Obamacare Startup Oscar Will Expand to New States

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(Bloomberg) -- Oscar Insurance Corp., the Obamacare-focused health insurance startup, plans to expand to Arizona and at least three other new markets next year, a bet on the health law’s survival despite the turbulent politics surrounding it.

In an interview, Chief Executive Officer Mario Schlosser said Oscar is meeting its goals to increase membership and revenue while gaining a better handle on medical costs.

“We feel comfortable that the risk pool will remain comfortable, and that we can roll out the blueprint for expansion that we have in more areas,” Schlosser said. The closely held insurer reported a profit in the first quarter, though it still expects a loss for the full year. Schlosser founded the company with Josh Kushner, brother to President Donald Trump’s son-in-law.

Oscar has stuck with Obamacare even after years of financial losses, as well as political uncertainty driven by the Trump administration’s push to repeal the law. After pulling back from several states for 2017, the company expanded into four markets for 2018 -- Cleveland, New Jersey, Austin and Nashville -- and enrolled about 240,000 members at the end of the first quarter, up from about 90,000 last year.

Regulatory filings reviewed by Bloomberg show that Oscar has set up a new insurance company in Arizona, a sign of its plans to expand in the state for 2019.

Schlosser said the company is expanding into four new markets, though he declined to name them because the company is still working on its filings with state regulators. Oscar will enter into close partnerships with hospitals systems, he said, as it did with the Cleveland Clinic in that hospital’s home city.

Hospital Partnerships

The hospital deals help Oscar make up for one of its main disadvantages to more-established health insurance rivals, which already have established networks of doctors, clinics and medical centers. By partnering, Oscar can offer customers access to care without having to rent a medical network -- a costly proposition.

“There’s more and more of a recognition that that’s the way you should build networks,” Schlosser said. “We’ve seen quite a bit of receptivity when we go around the country.”

The arrangements also play into Oscar’s strategy of forging tighter relationships with customers when they seek care. Oscar customers use the company’s mobile phone app, website or concierge-service teams to find doctors about 40 percent of the time, giving Oscar more control over how they get care.

“That is a key way that we can make sure that utilization happens at the right place in the system,” Schlosser said.

People can also talk with doctors directly in the company’s app. Oscar says that 80 percent of customers who do so wind up not needing any further care.

Pricing Challenges

For health insurers in Obamacare, one of the biggest challenges has been how to price their offerings as competitors exit and enter the market, and as the Trump administration and lawmakers have made changes to the law and its operation.

“It’s not entirely straightforward to price for next year,” Schlosser said. “But it is possible, and I do think people will see plans that will give them very good value”

Earlier this year Oscar raised $165 million, garnering a reported $3.2 billion valuation. In total, the company has raised about $892 million from investors.

Entities controlled by Josh Kushner, the founder of Thrive Capital, hold about 20 percent of Oscar’s fully diluted shares, and have a 56 percent voting stake, figures that are similar to previous filings.

The second-largest disclosed stake is by General Catalyst Group VI LP, with an 8.4 percent stake and 3.7 percent of the voting shares. General Catalyst has also invested in the home and apartment rental company Airbnb Inc., eyewear retailer Warby Parker and the diabetes care startup Livongo Health.

Medical Spending

Schlosser said Oscar’s first-quarter results show the benefits of its strategies to help gain control over medical spending. Oscar spent about 70 percent of customers’ premiums on medical care in the first quarter, compared with spending about 93 percent a year earlier. That figure, known as the medical loss ratio, typically climbs over the course of the year as more members meet their deductibles, but Oscar said it still thinks it’ll land somewhere in the 80s for the full year.

Here’s a summary of Oscar’s financial results from the company’s regulatory filings:

RevenueNet Medical SpendingNet Gain or LossMembership
New York$50,363,072$35,269,810$3,115,32959,189
Texas & Tennessee$89,165,800$59,492,193$6,574,146116,473
California$15,077,764$11,462,232-$3,595,14141,913
Ohio$17,439,578$12,334,070$2,302,62311,022

The regulatory filings don’t include New Jersey, which only makes annual filings public. Oscar said it lost about $1 million in the state, and enrolled about 11,000 members.

The results are difficult to compare to prior years, because the company entered into a reinsurance deal with Axa SA in late 2017. Axa effectively takes a portion of Oscar’s premium revenue for itself, and also shares a portion of the insurer’s financial results. The deal helps reduce how much cash Oscar needs to hold in each state.

Accounting for adjustments related to the insurance deal, Oscar said its gross premium revenue was about $312 million in the first quarter, on track for its goal of exceeding $1 billion in annual premium revenue.

©2018 Bloomberg L.P.

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