Oscar expansion. Clover's new products. p53 vs. CRISPR.
We had our third annual Future of Fintech conference this past week. Both Mario Schlosser, CEO of Oscar, and Vivek Garipalli, CEO of Clover Health, spoke at the conference.
Schlosser talked about how their full-stack approach was finally paying off. Some interesting stats he dropped: Oscar interacts with 26% of its total enrollees in some way in any given 7-day period (via telemedicine, app searches, etc.) and 43% of first-time physicians visits happen through Oscar. That’s the benefit when you have a more direct, constant, and real-time relationship with your enrollees.
The company also announced that it is entering individual markets in three more states (Florida, Arizona, and Michigan).
You can see our write up of the Oscar interview here.
On a more subtle note, Schlosser mentioned that the company’s road to expansion would likely include more cities (including possibly international ones) as well as new insurance products. In our Oscar strategy teardown we suggested Medicare Advantage as one area (hinted at in a now removed job posting).
Entry into Medicare Advantage would put Oscar more head-to-head with some of the other carriers like Clover Health. Vivek Garipalli spoke to us about some of his lessons learned and new products. The most interesting bit was about its pharmacogenomic product to detect potentially adverse medication events.
If Clover can prevent just a few adverse reactions because of this it generates a significant ROI AND it build a genotype/phenotype database of their members. If it can give a $240 genomic test for free to prevent a $14,000 readmission, then it becomes worthwhile to just give that test to all of its members for free.
In the process it also builds a genomic database, which it can link to the existing health records and outcome data it already has as an insurer. This is useful not only to find which other gene variants might be indicators of disease to watch out for, but it’s also a potentially useful data set if the company does end up getting into building therapies as was alluded to by Garipalli last year.
You can read our writeup of Vivek Garipalli’s interview here. He had a great quote about confusing businesses in healthcare: “The more opaque the P&L is, the higher the EBIDTA.”
Garipalli and Schlosser are both trying to build a consumer-centric health insurance carrier and the front door to the healthcare system for their enrollees. One small strategic difference is Oscar’s focus on providing scalable virtual services vs. Clover’s strategy of bringing care to patients’ homes physically and getting as much granular data as possible about each of its members.
A Heated Exchange
Speaking of insurance, the Kaiser Family Foundation put out some data around the individual markets that I thought was interesting.
These three charts basically tell a story about how insurers slowly managed to figure out their pricing and strategy more effectively by raising premiums. The plans also seem to have gotten better at managing care of this population, both from a claims and hospital admission standpoint (with both staying relatively flat). These stats should be taken with a grain of salt since everything could change depending on what happens with the individual mandate.
While the exchanges might slowly become a better story from the insurer side, it’s still not a great one for consumers. Insurers may have figured out how to price their product appropriately with a few years of data now, but the skyrocketing premiums are nothing to pop champagne over.