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Executive Summary OSCAR EXECUTIVE SUMMARY OSCAR EXECUTIVE SUMMARY WHAT’S THE STORY Oscar is a revolutionary, new Kind of insurance coMpany putting a major staKe in the ground to advance a tech-start-up-like, consuMer- driven healthcare experience. With Oscar and its “SiMple” plans, MeMbers receive free doctor visits, free preventive care, and free generic drugs. All eleMents of the Oscar plans are designed to cater to the Modern consumer, including slicK insurance cards sent in a box (a la receiving a brand new iPhone), a FacebooK-esque online portal that tracKs meMbers’ medical history, a wearable device and other technology handouts, health-incentivized rebates, price transparency tools, and doctors available anytiMe for minor symptoms and conditions. The coMpany’s priMary target as a start-up is on the individual insurance MarKet. Future plans are to expand Oscar to the sMall-group MarKet and eventually to large eMployers. The goal is to “win custoMers in today’s world while siMultaneously preparing for a world of consumer-centric health insurance that’s not quite here yet.” The coMpany was founded because of a frustrating experience by one of its founders related to a coMplicated bill froM a traditional insurer. He said, “I’m overeducated, and I had no idea what it all Meant. So I thought, OK, how can we take technology, data, and design and Make this transparent and easy to understand?” Oscar distinguished itself early via its quirKy subway advertising in New YorK City with a younger generation tone and imagery. It partners with MagnaCare’s local provider network in New York, and with QualCare’s in New Jersey. It plans to expand into other states and will pursue siMilar partnership strategies with provider networKs there. Just two years in business, Oscar faces challenges and has both fans and detractors. While investors and healthcare industry insiders credit Oscar for introducing a health insurance product that is appealing for consuMers, they question whether Oscar is ahead of its tiMe. Critics have raised concerns about Oscar’s personal health record inforMation being stored on a cloud-based internet server. Others question Oscar’s long-terM viability given the low-margin business of insurance and amidst the coMpetitive rich pocKets and deep foundations of the industry’s insurance giants. © Copyright 2017 Strategy Advantage. All rights reserved. 2 HOW IT WORKS Oscar prides itself on offering a “no-surprises” experience froM initial care to subMitting claiMs and paying bills. For exaMple, when searching for a provider, Oscar uses a Google Maps-enabled software that ranks available physicians in the closest geographic area to the member’s home or office. For Minor conditions (such as colds, stoMachaches, or sore throats), Oscar provides a search engine with “duMbed- down-speak” queries such as “My tuMMy hurts” or “My throat is scratchy” or “headache.” In addition, members can use a free doctor helpline to address symptoMs directly via the Oscar iPhone app. Oscar promises that a doctor will call bacK within one hour to provide care over the phone and, if necessary, to send in a prescription to the patients’ closest pharMacy. Oscar stresses that this feature is not Meant to be used for chronic or More serious issues. For this service, Oscar pays its physicians $40 – half the reiMbursement cost of an office visit – and believes the app-based service will reduce patients’ use of unnecessary visits. Oscar’s health plans are offered on the ObaMacare exchange in certain states. different options and Monthly pricing plans are available. While the plans are coMpetitively priced, they are not the cheapest plans and they typically offer fewer choices of doctors and hospitals than classic plans. With Oscar health plan sign-up, Members are provided with their own personal online portal that presents all of their Medical inforMation and records on a digital tiMeline in reverse chronological order, Much liKe social Media newsfeeds. Any care a patient receives, whether in person, on the phone, or in a hospital, is on the tiMeline including a record of the “visits”, notes from doctors, reminders for follow-ups, and warnings about possible drug interactions. Oscar also brings a serious focus to wellness and MeMber / patient engageMent via its health incentive prograMs that include free, Misfit Wearables fitness tracKers and money-bacK incentives in the forM of AMazon giftcards when MeMbers reach specific personal goals each Month. The coMpany believes that its “easy tech tools can actually Make people healthier, not just less unhappy with their health insurance.” HOW THE IdEA, COMPANY, ANd MOdEL OF CARE ARE EVOLVING © Copyright 2017 Strategy Advantage. All rights reserved. 