the network,
Oscar can capture value from all the elements of the
chain. Advertising for health products, revenues from the
development of new drugs and new services,
development of new IoT devices for the home or
wearables, care management for the providers. The
possibilities are endless.
7.	Strategic	Control	
57
No Brand
Recognition
ā€¢ā€ÆA newly built start-
up
ā€¢ā€ÆHave no Prior
Experience on
Health Insurance
Industry
Limited Area of
Expansion
ā€¢ā€ÆOnly New York
and New Jersey
Simple, Fast,
Integrated
Service
Cheaper Option than
existing health insurance
industry
ā€¢ā€Æ Cheaper consultation fee with
telemedicine ā†’Claim Is
cheaper ā†’ Oscar can provide
lower cost
ā€¢ā€Æ Its ā€œSimple Planā€ give one-
time payment for insurance
and health treatment.
Besides, it adopts ā€œno copaysā€
method
Lower Capital
Expenses
ā€¢ā€Æ Fewer Human
Resources
ā€¢ā€Æ No Brick-and-
Mortar Store
Google has
faith in
Oscar Health
Insurance
58
Strength vs. Weakness
Leveraging technology and data to make insurance simply, intuitive and human compared to traditional
competitors
ā€œGoogle Bets on Insurance Startup Oscar Healthā€
Source: http://blogs.wsj.com/digits/2015/09/15/google-bets-on-insurance-startup-oscar-health/
59	
Competitive Advantage
ā€¢ā€Æ Agility to innovate with emerging technologies
Starting small
ā€¢ā€Æ Early Mover Advantage
Speed to Market
ā€¢ā€Æ the Oscar process-based innovation
ā€¢ā€Æ But may not be suļ¬ƒcient to stay ahead if not supported by a rapid
scale
Customer-centric service provider
De-Facto Standard
ā€¢ā€Æ integrated platform to hand the complexity of the healthcare system
Oscar platform can estabilish as a front-end
Proprietary Algorithm to calculate personalized fees and risks
Control of the Closed Architecture: Proprietary
Communications System between doctors, patients, insurance
and hardware
High Barriers: the barriers to entry in the insurance market are
high for rising costs on one hand, but on the other hand they
are lowered due to the industryā€™s vertically disintegrated nature.
Privacy and Security: a potential breach could aļ¬€ect negatively
the brand reputation, so they must be protected
60	
Sustaining Proļ¬tability
Higher Switching Costs
ā€¢ā€Æ for patients: retention, ļ¬delity, user experience not exchangeable
ā€¢ā€Æ for brokers: ease and convenience for them to work with Oscars, building
good relations
ā€¢ā€Æ for doctors: eļ¬ƒcient platform to work anywhere anytime through
telemedicine, getting more patients by Oscarā€™s network eļ¬€ects
Advantages and promotions for new users and families
that contribute to the network eļ¬€ects, for active members
that contribute with contents, marketing and word of mouth
61	
Sustaining Proļ¬tability
8.	Recommenda)ons	&	
Conclusions	
62
63	
Crossing The Chasm
Things to do to Fix HealthcareĀ 
ā€¢ā€Æ Serve as the bridge between new tools and consumers
ā€œIn the ļ¬rst half of 2014, venture capital investment in digital health grew by
176%, spawning new consumer-centric companies with interesting approaches to
consumer health. But thereā€™s a chasm between these unscaled point solutions and the
consumers who could use them. Payers can bridge the gap, using Amazon-style
analytics and personalization to better understand consumer types and then connect
them at the right place and time to the best-suited oļ¬€erings. Better yet, payers donā€™t
need to build the bridge themselves: A growing set of powerful consumer-engagement
platforms are moving along this path.ā€
Can they win consumers over?
ā€¢ā€Æ Some consumers have had negative experiences with insurance ā†’ Key Success for
Oscar by bringing much better experiences, such as: more convenience,
personalization, 24/7 support for doctors and coordination of care
ā€¢ā€Æ Make health insurance industry more eļ¬ƒcient, eļ¬€ective, humane, and sustainable.
Source: What the Insurance Industry Can Do to Fix Health Care (Sukanya Soderland, 23 December 2014). Harvard Business Review.
