The epiphany came to Joshua Kushner one day when he opened his insurance bill and had no idea what it meant. He didn’t know what his benefits were, what doctors or hospitals he had available or how to file a claim. He called ten to twelve of his friends and asked if they knew how to navigate this amazing expense, none of them did. That signaled a business opportunity to Kushner. In January 2012, Kushner and his friend Kevin Nazemi and Mario Schlosser decided to take on one of the biggest and most conservative industries; Healthcare. Their idea was to “Transform health insurance.” Thanks to Obamacare they were able to infiltrate the sector.
Obamacare allowed all fifty states to open health insurance marketplace or “exchanges” to attend people who did not get coverage from their employer or a government program. The insurers in the exchange must provide a core package of benefits with clear pricing without discriminating on existing medical conditions.
It took the company two years to get certified in New York. Over 9,000 pages of contracts, filings, and description of how the business works. They required the company to have $1 in reserves for every $8 in premiums. They have over $29 million of their funding in reserve. According to the New York Business Journal, as of December 2014 Oscar has raised $174 million in capital, spent $35 million of it and has been in the market for thirteen months with around 17,000 users (Fischer, 2014).
What is Oscar Health Insurance offering? It offers a data-driven, state of the art user experience that has not been provided by any other health insurer. Oscar’s pharmacy benefits manager and other vendors are providing the company with real-time data that other insurers have not demanded (Greenwood, 2014). This system gives them an advantage because most people, especially here in New York want instant gratification.
Oscar's product was mainly designed for the tech community and young people. Oscar offers a web and mobile friendly intended to make the insurance experience smoother for plan members, even if their network isn't as strong as the competition (Ungerleider, 2014). Users can speak with doctors over the phone for problems such as the flu, or use the insurer's site that offers good search functionality for specialists. Oscar has a unique partnership with the telemedicine company, TeleDoc; which is how customers with reach doctors for frequent conditions or issues (Greenwood, 2014). Thru this system customer health records are accessed, and they can order prescription refills, saving a trip to the doctor’s office. Oscar also has a partnership with CVS CareMark that provides added locations for customers to see Doctors.
Oscar gathers metrics on medical professionals for performance reviews and uses them for customer recommendations just like other insurance providers. Using Oscar's web front end, consumers can see whether individual doctors mainly treat patients in their twenties or thirties, what language the doctors speak, and other metrics (Ungerleider, 2014). The concept behind Oscar is that using your insurance should be as natural and intuitive as using your Facebook account.
Through the Oscar health plan members are provided unlimited calls to a doctor at any time of the day, three free physician visits and unlimited generic drugs (Gannes, 2013).