August 16, 2018

Talking with Oscar, a New Kind of Health Insurer

by Chas Roades


We recently had the opportunity to sit down with Dennis Weaver, MD, Chief Clinical Officer of Oscar, the New York-based startup that’s positioned itself as a “new kind of health insurance company”, built around digital consumer engagement and partnerships with high-value providers of care. Oscar announced this week that Alphabet, the parent company of Google (an early Oscar investor), is investing $375M in the firm, to super-charge its growth and suite of digital tools. In an interview with WIRED, Oscar CEO Mario Schlosser also revealed plans to enter the Medicare Advantage market for the 2020 plan year.

As Chief Clinical Officer, Dr. Weaver spearheads new integrations with leading providers and coordinates Oscar’s clinical teams and initiatives to ensure members have access to the highest quality care. He joined Oscar after years committed to promoting patient advocacy programs and greater transparency in the industry through his work as a leading health system advisor and as a practicing physician, most recently as Executive Vice President and Chief Medical Officer at Advisory Board, where he worked with hospitals, health systems, payers, governments and employers on critical health care issues, including value-based care models, optimal payment systems, and innovative technology solutions. (We first got to know Dennis when we worked together at Advisory Board.)

Our dialogue with Dennis Weaver, Chief Clinical Officer, Oscar

A new kind of health insurance company

 Gist Healthcare: Dennis, a common theme across your career has been a mission orientation toward improving healthcare, whether as a practicing physician or a consultant helping to pioneer the development of medical homes and accountable care organizations. How is it now working on the payer side—do you even think of the company as a payer, or do you think of it as something different?

Dennis Weaver, MD: There’s no doubt we’re a payer. But there’s two heartbeats that beat in the chest of Oscar. One is as an insurer. And one is a technology company.

We see the patients as the consumers of healthcare. I really believe that the folks who work here every day come to work thinking, what can we do to make the American healthcare system better?

In contrast, we see doctors and health systems as partners. I look at it not as an adversarial relationship, but absolutely as a partnership. I don’t think I would’ve joined an insurer if that ethos wasn’t here before I got here.

GH: How has it been to transition from the provider world, which in many ways has a very traditional culture, to the start-up environment at Oscar?

DW: What got me here is that it’s a start-up and it’s not a traditional insurance company. The fact that we weren’t constrained to either traditional insurance thinking, or, frankly, to delivery system thinking, was compelling. You’re stuck when you’re just in the delivery business and you don’t have the ability to do telemedicine and other cool things without the insurance business. The fact that those two worlds come together in Oscar as one, and the fact that we’re here to make healthcare better were very important to me.

The other thing that I love about the startup business is just questioning the status quo. I love the transition, I love what I do today. I haven’t looked back.

I think Americans are looking for a more personalized, interactive approach to their healthcare, and that’s why I’m so excited about getting to work here every day.

GH: We got to know you when you were in the consulting world, helping providers transform their business model and their care model. Having spent a year on the insurance side with access to all the data and technology you have here at Oscar, what would you tell Dennis Weaver of three years ago that he should do differently or think differently about provider transformation?

DW: In my early days of creating medical homes, I thought that everybody needed a medical home. It became pretty obvious that level of infrastructure support for healthy people makes no sense.

Regarding ACOs, I still believe that fee for service is fundamentally inflationary and that we’ve got to find a different economic model that will run healthcare. But rather than just focusing on care management and the economic model of risk, you can tell can tell that story through consumerism as well, as you guys have written.

I’ve also become more realistic about the pace of change. Three years ago, I thought, ‘This is all going to change quickly,’ but I think there’s going to be parts of it that are going to be static, and that we’ve got to figure out how to get through that.

There are some incumbents in the system that are going to fight it, and it’s going to be hard to thread that needle. I think it can be done—we were making great progress on the provider delivery side—but it has to be done intelligently. We all know now that shared upside isn’t a long-term viable thing for most health system. At Oscar we ideally would like to have both parties have skin in the game, and we’re in creative conversations to try to get that done. Three years ago, I was just banging the table, ‘It’s all going to be value based care.’ I think I’m more realistic now, but that doesn’t mean that the principles of that, and the partnership, and the narrow-network pieces, aren’t fundamental to who we are at Oscar.

GH: You’ve described it as both an insurance company and a technology company. “Two beating hearts,” I like that phrase. But whatever you are, you’re certainly a disruptor; you’re a startup player in an industry that has lumbering giants…gigantic, $200 billion, $150 billion, corporations.