64	
Priority Matrix for Consumer Engagement
65
Opportunities: After Obamacare Launch
Source: http://www.nytimes.com/interactive/2015/10/31/upshot/who-still-doesnt-have-health-insurance-obamacare.html?_r=0
The area where Medicaid has not
expanded to the State, the
uninsured level goes up
(as shown in Area not outlined in
Black)
ā€¢ā€Æ Continue expanding to other
States, beneļ¬ting from the
favorable wave of
ObamaCare
ā€¢ā€Æ New opportunities in the
areas with lower
competitors (the South and
Southwest area of the U.S)
ā€¢ā€Æ Financial evaluation is a
MUST, to minimize the risk
and sustain the growth
Expansion	in	other	parts	of	
The	United	States
66	
After the chasm: recommendations
Expansion	in	companies	insurances	(B2B)	
ā€¢ā€ÆAttack B2B market with: deals, direct sales to companies to provide
insurance to the target employers.
Expansion	in	other	insurance	markets	
ā€¢ā€ÆExpand and attack new markets other than healthcare market, such as:
home ins., car ins. , life ins., leveraging on the experience gained from
the healthcare market.
ā€¢ā€ÆOnly applicable once Oscar has extremely strong network eļ¬€ects [Long-
Term Plan]
67	
After the chasm: recommendations
Spend more in Advertising
ā€¢ā€ÆIn marketing with Digital Advertising and Third Parties Recommendations
(Inļ¬‚uencers, Blogs, Tech Magazines)
Continue to award virtuous behaviors
ā€¢ā€ÆHealthy behaviors should be always encouraged and rewarded with
discounts, as they not only serve as a promotion tool but also minimize the
risks and operating costs. It is a win-win solution for both the insured and
the insurance companies
Manage Chronic Diseases and provide the data to pharma
companies and researchers, in change of revenues of new drugs?
ā€¢ā€ÆAnother way to capture value can be to provide a centralized hub for
providers to better manage metrics that are linked to improved health
outcomes for people with chronic diseases. A possible tradeoļ¬€ could be
ā€œpatients data and trackingā€ in exchange of percentages from the selling of
newly developed drugs.
68
After the chasm: recommendations
Continue to be always One Step Ahead of Competitors
ā€¢ā€Æ Exploring partnership to improve its telemedicine to telehealth
ā€¢ā€Æ A big company can imitate
Expand and strive to provide better services to
build trust and lock-in the customers
(The importance of Network Eļ¬€ects)
Get more fundings
ā€¢ā€Æ Increase the capital to enter in the new market and absolve any needed
regulation
69	
Thank	You!	Ques)ons	Time
Web	References	
ā€¢ā€Æ http://www.hioscar.com/
ā€¢ā€Æ http://graphics.wsj.com/billion-dollar-club/
ā€¢ā€Æ http://blogs.wsj.com/digits/2015/09/15/google-bets-on-insurance-startup-oscar-health/
ā€¢ā€Æ http://www.economist.com/news/business/21600147-attempt-change-americas-most-arcane-industry-better-geek-guide-
insurance
ā€¢ā€Æ http://www.zdnet.com/article/how-oscar-is-using-cloud-and-big-data-to-disrupt-health-insurance/
ā€¢ā€Æ http://www.bloomberg.com/news/articles/2015-09-03/for-health-insurance-startup-oscar-cute-ads-only-go-so-far
ā€¢ā€Æ http://www.wired.com/2015/04/oscar-funding/
ā€¢ā€Æ http://fortune.com/2014/12/09/oscar-health-insurance/
ā€¢ā€Æ http://www.businessinsider.com/oscar-raises-145-million-at-a-15-billion-valuation-2015-4/
ā€¢ā€Æ http://www.crainsnewyork.com/article/20150810/HEALTH_CARE/150809883/oscars-losses-are-huge-but-investors-dont-care
ā€¢ā€Æ http://www.usatoday.com/story/tech/2015/06/24/oscar-uses-tech-to-make-consumers-less-grouchy-about-health-care/29150055/
ā€¢ā€Æ http://www.lowcosthealthinsurance.com/who-are-the-top-10-health-insurance-companies-by-market-share/
ā€¢ā€Æ http://www.unitedhealthgroup.com/About/default.aspx
ā€¢ā€Æ https://www.simplyinsured.com/about
ā€¢ā€Æ http://techcrunch.com/2015/04/20/oscar-145m/
ā€¢ā€Æ http://techcrunch.com/2015/06/30/simplyinsured-series-a/
ā€¢ā€Æ http://www.nytimes.com/2015/04/21/business/dealbook/oscar-a-health-insurance-start-up-valued-at-1-5-billion.html
ā€¢ā€Æ https://www.ehealthinsurance.com/ehealthinsurance/beneļ¬ts/ifp/NY/NYOscar_Consumer_Brochure.pdf
ā€¢ā€Æ http://www.forbes.com/sites/greatspeculations/2015/09/16/googles-oscar-deal-could-be-game-changer-for-diabetes-
management/
ā€¢ā€Æ https://www.ehealthinsurance.com/ehealthinsurance/beneļ¬ts/ifp/NY/NYOscar_Consumer_Brochure.pdf
