Oscar Health Product Gives Members Free Virtual Care, Telehealth

Oscar Health has introduced a new insurance product, Virtual Primary Care, that aims to provide members with access to free virtual care and telehealth services.

“Virtual Primary Care is the latest addition to the suite of Oscar Care features that provide a personalized experience for Oscar members,” the press released announced.

Among other aspects, the new product—which is available for individual and family health plans—offers unlimited virtual care visits for primary care services. Additionally, members can access free virtual urgent care at any point in the day, any day of the week.

These plans also offer for free some tier 1 prescriptions; lab results; and, in the case of virtual primary care, durable medical equipment, imaging, and specialist referrals at a provider’s recommendation.

Members also have care guides, or healthcare navigators. These individuals are meant to help facilitate care coordination and are familiar with the member’s medical history.

The payer plans to make Virtual Primary Care available to a total of ten markets in Florida, Texas, California, Colorado, and New York.

In addition to these new elements, Oscar Health is once again broadening its reach geographically.

Under these changes, it will now serve 47 markets in 19 states in the year 2021. Oscar Health has been pushing its market boundaries farther quickly for the last four years and is expected to continue along this trajectory, particularly in the Affordable Care Act exchanges.

Next year’s expansion will encompass four new states and expansions within six states with existing markets.

Members and employers have been disillusioned by payers’ promises that they are reducing healthcare costs for stakeholders. In 2019, members were not satisfied with payer efforts to reduce healthcare spending, specifically due to high co-pays for physician visits.

In 2020, the story is no different. A J.D. Power survey indicated that members blame payers for rising healthcare costs and cost-sharing.

“Consumers tend to fail to meet those high deductibles year in and year out and that produces a level of pent up frustration. They largely assign the blame to the health insurance carrier rather than the employer or the local health systems,” James Beem, managing director of global healthcare intelligence at JD Power, explained to HealthPayerIntelligence.

Healthcare cost was an area where large payers were vulnerable to disruptors, Beem added. Disruptors could either lower costs for members or utilize price transparency to allow members to manage their own healthcare spending.

With its new, free virtual care product, Oscar Health appears to be aiming for the former strategy—disruption through lower costs.

Mario Schlosser, Oscar Health’s co-founder and chief executive officer, essentially said as much in the press release.

“Americans consistently cite cost, quality and convenience as their biggest struggles with the healthcare system—our new offering solves for all of them,” Schlosser explained. “With the launch of Oscar Primary Care, Oscar is making even more unprecedented, cost-effective plans available.”

However, lowering costs may not be Oscar Health’s approach across all lines of business.

When the state of New York released its rate setting proposals for 2021, Oscar Health proposed a 19.1 percent increase on the individual health insurance market, 7.4 percent of which the payer attributed to coronavirus costs.

On the small group health insurance market, the company proposed the highest increase at 29.1 percent, which was 8.2 percentage points higher than the runner up, Emblem.

In fact, in comparison to any of the other rate increases in New York that were published on both the individual health insurance marketplace and the small group health insurance marketplace, Oscar Health’s were the highest.

Oscar Health’s new portfolio is still under review with more solidified specifics to come in the fall of 2020.