Oscar Health expects the number of people signed up for its marketplace plans to grow by nearly a third compared with last year, CEO Mark Bertolini said during a presentation at the J.P. Morgan Healthcare Conference Wednesday.
The company anticipates increasing its membership by 31%, to 1.3 million, when open enrollment ends Jan. 16, he said at the gathering in San Francisco.
Most of Oscar Health’s growth has come from new members in existing markets, although “retention in enrollment for this year is going to be as high as it’s ever been,” Bertolini said. The company laid out plans last summer to expand its geographic reach and launch new products this year to combat shrinking membership, partially driven by exchange products.
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“We had a good start for the year that has allowed us to now focus on strategy earlier than I thought we would,” Bertolini said.
The company will unveil a three-year strategic plan at its investor day in late spring, which is expected to highlight an expansion beyond individual coverage into other markets, he said. Individual coverage health reimbursement arrangements represent the company’s first expansion opportunity, Bertolini said, and the insurer aims to start pitching them to self-insured and level-funded employers this year.
Oscar Health will also re-enter the Medicare Advantage market, Bertolini said, but not for some time.
“Ultimately, we’ll get into [Medicare Advantage] but that’s a few years out using our +Oscar platform with health systems to provide private label products to patients in their markets versus having to sell through brokers,” he said.
Bertolini resigned from his role as CEO and chair of rival Aetna after CVS Health closed its $70 billion acquisition of the insurance giant in 2018. He remained with the company's board until 2020 when he resigned and claimed he had been pushed off of it.
Oscar Health executives initially asked him to join its board, he said Wednesday, but Bertolini declined, calling board positions "death by a thousand knives." He was named head of the insurtech last March.
"The culture is amazing, the people are great and they all want to learn, which is fun. In this role, versus my other roles at Aetna, there [was] a creeping dumbness when you became CEO and chairman of a company because there's a lot of stuff happening at the lower levels of the organization they tell you not to worry about. Now I'm down at the ground level working with the team," Bertolini said.
When Bertolini started at the insurtech, Oscar Health had a claims backlog, he said. By accelerating clinician reimbursements, the company can better retrieve payments from reinsurers and report to the Affordable Care Act risk adjustment program, Bertolini said.
Oscar Health also renegotiated its pharmacy benefit manager contract with CVS Health Caremark last year to achieve a “sizeable return” and has started reviewing the PBM’s drug price list quarterly to obtain better discounts, Bertolini said. The carrier is also reviewing financial agreements with its in-network providers, tightening prior authorization requirements and implementing an in-house artificial intelligence tool to flag inappropriate payments, he said.
“I see Oscar as a pirate ship with cannons against Spanish ships with gold that are called big insurance companies," Bertolini said.