DW: And getting bigger, with these mergers.

GH:  Is this industry disruptable, or is it so dominated by incumbents that you’re just pushing the boulder up the hill?

DW:  I think Americans are looking for a more personalized, interactive approach to their healthcare, and that’s why I’m so excited about getting to work here every day.In some ways the incumbents are big lumbering giants, and I don’t think they can respond to individuals. We put the data together and we can quickly respond to your needs.

GH: So you’re truly a consumer company?

DW: We are unabashedly a consumer company.

There’s two heartbeats that beat in the chest of Oscar. One is as an insurer. And one is a technology company.

GH: How do you overcome the skepticism that the average person has about their relationship with an insurance company? Insurers have some of the lowest net promoter scores of any segment of the economy.

DW: Some of our success has been based on the fact that we didn’t buy any of that legacy background. In fact, we went out to prove that it was wrong.  Our net promoter score is in fact triple the industry average, so I think we’re already seeing success on that front.

Take free telemedicine from day one. You pick up the phone; we’re about solving your problems. There are many things that I do as Chief Clinical Officer that actually cost us money. Chronic care management; you’re missing meds, you don’t have DME in your room—I want to give you those things so your life is better, because those things actually add to your value and will add value for us as well too.

The philosophy at Oscar is not, ‘We’re trying to take our data and information and use it to our economic advantage’. We’re trying to use data to differentiate your experience in a way that we think will allow you to navigate through a complex healthcare system.

GH: Taking a consumer-driven or consumer-centric approach to the insurance business is very different from the way the insurance industry has traditionally worked. Are you focusing on the consumer because you think that’s where the rest of the industry is going to go, because of industry trends, or are you trying to push the industry in that direction?

DW: I think we would say it’s the right thing. We believe Oscar is a product that the patients are interested in and that’s what we’re interested in.

We’re positioned well if the defined benefit marketplace remains, but if these benefits transition to defined contribution then we’ll be well positioned for that as well.

Positioning Oscar in the insurance marketplace

GH: Oscar recently moved from selling exclusively to individuals to working with small businesses and selling to some employers. Have there been any changes that you need to make to now have employers as customers?

DW: Interestingly enough, in some places the free telemedicine is legally considered a benefit, and because it’s a benefit, you can’t have free telemedicine and qualify for HSAs. But in some states telemedicine is perfectly fine (not considered a benefit) and you can be an HSA plan. We’ve found that HSA [health savings account] compliance is important for small businesses. It’s an example of something we’ve had to change in a few places due to local state interpretation of the law. Otherwise we find that small businesses appreciate the same consumer-focused approach.

GH: So, you’re finding that small businesses buy in the same way consumers buy? It sounds like you’re developing a vision for Oscar that’s beyond just the individual market?

DW: That’s right.

GH: Where does that take you then, when you think about where to grow? Because that gives you a whole vista of opportunities of where to go.

DW: Well, Medicare Advantage is another product that’s highly consumerized—it doesn’t take a rocket scientist to recognize that that’s an obvious place of growth. We’re about to announce that we’re planning to go into Medicare Advantage for 2020, enabling us to bring the Oscar product to even more people. We’ll be in the individual, small group, and Medicare Advantage spaces.

GH: As you know from your consulting days, there are a lot of ACO-type providers who are pursuing direct-to-employer contracts. Whether it’s Boeing or Intel or any of those kinds of businesses, can you see Oscar’s model working there? I can imagine you filling that same kind of a space.

DW: Again, that’s not off the table. Nothing’s off the table.

Medicare Advantage is another product that’s highly consumerized—it doesn’t take a rocket scientist to recognize that that’s an obvious place of growth.

GH: You mentioned HSAs, and I want to go back to Oscar’s consumer value orientation. The reason HSAs exist is because of the greater consumer contribution with high deductibles, and it feels like we’re in a moment now where there is some backlash against the high deductible. How do you square a consumer orientation with the fact that with the economics, many of your consumers carry quadruple-digit deductibles?

DW: The young, healthier folks are looking for high-deductible, lower cost plans, and some of the older patients in our population are looking for the opposite, telling us ‘We want lower deductibles’.

Everybody thinks we’re a millennial company; we are not—it’s more of a barbell.We have young customers for sure—but we’ve got just as many people that are older, and they’re looking for something different. They’ve got more chronic disease, they don’t want to pay out of pocket, they need help with the insurance economics versus younger folks.

GH: So, you’ll create a product to match the level of accountability that any individual is willing to take on?