ā€¢ā€Æ http://www.wsj.com/articles/google-backs-startup-oscar-health-insurance-1442374756
ā€¢ā€Æ http://marketrealist.com/2015/02/aļ¬€ordable-care-act-hurts-managed-care-industry/
70

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Oscar health insurance

  • 2. 1. US Healthcare Insurance: The state of the industry 2. Oscar Health Insurance 3. Value Proposition 4. Customer Selection 5. Scope of Activities 6. Value Capture 7. Strategic Control 8. Recommendations & Conclusions 2 Outline
  • 4. VALUE NETWORK 4 Traditional Health Insurance Intermediate in the Healthcare Value Chain Sources: The World Financial Review ā€“ The Business of Healthcare Innova)on: Convergence in The h]p://www.worldļ¬nancialreview.com/?p=1451/
  • 6. High Barriers to Entry ā€¢ā€Æ Residents may not buy policies from insurers located outside of their state. McCarran-Ferguson Act ā€¢ā€Æ Universal Access - Insurers must oļ¬€er and provide health insurance for all applicants ā€¢ā€Æ Rate Bands - Limits insurersā€™ range of policy premiums Regulations ā€¢ā€Æ Minimum amount of capital for the insurer to avoid insolvency Risk Based Capital
  • 7. 7 Opportunities: Obamacare OBAMACARE: Obama Administration's Aļ¬€ordable Care Act (2010, eļ¬€ective from 2014) shifted the health insurance market from a B2B focus to a B2C ā€¢ā€Æ It gives consumers more control over which plan they choose ā€¢ā€Æ It requires individuals to have health insurance, or face penalties, starting in 2014 and increasing through 2016.
  • 8. 8 Opportunities: Obamacare ā€œCommon-sense insurance market reforms should be implemented to increase competition and improve options for consumers as well. Such a truly competitive marketplace would have the power to keep health insurance costs lower and quality higher.ā€ Alyene Senger, 2013 (Heritage Foundation) Competitive Pricing depends on the number of suppliers available. South side of the U.S has lack of health insurance carriers in Obamacare exchanges Source: http://www.heritage.org/research/reports/2013/11/obamacare-insurance-exchanges-and- the-lack-of-competition
  • 9. Sources: h]p://www.economist.com/news/business/21600147-a]empt-change-americas-most-arcane-industry-be]er-geek-guide-insurance h]p://www.usatoday.com/story/tech/2015/06/24/oscar-uses-tech-to-make-consumers-less-grouchy-about-health-care/29150055/ 9 Opportunities Sources : h]p://www.cdc.gov/nchs/data/nhis/earlyrelease/earlyrelease201506.pdf U.S. health care costs is 2X more expensive compared to other rich countries Health Insurance cost keeps increasing ā€¢ā€Æ Results : 40% forego the health insurance plan Health Insurance Market Value of $750B in 2015, expected to grow annually by 1.8%
  • 10. Opportunities 10 Private Insurance 2. Get Receipt Back 1. Go to Clinic 3. File Claims 4. Conļ¬rmation from the Clinic 5. Long process before approval 6. Payback to The Insured (Very Long Processes and Time).. May Take Months ā—ā€Æ High complexity on health insurance claim process
  • 13. Simple, Smart & Friendly "We wanted to build a company that was like having a doctor in the family" Oscar ADV: https://www.youtube.com/watch?v=WZJMk2HEU1s
  • 14. ā€¢ā€Æ Technology-Based Healthcare Insurance Company ā€¢ā€Æ Launched in 2013 after ā€˜Obamacareā€™ ā€¢ā€Æ Founders: Josh Kushner, Kevin Nazemi and Mario Schlosser (CEO), all from Harvard ā€¢ā€Æ Current Markets in US: New York, New Jersey, California, Texas ā€¢ā€Æ Funding: ā€œBillion Dollar Startupā€ ā€¢ā€Æ Valuation: US$1.75B 14 The Company Notable investors: General Catalyst, Goldman Sachs, Li Ka-Shing, Alphabet
  • 15. ā€¢ā€Æ Revolutionize health insurance through technology, data and design Mission Statement ā€¢ā€Æ Better plans, lower costs ā€¢ā€Æ Better healthcare ā€¢ā€Æ Better experience What Oscar Oļ¬€ers ā€¢ā€Æ Expand to become a national insurer and compete with the established old big players Vision 15 Mission, Oļ¬€er, Vision Sources: www.hiOscar.com http://www.npr.org/2014/01/03/259432738/this-is-not-your-parents-health-insurance
  • 17. 17 Better Healthcare: Network Eļ¬€ects Using geofencing technology, Oscar members can choose amongst a list of available and relevant doctors based on the patientā€™s location. Geo-fencing (geofencing) is a feature in a software program that uses the global positioning system (GPS) or radio frequency identiļ¬cation (RFID) to deļ¬ne geographical boundaries. More doctors = More choice for Insured + Greater Convenience More Insured = More potential customers for doctors