3 Headquartered in New YorK, for-profit Oscar was organized in the SumMer of 2013 by three Harvard Business School classMates: Joshua Kushner (the son of a proMinent real estate faMily and founder of venture capital firM Thrive Capital), Mario Schlosser (a Stanford-trained coMputer prograMMer and former McKinsey & CoMpany employee), and Kevin Nazemi (an ex-Microsoft healthcare division executive). By Fall 2013, Oscar launched the new health plan in New YorK, right ahead of the first ObaMacare open enrollMent period, after having raised $174 Million in capital from bacKers including Thrive, Peter Thiel’s Founders Fund, Horizon Venture, General Catalyst, Wellington ManageMent, GoldMan Sachs, and Khosla Ventures. In its first year as a health plan, Oscar touted 17,000 subscribers and year-end revenue of $72 Million. Oscar expanded into New Jersey in late 2014, in tiMe for the second ObaMacare open enrollMent period. The coMpany has since grown to More than 40,000 MeMbers and annual revenue of $200 Million. In late August 2016, the company announced that they were exiting the New Jersey MarKetplace as of 2017. Oscar has raised More than $300 Million since its 2013 start. It has recruited a sMall arMy of tech engineers and website architects froM TuMblr, Google, FacebooK, and Spotify to advance its digital-first mindset. In April 2015, the coMpany was valued at $1.5 billion despite a loss of $27.5 Million in 2014. They project reaching profitability by 2016. In SepteMber 2015, Oscar received significant support froM Google Capital with a $32.5 Million investMent for its potential to lower hospital bills for patients. This brings Oscar’s overall value at $1.75 billion. This supports opens the door for other potential collaborations liKe potentially Oscar helping to push Google’s new glucose-monitoring contact lenses out to Market. During the 2015 NoveMber enrollMent cycle, Oscar Moved into select California Markets with plans to move into Texas, specifically Dallas and San Antonio, in 2016 where they plan to partner with Tenet Healthcare and Baylor Scott & White Health. It was reported in February 2016, that they gained 43,000 meMbers in Dallas and San Antonio with this first offering, however only enrolled 5,000 in Los Angeles and Orange County. In February 2016, with Oscar having over 145,000 Members up from last year’s 40,000, Fidelity InvestMents invested $400 Million in Oscar health (maKing that a total of $700 Million in funding) bringing their valuation to $2.7 billion dollars despite recently reporting losses of $105.2 Million in New YorK and New Jersey for 2015. According to reporting, the losses are due to a hit from the ACA’s risK adjustMent program as well as their inability to negotiate as a young insurance provider with costly health networK contracts – Oscar spent 75% of their premiums on hospital costs alone in 2015. Oscar CEO Mario Schlosser stated that their strategy to grow to 1 Million MeMbers within 5 years is to “use tight, exclusive networKs with hospitals to sell coMpetitively priced insurance in perhaps 30 U.S. MarKets” which is differentiated from their initial strategy to go after a broad networK of hospitals liKe the More traditional insurers. In March 2016, veteran Google VP Alan Warren joined Oscar as Chief Technology Officer and SVP of engineering. In June 2016, Oscar announced that they would expand into TeMpe, Arizona. During that saMe Month, Oscar revealed that they plan to start an initiative in September 2016 that would lead to the opening of their own New YorK health clinic where Members can have in-person visits with priMary care doctors. In August 2016, it was reported that Oscar lost $52.2M during the first half of 2016. These nuMbers only reflected losses in their New YorK marKet area, however, they also experienced losses in their California and Texas marKets as well. As a result of these losses, Oscar decided to significantly raise their premiums by 20% and eliMinate alMost half of their provider networK. These extreMe changes went into effect in 2017. © Copyright 2017 Strategy Advantage. All rights reserved. 4 In SepteMber 2016, Dr. Shaden MarzouK, who previously worKed a Cardinal Health, was recruited to Oscar as their Chief Medical Officer. In NoveMber 2016, Oscar reported another $45 million in losses during the third quarter of the year. These losses occurred in Texas, California and New YorK. In DeceMber 2016, Oscar opened their first in-person clinic, what they are calling an ‘Oscar Center’, in BrooKlyn, NY. This clinic was opened through a partnership with Mount Sinai Health SysteM and features online, saMe day appointMents and paperless records in a Modern and sleek office. © Copyright 2017 Strategy Advantage. All rights reserved. 5 .
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