DW: One of the things that’s interesting is we find four different bands of the blend between price and deductible. We don’t put just one bronze plan in a market, we may have four or five different ones. I think one of the lessons that Oscar learned is you’ve got to give the consumer more options or they won’t find what they’re looking for.

GH: But buying insurance is so complex. How do you help individuals make that decision?

DW: Our team helps potential members with that all day long, and it’s one of the things we have gotten really good at over the past five years. People want to buy through all kinds of different channels, some people want to call and talk to someone on the phone and we’ve got to make that channel available. Some people want to go to our website, somebody wants to go out to the public exchange and sort through it. Frankly, we’ve put more and more resources into that as the federal government has put less and less resources into it. You have to do that so you can be responsive to helping people make those decisions.

GH: A lot of the incumbents that you compete with, at least in the traditional market, view the individual market as a little bit of a sideshow. Do you find that that gives you a competitive advantage, since you’re so focused on it, since you’ve built everything on the ability to manage cost for individuals on the back end?

DW: We absolutely believe we’ve got a differential advantage because of that and we think about those customers all day, every day.

GH: The individual market is complex. You’ve got a segment that’s made of younger, healthier people, who don’t have access to the traditional insurance because they are self-employed. Then you’ve got people who can’t afford insurance because they’re lower-income, maybe eligible for a subsidy, and they actually do cost more to cover. Does that drive you toward a certain segment or another?

DW: It drives us to customer-specific solutions. Consumer segmentation is something we think about every day, and we’re trying to address our product to each of the segments of the market so that we can provide the same stellar member experience across the board. We don’t get out of bed and say, ‘Hey that’s the segment we want to get to,’ we view Oscar as a “consumerized” product, and we’re trying to get that product to work for each of those different segments and customize it for them.

GH: With regard to the product, imagine two very different individual customers: First, I’m a 32-year-old who lives in Brooklyn, I work for a startup, I’m making good money but I just need to buy individual insurance. Or, I’m a 55-year-old woman who was laid off, now gets a subsidy from Obamacare, I live in San Antonio, and I have hypertension and diabetes. For both of those customers, give me the value pitch for Oscar.

DW: I don’t know that it’s markedly different. We put the customer in everything we do: concierge team, doctors on call, digital tools, virtual and retail care. We’ve got to route every customer through the system to partner docs and networks that are going to solve their problems. My argument would be, both of these patients need to be routed; they just need to be routed to different docs and different experiences.

One may want more virtual care or need to be routed to an urgent care solution. But even the person who has chronic diseases doesn’t think of themselves as a patient more than one percent of the time, you want them taken care of. So, we may route in a different way and provide care management, even send someone a home healthcare provider. It’s about a consumerized experience that is different for everyone.

GH: Did you find that health systems were pushing you towards Medicare Advantage and a more senior population?

DW: Yes.

GH: Is that somewhere that you feel like your consumer engagement and care management tools allow you to go?

DW: Yes, we’ve got this technology for consumer engagement and interaction. But we’ve also got a small army of staff supporting patients who are sick. We actually put people on the ground going door to door for care management and integration of care. We’ve built it so that there’s some telephonic support, but in many of our 14 markets we’ve got feet on the street doing that as well.

The Oscar Center in Brooklyn, NY

Building an industry-leading consumer platform

GH: I want to talk about the consumer engagement platform, because it seems like that’s where you’re really differentiated. Can you talk a little bit about the range of things you do? How do you think about consumer engagement, how do you drive consumer engagement? How do you get a net promoter score that’s so much higher than anyone else in the insurance market?

DW: It’s actually in the 70s now. And 70 percent of patients turn to their Concierge team for help navigating the health care system. We are getting there by trying hard to solve problems for our customers.

One of the biggest questions you get when you’re a consumer-focused plan and you’ve got deductibles, is ‘I have to go to the doctor, how much is it going to cost me?’ And it’s probably one of the hardest things we do, because you can’t predict what a doctor is going to order or exactly what MRI will be done when you get the order, but we’ve really tried to use our data science to understand that and be able to give an answer.

We think access in the traditional system is broken. We’re testing open access in our clinic in Brooklyn. It’s open anytime, just walk in the place and we make a commitment to see you. But getting in is just one component. We send you a text when you walk out of the doctor’s office: ‘How was your experience, what did they tell you, what referral, how can we get you to the right referral, what do you need?’