  • 18. 18 Better Healthcare: Telemedicine In Oscar, Telemedicine is a core value-added service ā€¢ā€Æ Cut down Oscar expenses ā€¢ā€Æ Beneļ¬cial for both parties, doctor and patient as below
  • 19. Better Experience 1. Short Claim Time due a digitalized process: Claims are processed within 20 mins without troubling the insured 2. Simple Sign-up Steps: 19
  • 20. 20 Better Experience 3. Billing made simple ā—ā€Æ digitally printed/less paperwork ā—ā€Æ more readable to the patients ā—ā€Æ faster and more eļ¬ƒcient process for the doctors to key in due to technology Oscar Bill Statement Traditional Bill Statement
  • 21. 21 Wearable Technology for monitoring Incentive for being healthy and active ā€¢ā€Æ Oscar takes a calculated risk by giving cheaper health insurance if the insured is living a healthy lifestyle ā€¢ā€Æ Rewards for staying active with a free wearable tracking device ā€¢ā€Æ Partnership with Misļ¬t Inc.: wearable given free to the insured, to track and monitor the insuredā€™s lifestyle ā€¢ā€Æ Partnership with Amazon Inc.: to provide gift cards in exchange for meeting health goals
  • 24. 24 Competitors Type Company Example Main Market Value ProposiDon Tradi)onal B2B (Main proļ¬t from employers) Nego)ate lower prices using large scale of demand CO-OP Individual Non-proļ¬t Startup Individual (Elderly) Data-driven care Health Sharing Program Individual (Healthy) Lower risk customers, non- proļ¬t
  • 25. ā€¢ā€Æ Mostly Traditional ā€“ UnitedHealth Group, Fidelis Care ā€¢ā€Æ Highly Competitive ā€¢ā€Æ Market leaders possess relatively small market shares 25 Competition in the NY state Figure shows market share of the New York Health Insurance Industry in 2015 Source: http://info.nystateofhealth.ny.gov/sites/default/ļ¬les/2015%20NYSOH%20Open%20Enrollment%20Report.pdf
  • 26. 26 Example: Average Pricing in NY, 2014 Market Share Company Catastrop hic Bronze Silver Gold PlaDnum 19% Health Republic $212.73 $307.12 $387.42 $438.69 $515.81 17% Fidelis $189.86 $323.75 $409.66 $501.60 $606.03 15% Metroplus $323.38 $365.30 $392.41 $432.28 $484.13 14% Empire $186.20 $391.97 $456.39 $544.32 $645.52 9% Emblem $202.83 $342.88 $396.87 $474.68 $570.85 8% MVP $238.09 $460.56 $598.90 $720.93 $850.19 3% Healthļ¬rst $317.38 $379.41 $444.40 $519.47 $615.54 3% Oscar $217.95 $341.95 $422.41 $489.98 $570.42 2% United $418.93 $685.49 $803.68 $950.36 $1,121.38 Data Source: Informa)on Source: h]p://www.capitalnewyork.com/ar)cle/city-hall/2014/09/8552029/tracking-premium-changes-new-yorks-health-exchange Oscar pricing is compe))ve and some)mes lower
  • 27. Value Proposition ā€¢ā€ÆSaves time and simpliļ¬es selection process by comparing 13,000+ plans from 180+ carriers Customer base ā€¢ā€ÆIndividuals Market Value Capture ā€¢ā€ÆFee for service/Commission/Referral Signed agreement with Federal Government to access the Federal electronic data hub to automatically determine tax subsidy eligibility and amount of subsidy 27 Complementary Services - Online Brokers
  • 30. Oscar provides value to the insured: ā—ā€Æ a simple technology interface for consumers ā—ā€Æ unprecedented beneļ¬ts (e.g. three free doctor visits, free generic prescriptions, a home nurse visit after giving birth and telemedicine) ā—ā€Æ a broad and deep provider network (40,000 physicians are in it so far) at prices comparable or lower than the rest of the market ā—ā€Æ transparency and a great customer service 30 Value Proposition
  • 31. Oscar brings value to healthcare providers: ā—ā€Æ Save time by automating the claim conļ¬rmation process ā—ā€Æ Connect to a wide network of patients ā—ā€Æ Allow diļ¬€erentiation through review system in platform 31 Value Proposition
