OSCAR Health Plans Building its own network

While I will attend a web conference next week on this, here is what they have released so far.  Note that nothing changes until January 1:

“For 2017, the Oscar experience in NY will be built around three world-class hospital systems—Mount Sinai, Montefiore, and the Long Island Health Network—and over 20,000 first-rate physicians. Rather than working through a rented network, we have contracted directly with these systems so we can build deeper partnerships with them and improve our members’ experience.

Powered by partnerships
We’ve worked hard over the last four years to build the Oscar experience, and it is already superior in many ways—I know this as a result of managing my own family’s health through Oscar. When my four-year-old son had to get his tonsils removed due to chronic sleep apnea, Oscar was able to recommend the best surgeon in New York for this procedure—using data I wouldn’t have access to if I tried to find a surgeon on my own. This is data that every member has access to in our new network.

But there’s still a lot of work to be done. Why are there still so many paper forms? Why didn’t the after-hours team have more of my son’s information when he ran a fever after his surgery? Today I can request an appointment through Oscar, but why can’t I see the doctor’s availability? I’m sure your clients ask you the same questions when it comes to their care.

The short answer is that nobody has been able to integrate with every system that powers the multitude of doctors’ offices and hospitals in our fractured healthcare system. Our new partnerships will change that, enabling new tools that make it even easier to get the care our members need and improving the Oscar tools they’ve come to love (like Doctor-on-Call) in powerful ways. If you’re interested in a longer answer, you can read more on our blog.

It’s all about improving our members’ experience
When we connect our partners’ systems with ours, we’ll be able to launch instant appointment scheduling, share clinical data between doctors, and give members more guidance to get them to the right doctor. We are enhancing Doctor-on-Call to greatly expand the types of medical issues that can be treated virtually. We are making it easier to manage prescriptions and labs directly directly through Oscar tools. Many of our members have already happily interacted with our Concierge teams, a dedicated nurse and care guides who know their health history and can use the same tools to help them every step along the way.

A more sustainable future
America spends almost twice as much as any other industrialized country for medical results that are the same or worse. These new partnerships position us to address the rising cost of care, which is the biggest reason we recently had to ask to raise our New York rates by an average of 16%. Unfortunately, this trend of unsustainable rising healthcare costs isn’t new, and it won’t stop unless we make the kind of major network change we’re describing here.

So, in addition to sharing our tools and data, we will use risk-sharing agreements to pay our provider partners for keeping our members healthy, a practice that is not yet as widespread as many believe it needs to be. We will be able to keep premiums low only if all among us delivering healthcare are jointly on the hook for keeping people healthy. If we had not made this change, our rate increase for 2017 would have been significantly higher than it was, with no end in sight.

What does this mean for our members and you?
Nothing will change until January 1, 2017. The doctors and office locations in our 2017 network will be listed on our website by September 30 so you will have plenty of time to work with your clients to understand if there are any changes that will affect them. Some doctors and hospitals that are in our network today will not be with us next year. In particular, the NYU and Northwell hospital systems will be out of network in 2017. While we’re confident we can give our members a better experience with our new partnerships, we will work hard to ensure this doesn’t negatively impact their care during the transition. So starting in October, we’ll be proactively reaching out to members who may be impacted by this change. We’ll work to create a smooth transition plan for their care if any of their physicians are leaving the network, including setting up appointments with partner physicians who can take over.”