“Frictionless” is another thing we think about; it’s got to be easy. We do A/B testing on our consumer interface—we know the outcome we’re trying to get to, so for the color of a button if we find green and blue work better than red, even though you’d think red, that kind of thing can create better engagement with our tools.

We think access in the traditional system is broken. We’re testing open access in our clinic in Brooklyn.

GH: Oscar has been very successful in getting patients to use and interact with the digital components of your system. Are you able to intervene or get ahead of some of the frustrations that people typically have?

DW: Awareness in the beginning is of a patient’s relationship with Oscar is so critical. It begins with the ID card, which is really more of a welcome package. Of the things we’re trying to do, from the very beginning, is say, ‘Engage with us, engage with us, engage with us.’ We try to get customers online, where we create your account and you download the app—conversion across channels, making sure our members know that we can be the entry-point to all their health care needs.

GH: So, what you most want someone to do is download the app?

DW: Yes.

GH: Is that the best case for you? Better than call us, better than go to the website?

DW: Yes, download the app. And to download the app you have to create a digital account with us, and then that gives us the ability to start secure messaging you or texting you. Then we can then interact with you how you want to interact. You can choose when you download that app: do you want to text with us, do you want us to call you, do you want us to email you? Then you basically are starting to engage with us.

GH: So, why is it best that they use the app?

DW: There’s no doubt that the app is a more cost-effective mechanism. There’s hundreds of different consumer journeys, and we take the data, every single interaction, whether it’s text or it’s email or it’s a phone call, all of it goes into our database, and we run all kinds of machine learning and other algorithms across it to begin to understand patterns. As we start to understand the patterns of your behavior, we want to know, should we text, or should we call? We’re trying to increase your engagement and we’re trying to affect your behavior. But the behavior we want is not an insurance behavior.

GH: What’s an example of a kind of behavior that you are trying to drive by being predictive?

DW: Probably the number one piece of information we ascertain through the data is that different doctors have different quality outcomes for different costs. If you’re in a network, different doctors perform differently. We really segment our networks to figure out performance. There’s not just one kind of cardiologist, there’s five or six different kinds of cardiologists. There are 14 or 15 kinds of orthopods, all of those are bundled to figure out which doctors do which things really well.

We interact with you, and we use our engagement to route you to those doctors that have the differential network experience, quality, cost and member experience outcomes, because that’s actually beneficial to you.

GH: As you get more and more feedback from your members, you’ll have more member experience data. How are you getting your hands around the quality information?

DW: It’s hard; it’s probably one of the things we struggle with the most. One of the things I’m proud of is I think we try and measure member experience. No other insurance company has it—because we’ve got this app, after every visit we text you, ‘Chas, did you like the doctor today?’ We ask a couple of quick questions and it’s interesting, with that routing capability, it’s all real-time.

Dennis Weaver, MD, could be #1 on the OB-GYN list this morning, for example, but if we get a data point on a bad member experience, I could go from #1 to #32 in a few hours because it all runs real time, 24/7. That’s how the data model works to continue to update what we do on cost, quality, and member experience. With regard to quality, I don’t know that I’ve got it 100 percent figured out at this point. We’ve got a ton of data, and we’re correlating with outcomes, but we’ll continue to push ourselves to get better and better.

GH: On the quality front, if you could wave a magic wand and get a few pieces of information, what would really move the dial on getting patients to the highest quality physician?

DW: Patient-centered outcomes would be top on my list. Here’s a personal example. My father is 85 and he fell and broke his hip a couple of months ago. I don’t know if you know this, but at the age of 85 your mortality is greater than 50 percent.

I got him into the best rehab center, he was going through rehab, and he got to day 7 or 8, and said ‘This sucks, I don’t want to be in the hospital anymore.’ He was telling us, ‘I may not eventually get better, but I don’t want to be here.’ For him, his patient-centered outcome was: ‘I want to be at home.’

This is the piece that makes me think we can kick the industry’s butt. We text you, we ask you what you want, and we can use this information to customize experiences for our patients.

It’s a huge part of our mission, something I haven’t experienced anywhere else in healthcare.  We’ve got people here that are so passionate they spend their nights and weekends trying to figure this stuff out.

GH: It’s so interesting that you went immediately to referral management and referral flow as one of the main levers. Should I infer from that you’re finding more value there versus utilization management or care management?

DW: Wonderful question. The consumer is segmented, essentially, by how we want to interact with you, but there is return on investment in the patients that are really sick in chronic care management.

GH: And how are you working with those patients?