  • 32. Customerā€“Centered Health Insurance: target on ā€œIndividualsā€ and not only ā€œEmployersā€. This will allow Oscar to learn and know individualsā€™ needs in-depth so as to serve them better Bring Simplicity resulting in Higher Convenience and Lower Cost by leveraging the telemedicine technology and predictive data analytics intensively (i.e oļ¬€er customized pricing plan by analyzing the wearables tracking result, not merely on historical health records) Integrated software platform to quickly and easily ļ¬nd a doctor, indicate one's question and make an appointment or speak directly to a doctor within 10 minutes of one's request Oscar keeps track of the patientā€™s medical history so they can access their past prescriptions, lab work, and oļ¬ƒce visits without the hassle of making phone calls and completing lots of paperwork 32 Value Proposition Leveraging technology and data to make insurance simple, intuitive and human compared to traditional competitors
  • 34. 34 VP Recommendations ā€¢ā€Æ What Oscar oļ¬€ers can disrup)ve. Tradi)onal health insurance popularity is so low that as a new entrant, Oscar should diļ¬€eren)ate themselves as a customer-centric insurer Superior Value ProposiDon vs. CompeDtors: Usability, Speed, Psychological Friendliness ā€¢ā€Æ Simple, easy to use ā€¢ā€Æ Share data between doctors, hospitals and pharmacies ā€¢ā€Æ Integrated medical history Uniļ¬ed plaVorm network for all the healthcare players ā€¢ā€Æ The data that Oscar own is one of their most important assets. Partnering with the right companies will provide beneļ¬ts to the development of new products from both sides Data to the right partners
  • 36. 36 Customer Selection Lead Users Millennials/ Generation & Tech ā€“ Savvy Individuals (B2C) New Families New Jobs, Freelancers Not eligible for ā€¢ā€Æ Medicaid ā€¢ā€Æ Medicare Target Speciļ¬c Markets, starting from NY & NJ Why Oscar targets this customer segment? ā€¢ā€Æ Healthy people ā†’ Lower Risk & Lower Cost
  • 40. 40 CS Recommendations ā—ā€Æ Quickly expand in states with high population density to increase the customer base, supported by a large network of doctors ā—ā€Æ Luxury plans for rich people promising premium treatment and fastest response while keeping the easy and technology-focused user experience Once the US individuals market is conquered, adapt sales division and attack: ā—ā€Æ Groups ā—ā€Æ Employers: According to S&P Capital IQ, by 2020, 90% of employees with employer-sponsored insurance are expected to shift to individual coverage. The easy access to health insurance exchanges following the Affordable Care Act (or ACA) is expected to lead to employers paying a stipend for employees to pay for health insurance rather than sponsoring the plan themselves.
  • 42. Integrated Services Health Insurance Technology Tele- medicine VISION 42 Integration In Vertically Disintegrated Industry ā€¢ā€Æ Oscar does not hire the medical practitioners, like doctors. Oscar partners with them to obtain lower costs ā€¢ā€Æ Oscar does not produce and does not own the wearables
  • 43. VALUE NETWORK Oscar Value Network Customers, Collaborators, Suppliers More Integrated Services between Healthcare & Health Insurance
  • 44. VALUE NETWORK Value Network Traditional Insurance vs Oscar Customers, Collaborators, Suppliers 44
  • 45. VALUE NETWOR K Oscar Value Chain Health Plan Core Processes Finance, Legal, Compliance/Regulatory, Quality/Audit, Human Resources, 3rd Party Wearables Technologies Support Functions ā–Ŗā€Æ Product ā–Ŗā€Æ Sales ā–Ŗā€Æ Marketing ā–Ŗā€Æ Actuarial ā–Ŗā€Æ Underwriting Health Plan Functions ā–Ŗā€Æ Network ā–Ŗā€Æ Care management ā–Ŗā€Æ Medical Informatics ā–Ŗā€Æ Telemedicine ā–Ŗā€Æ Enrollment ā–Ŗā€Æ Billing ā–Ŗā€Æ Beneļ¬ts ā–Ŗā€Æ Claims ā–Ŗā€Æ Service Establish & Manage Customer Relationships Market & Promote Products Perform Pricing & Risk Management Develop & Manage Products Perform Care Management Develop & Maintain Provider Network Data Analytics and Reporting Provide Customer Service Manage Membership & Accounting Manage Beneļ¬ts & Claims T E C H N O L O G Y
  • 46. Technology & Data Analytics ā€¢ā€Æ software platform plays an essential role in Oscarā€™s activities because itā€™s the main enabler of all the functions of the plan, from the data to the customer relationships to the providers network Marketing & Communication ā€¢ā€Æ the design is crucial to customer growth and engagement Customer Services ā€¢ā€Æ membership, accounting, claims, relationships, services Provider Networks ā€¢ā€Æ developing and maintaining them is a strategic activity that cannot be underestimated Products Development and Risk Management 46 Scope of Activities
