Abstract

The case is about New York-based health insurance start-up Oscar Health that leverages technology, data, and design to guide its customers through a transparent healthcare and insurance claims system. As a tech start-up powered by data analytics, Oscar was emerging as a disruptive force in the massive health insurance industry by providing simpler and affordable health insurance. It focused on back-end analytics, real-time data, and personalized concierge teams to guide patients to the appropriate site of care. Oscar launched its individual business when the ACA’s individual coverage known as Obamacare was rolled out. ACA created an opportunity for Oscar to pitch its plans to consumers who were familiar with the idea of getting online information about healthcare plans. The key ingredient to the Oscar model was a narrow network that channelized customers to a relatively small number of hospitals and doctors to eventually reduce healthcare costs. This strategy worked well for the company, lowered its administrative costs, and improved profit levels. Through its robust partnership model, the company attracted membership from patients. Oscar faced challenges after several sections of Obamacare were repealed by the Trump administration. To face these, Oscar devised its aggressive expansion plan for 2019. However, it remains to be seen whether going forward, Oscar’s narrow network strategy will be help it in achieving growth and attracting customers.

Learning Objectives

The case is structured to achieve the following Learning Objectives:

• Understand the use of technology in healthcare services.
• Understand how rich customer experience and technology can disrupt health insurance.
• Understand how a simple and easy insurance process can win over customers.
• Explore how a narrow network of healthcare providers can offer coverage at lower prices.

Keywords

Data Analytics; disruption Narrow Network; Affordable Care ActHealthcare reform; strategic use of IT; business processes; marketing of insurance services; innovations in healthcare; entrepreneurial healthcare venture; managed care