DW: Very, very hands on, intensive—we’ve got programs for our top one or two percent, where we’ve got active outreach, nurses on the ground.

GH: Earlier you mentioned all Oscar patients have access to telemedicine—give us your perspective on how far you think Oscar could push virtual care. Wave a magic wand, five years from now, how much of my care as a customer could be done not sitting face-to-face with my provider?

DW: We’re going to experiment with that, across the next five years, try to push that boundary as far as we can. I am also committed to experimenting not just with healthy patients. We can’t replace the hospitals, we can’t replace the specialists…but how far can I push that boundary?

I want to watch in two ways: what kind of engagement can we get, do the patients like it, and I also want to evaluate what kind of provider partners can help us get it done. Cleveland Clinic is a heck of a partner because they want to experiment together with us on this kind of thing.

We can’t replace the hospitals, we can’t replace the specialists…but how far can I push that boundary?

GH: Is your bias to want to own those new care approaches, or is it to partner with others who are producing it?

DW: We would like to own as much of it from a data standpoint as possible. What we have found is if we insert a vendor into the experience of the care journey, the vendor often can’t match us with respect to patient satisfaction with the journey. Second, if we don’t own as much of it as we can, the data collection is hard for us.

Now, I’m not sure we ever need to own an MRI machine, but there are certain things where we find it’s critical to have a consistent experience, and we want to make absolutely sure that we capture data through the process so we know what the experience is like from the patient’s perspective. Those are the crucibles.

GH: Tell us about the clinic Oscar has launched in Brooklyn. What was the impetus for starting it, what do you do there, what’s it for?

DW: I would call it an experimentation lab. On one side is the clinic, and on other side and you’ve got a health and wellness experience. We run Pilates and Zumba classes. Some of the most subscribed classes address anxiety relief. And there’s no copay, it’s completely free at the point of service for Oscar members.

GH: Is it all walk-in, or can I schedule an appointment?

DW: Both.

GH: Is that a model that you envision rolling out in other markets?

DW: Yes.

GH: So, it’s not just an experiment, it really is a delivery model in development?

DW: I’d have it in two or three places now if I could put one up tomorrow. But there are certain markets where there’s just not enough density to support it.

GH: Who do you staff it with?

DW: We experiment with the model, but we have docs, we’ve got NPs, we’ve got PAs, and we have social workers.

GH: Do you employ the docs?

DW: It’s a captive PC [professional corporation]—I think we’re approaching 50 docs at this point.

GH: What’s the profile of an Oscar doc? What are you looking for?

DW: A lot of them are primary care physicians who for any number of reasons kind of got fed up with a traditional clinic environment. It’s a group of docs who are fed up with the rat race, the bureaucracy, and just want to provide care.

GH: Are they all here in New York?

DW: No, they’re all over the country.

Forging new partnerships with providers

GH: How do you choose your provider partners as you go into a new market? What are the criteria that you use to choose an ideal health system partner?

DW: It’s really hard, prospectively, to figure out quality. We have built a number of proxies from publicly reported data. Beyond that, when we’re going into a new market there are two methodologies we use. Let’s say there’s three health systems in a market we want to go into. We generally go with one or two of the three. You look at quality, you look at cost as best you can.

Then you try to talk to all three and figure out who will be the best fit for Oscar: can you be a good partner with us, what’s the quality that we can get our hands around, and then frankly, cost competitiveness. Because at the end of the day, our market is still price sensitive. If I could write the ideal deal, we’d love to produce an 80 percent MLR with our tech and our partnership with you, we would love to get a lower fee for service rate, and then we would love to give you the shared savings. We have learned that the same shared savings won’t work for every system. We aren’t necessarily going in saying that that has to be 50-50, it could be a higher number depending on what we want to do.

GH: So, the way you solve the problem of not having the same kind of leverage that one of the monopoly Blues or another incumbent has to drive the kind of rate that you want, is the promise of the savings that you can produce with your consumer engagement and care management tools, which you’ll share with the health system partners?

DW: When we go into a market, we’ve got to be able to give concrete examples of the percent of share that shifted to us from our health plan competitors in the markets we are currently in, and then we show how we routed that share to this narrow network partner. We can tell an end-to-end story that says this is why you want to partner with us.

GH: So, you provide savings from better consumer engagement and care management and network integrity that helps them secure the volume that might otherwise be going elsewhere.

DW: Yes, that’s exactly right—reduce the leakage and grow the share for the health system.

GH: If you think across your book of provider relationships, where do you often find that you might butt heads? What issues sometimes cause friction?