  • 47. ā€¢ā€Æ Sales/Brokers: can s)ll rely on tradi)onal brokers to a]ract other customers ā€¢ā€Æ Finance ā€¢ā€Æ Legal ā€¢ā€Æ Human Resources ā€¢ā€Æ Wearables and Internet of Things ā€¢ā€Æ Health EducaDon ā€¢ā€Æ Rural unserved areas acDviDes 47 Collateral Activities
  • 48. ā€¢ā€Æ Managed Care Organizations to access their network of providers. Healthix (NY), Qualcore (NJ) ā€¢ā€Æ Technology Infrastructure: Amazon Web Services can save cost through a pay per use model ā€¢ā€Æ Selected Providers : CVS Caremark for pharmacy, Value Options for behavioral health/substance abuse, Davis Vision for pediatric vision and Healthplex for pediatric dental ā€¢ā€Æ Recognized Hospitals: e.g. UCLA in California ā€¢ā€Æ Wearables companies for biometrics informations: Misļ¬t 48 Current Partnerships
  • 49. 49 Recommended Partnerships Google: ā€¢ā€ÆAlphabet invested in Oscarā€™s capital. This investment will lead Oscar to have better deal in using Google Cloud Platform at better prices as compared with Amazon (Amazon Web Services) ā€¢ā€ÆChance to leverage Google Analytics for better web analytics ā€¢ā€ÆMore digital devices: by having its own health insurer, Google has a platform from which it can distribute drugs and devices (products from the alliances with Dexcom (DXCM) and Novartis (glucose monitor lenses)) Apple: ā€¢ā€ÆiPhone iOS is one of the major players of the smartphones market ā€¢ā€ÆPartnership with major players will enforce Oscar recognition featured in the Apple Store integrated in the Appleā€™s Healthkit Platform ā€¢ā€ÆApple too will beneļ¬t from a synergy between the two companies.
  • 50. 50 Recommended Partnerships GE Healthcare: ā—ā€Æ GE sells and maintain big machines for hospitals, collecting data including monitoring and diagnostics and operations intelligence. Combining these data with Oscar would help improving clinical, ļ¬nancial and operational outcomes for the healthcare industry. ā—ā€Æ Contractual agreement with healthcare providers based on services, quality of treatment, and prices. Selected Network and Providers: UniversiDes and Research centers, Pharma Companies: ā—ā€Æ Providing data for the development of science and new products to get more revenue and increase the base and the brand reputation
  • 52. 52 $2.7 trillion in expenditures on Health Plans $580.0 B $286.7 B $952.6 B $1172 B $305.1B $305.1B Individuals Government Employers Health Plans Providers ā–Ŗā€Æ Health plans consume 15.2% of the $1172 billion that flow through insurance providersā€™ doors (2012). ā–Ŗā€Æ As cost pressures in the US healthcare system continue to rise, the pressure to reduce this spending will continue to intensify. Source CMS Healthcare Money Flow
  • 53. 53 Value Capture (Current) Subscription Gift Card Data Uncovered Covered Government Providers (Doctors, Hospitals, Pharmacies...) Individuals Visits,Assistance, Prescriptions Subsidies ACA Matchmaking Lower Risks Discounts on scale
  • 54. 54 Value Capture (Current) ā—ā€Æ From the Insured Main Revenue: Subscription Fee Model Monthly Premium In future : Personalized pricing plan depends on the customerā€™s risk. Healthier person gets lower premium fee ā—ā€Æ From Oscarā€™s Data Identify Risk ā†’ Lower Cost ā†’ Oļ¬€er lower price Oscar could determine that an unexpected sedentary period in a personā€™s life, maternity, depression or even just an out of pattern resting heart rate recorded from the userā€™s ļ¬tness tracker is more than suļ¬ƒcient to triple a personā€™s health insuranceĀ costs. In future : Sale of data to pharmaceutical or advertising companies ā—ā€Æ From Healthcare Providers Discounts for scale of demand
  • 55. 55 Value Capture (Future) Subscription Gift Card Data Uncovered Government Providers (Doctors, Hospitals, Pharmacies...) Individuals & Employers Subsidies Research Matchmaking Covered Visits,Assistance, Prescriptions Advertising Discounts on scale Wellness Programs
  • 56. 56 Value Capture (Future) ā—ā€Æ Data play the biggest role Partnering with Google (and Apple) to become an integrated platform for all the players of the network, Oscar can capture value from all the elements of the chain. Advertising for health products, revenues from the development of new drugs and new services, development of new IoT devices for the home or wearables, care management for the providers. The possibilities are endless.