DW: For large health systems, particularly those with significant market share, it’s hard to get them to understand that you’ve got to put something that people are willing to buy, and sometimes it’s just too narrow if you only build it around one provider. It’s a judgment call, but there are places where two systems may be bitter competitors…but our assessment is that they both have to be in the network for it to be viable.

I don’t know that we’ve come to a conclusion [on getting into the provider business]. I think we are trying to experiment with what our point of view is.

GH: What kind of tools do you provide to your provider partners?

DW: A lengthy list. One of the ones that they’re most excited about is one that will give a patient a list of options for a certain condition. Take a urinary tract infection, ‘It burns when I pee.’ When you type it in, it says, ‘If you go to primary care doc, it’s going to cost you this. If you go to an urgent care doc it’s going to cost you more, if you go to ED, it’s going to cost you even more.’ Then you say, ‘I want to go to a primary care doc,’ and you push the button and you immediately get the range of doctors. And taking into account the quality, cost, access, here’s the score of the particular doctor that we would recommend to you.

On the back end, in the best partnerships that we have, those docs allow us a tech integration into their systems, and you can directly schedule. The patient picks the appointment right there on the app then we send all of that information over to [the practice], ‘Chas is on his way over to you for his 4:00 appointment.’

Second, we also want to make sure that systems have the data they need to feel comfortable taking risk with us. Systems use a range of tools. IBM Watson, Optum One, or they may have their own EPIC tool. We will work to create an interface so that they can get their claims and other data in to make their algorithms run.

Third, we are working with some partners to integrate workflow. We’ve got experiments going with Cleveland Clinic right now where the information on all prior clinical interactions is available at the point of care. Every time we texted you, we called you, we mailed you, when you call up, your information pops up. Any interaction you’ve had with us, it all pops up on one screen in one place, and we can talk to you about anything at any time. That’s the big differential advantage we have.

We’ve also got our team here at Oscar trained on the EPIC EMR. We do some documentation for them now, and then feed it back to Cleveland Clinic.

GH: How do you get past the hurdle that I hear from doctors: ‘This all sounds fantastic, it might be 10,000 patients in this market, but for me, it’s going to be five patients, ten patients, of my 2,000-patient panel. How do you engage that doctor in Oscar’s process?

DW: It’s a big part of what we struggle with, and I can’t tell you I’ve got it 100 percent solved. What we have found is that most of our partner health systems can manage their employed docs but have less functionality to work with the independent docs that are a part of that contract.

With new physicians, before we get them into our technology, we need an education process. Somebody centrally may have signed the contract, but the rank and file physicians, whatever the alignment model, may not know that somebody’s signed a contract for them. So, then you’ve got an Oscar patient who shows up and the office says, ‘We don’t take Oscar.’ But they do take Oscar, they just don’t know. So, the first part, out of the gate is just awareness that we’re now part of your network. We’ve got a relationship with you, and we want to know how we can make you successful in that relationship.

GH: Let me ask you a philosophical question about provider partnerships. Oscar is already beginning to experiment with employing doctors and running your own clinics. Ultimately for Oscar to achieve the vision you’re talking about do you have to be in the provider business?

DW: It’s an interesting debate that’s going on around here; I don’t know that we’ve come to a conclusion. I think we are trying to experiment with what our point of view is.

What does the experiment look like today? It’s our 50-50 partnership with Cleveland Clinic. We’ve got other places where we’re into true capitated deals, true upside-downside; they pay us, we pay them. We have other types of shared savings, and even some fee for service deals when it’s been necessary. And we’re trying to understand the infrastructure we need to get the outcome.

GH: Is partnering with Oscar a viable strategy or an attractive strategy for a health system that’s looking to get further into the insurance business but isn’t yet?

DW: The question is how far into the insurance business a system wants to go: do you want to just go with MLR risk, or do you want to get into true actuarial risk? That’s a conversation that people want to have, and we’ve got both true actuarial risk and just clinical risk. That’s one of our differentiators.

Second, there’s a lot that we can do in partnering together to help systems understand the consumer engagement piece. We can help you down your consumer path journey, and we’re willing to be a partner to take you from where you are today to value-based care.

GH: One last question: are you having fun?

DW: I am; I’m loving it. In my career, did I think that I would get to talk about consumer journeys, and I would get to work with cool people who get out of bed trying to think about what consumers really want from their healthcare system? Where can you go find a job that that’s what you get to think about? I mean, that’s pretty cool!