  • 58. No Brand Recognition ā€¢ā€ÆA newly built start- up ā€¢ā€ÆHave no Prior Experience on Health Insurance Industry Limited Area of Expansion ā€¢ā€ÆOnly New York and New Jersey Simple, Fast, Integrated Service Cheaper Option than existing health insurance industry ā€¢ā€Æ Cheaper consultation fee with telemedicine ā†’Claim Is cheaper ā†’ Oscar can provide lower cost ā€¢ā€Æ Its ā€œSimple Planā€ give one- time payment for insurance and health treatment. Besides, it adopts ā€œno copaysā€ method Lower Capital Expenses ā€¢ā€Æ Fewer Human Resources ā€¢ā€Æ No Brick-and- Mortar Store Google has faith in Oscar Health Insurance 58 Strength vs. Weakness Leveraging technology and data to make insurance simply, intuitive and human compared to traditional competitors ā€œGoogle Bets on Insurance Startup Oscar Healthā€ Source: http://blogs.wsj.com/digits/2015/09/15/google-bets-on-insurance-startup-oscar-health/
  • 59. 59 Competitive Advantage ā€¢ā€Æ Agility to innovate with emerging technologies Starting small ā€¢ā€Æ Early Mover Advantage Speed to Market ā€¢ā€Æ the Oscar process-based innovation ā€¢ā€Æ But may not be suļ¬ƒcient to stay ahead if not supported by a rapid scale Customer-centric service provider De-Facto Standard ā€¢ā€Æ integrated platform to hand the complexity of the healthcare system Oscar platform can estabilish as a front-end
  • 60. Proprietary Algorithm to calculate personalized fees and risks Control of the Closed Architecture: Proprietary Communications System between doctors, patients, insurance and hardware High Barriers: the barriers to entry in the insurance market are high for rising costs on one hand, but on the other hand they are lowered due to the industryā€™s vertically disintegrated nature. Privacy and Security: a potential breach could aļ¬€ect negatively the brand reputation, so they must be protected 60 Sustaining Proļ¬tability
  • 61. Higher Switching Costs ā€¢ā€Æ for patients: retention, ļ¬delity, user experience not exchangeable ā€¢ā€Æ for brokers: ease and convenience for them to work with Oscars, building good relations ā€¢ā€Æ for doctors: eļ¬ƒcient platform to work anywhere anytime through telemedicine, getting more patients by Oscarā€™s network eļ¬€ects Advantages and promotions for new users and families that contribute to the network eļ¬€ects, for active members that contribute with contents, marketing and word of mouth 61 Sustaining Proļ¬tability
  • 63. 63 Crossing The Chasm Things to do to Fix HealthcareĀ  ā€¢ā€Æ Serve as the bridge between new tools and consumers ā€œIn the ļ¬rst half of 2014, venture capital investment in digital health grew by 176%, spawning new consumer-centric companies with interesting approaches to consumer health. But thereā€™s a chasm between these unscaled point solutions and the consumers who could use them. Payers can bridge the gap, using Amazon-style analytics and personalization to better understand consumer types and then connect them at the right place and time to the best-suited oļ¬€erings. Better yet, payers donā€™t need to build the bridge themselves: A growing set of powerful consumer-engagement platforms are moving along this path.ā€ Can they win consumers over? ā€¢ā€Æ Some consumers have had negative experiences with insurance ā†’ Key Success for Oscar by bringing much better experiences, such as: more convenience, personalization, 24/7 support for doctors and coordination of care ā€¢ā€Æ Make health insurance industry more eļ¬ƒcient, eļ¬€ective, humane, and sustainable. Source: What the Insurance Industry Can Do to Fix Health Care (Sukanya Soderland, 23 December 2014). Harvard Business Review.
  • 64. 64 Priority Matrix for Consumer Engagement
  • 65. 65 Opportunities: After Obamacare Launch Source: http://www.nytimes.com/interactive/2015/10/31/upshot/who-still-doesnt-have-health-insurance-obamacare.html?_r=0 The area where Medicaid has not expanded to the State, the uninsured level goes up (as shown in Area not outlined in Black) ā€¢ā€Æ Continue expanding to other States, beneļ¬ting from the favorable wave of ObamaCare ā€¢ā€Æ New opportunities in the areas with lower competitors (the South and Southwest area of the U.S) ā€¢ā€Æ Financial evaluation is a MUST, to minimize the risk and sustain the growth Expansion in other parts of The United States
  • 66. 66 After the chasm: recommendations Expansion in companies insurances (B2B) ā€¢ā€ÆAttack B2B market with: deals, direct sales to companies to provide insurance to the target employers. Expansion in other insurance markets ā€¢ā€ÆExpand and attack new markets other than healthcare market, such as: home ins., car ins. , life ins., leveraging on the experience gained from the healthcare market. ā€¢ā€ÆOnly applicable once Oscar has extremely strong network eļ¬€ects [Long- Term Plan]
  • 67. 67 After the chasm: recommendations Spend more in Advertising ā€¢ā€ÆIn marketing with Digital Advertising and Third Parties Recommendations (Inļ¬‚uencers, Blogs, Tech Magazines) Continue to award virtuous behaviors ā€¢ā€ÆHealthy behaviors should be always encouraged and rewarded with discounts, as they not only serve as a promotion tool but also minimize the risks and operating costs. It is a win-win solution for both the insured and the insurance companies Manage Chronic Diseases and provide the data to pharma companies and researchers, in change of revenues of new drugs? ā€¢ā€ÆAnother way to capture value can be to provide a centralized hub for providers to better manage metrics that are linked to improved health outcomes for people with chronic diseases. A possible tradeoļ¬€ could be ā€œpatients data and trackingā€ in exchange of percentages from the selling of newly developed drugs.
  • 68. 68 After the chasm: recommendations Continue to be always One Step Ahead of Competitors ā€¢ā€Æ Exploring partnership to improve its telemedicine to telehealth ā€¢ā€Æ A big company can imitate Expand and strive to provide better services to build trust and lock-in the customers (The importance of Network Eļ¬€ects) Get more fundings ā€¢ā€Æ Increase the capital to enter in the new market and absolve any needed regulation
  • 70. Web References ā€¢ā€Æ http://www.hioscar.com/ ā€¢ā€Æ http://graphics.wsj.com/billion-dollar-club/ ā€¢ā€Æ http://blogs.wsj.com/digits/2015/09/15/google-bets-on-insurance-startup-oscar-health/ ā€¢ā€Æ http://www.economist.com/news/business/21600147-attempt-change-americas-most-arcane-industry-better-geek-guide- insurance ā€¢ā€Æ http://www.zdnet.com/article/how-oscar-is-using-cloud-and-big-data-to-disrupt-health-insurance/ ā€¢ā€Æ http://www.bloomberg.com/news/articles/2015-09-03/for-health-insurance-startup-oscar-cute-ads-only-go-so-far ā€¢ā€Æ http://www.wired.com/2015/04/oscar-funding/ ā€¢ā€Æ http://fortune.com/2014/12/09/oscar-health-insurance/ ā€¢ā€Æ http://www.businessinsider.com/oscar-raises-145-million-at-a-15-billion-valuation-2015-4/ ā€¢ā€Æ http://www.crainsnewyork.com/article/20150810/HEALTH_CARE/150809883/oscars-losses-are-huge-but-investors-dont-care ā€¢ā€Æ http://www.usatoday.com/story/tech/2015/06/24/oscar-uses-tech-to-make-consumers-less-grouchy-about-health-care/29150055/ ā€¢ā€Æ http://www.lowcosthealthinsurance.com/who-are-the-top-10-health-insurance-companies-by-market-share/ ā€¢ā€Æ http://www.unitedhealthgroup.com/About/default.aspx ā€¢ā€Æ https://www.simplyinsured.com/about ā€¢ā€Æ http://techcrunch.com/2015/04/20/oscar-145m/ ā€¢ā€Æ http://techcrunch.com/2015/06/30/simplyinsured-series-a/ ā€¢ā€Æ http://www.nytimes.com/2015/04/21/business/dealbook/oscar-a-health-insurance-start-up-valued-at-1-5-billion.html ā€¢ā€Æ https://www.ehealthinsurance.com/ehealthinsurance/beneļ¬ts/ifp/NY/NYOscar_Consumer_Brochure.pdf ā€¢ā€Æ http://www.forbes.com/sites/greatspeculations/2015/09/16/googles-oscar-deal-could-be-game-changer-for-diabetes- management/ ā€¢ā€Æ https://www.ehealthinsurance.com/ehealthinsurance/beneļ¬ts/ifp/NY/NYOscar_Consumer_Brochure.pdf ā€¢ā€Æ http://www.wsj.com/articles/google-backs-startup-oscar-health-insurance-1442374756 ā€¢ā€Æ http://marketrealist.com/2015/02/aļ¬€ordable-care-act-hurts-managed-care-industry/ 70