Oscar Health, a health-insurance startup, will work with the Cleveland Clinic to offer individual health insurance plans to consumers in northeast Ohio.
On June 15 Cleveland Clinic and Oscar Health announced that they will offer co-branded health insurance plans to consumers in northeast Ohio, marking Oscar Health’s expansion into Ohio and Cleveland Clinic’s first entrée into the health insurance market with a product bearing its name.
Pending regulatory approvals, consumers in five northeast Ohio counties-Cuyahoga, Summit, Lorain, Medina, and Lake-will be able to purchase Cleveland Clinic/Oscar individual health plans. It is anticipated that they will be sold on the Ohio health insurance exchange as well as off the exchange, with coverage beginning January 1, 2018.
According to Steve Glass, Cleveland Clinic’s chief financial officer, the plans will break down the complexities between providers and insurers, allowing patients to easily navigate the healthcare and health insurance systems, get the highest quality care at a reasonable price, and improve their overall health.
Every member will be matched with both a Cleveland Clinic care team-a dedicated primary care doctor and care managers-and an Oscar concierge team, with a nurse and three care guides. These clinical and concierge teams will act as one unit, sharing data across the continuum of care to ensure that the patient's health and wellness needs are proactively met and unnecessary hospitalizations are reduced. Members will also have free, 24/7 access to telemedicine. Out-of-network costs will only be covered in an emergency, says Thorsten Wirkes, vice president of Strategic Partnerships, Oscar Health. What should else MCOs know about the partnership? Healthcare analysts offer their insight.
The pairing hopes to buck a trend reported by the Robert Wood Johnson Foundation that stated that of 37 provider-sponsored health plans formed since 2010, only four were profitable in 2015. Another five have gone out of business.
Another challenge will be to make sure the systems work harmoniously, Demetriou says. “This will require blending the traditional culture of Cleveland Clinic with Oscar Health’s very different technological culture,” he says. “Both organizations will say that the objective is ‘putting the patient first,’ but the issue is whether they have a common understanding of what that means. Since Oscar Health has evolved very differently from major health plans and has built its brand on developing a more consumer-friendly portal for patients, there may not be the same tension between it and Cleveland Clinic that has characterized other provider ventures into plan markets.”
John Hansel, vice president of healthcare provider solutions, MedeAnalytics, a provider of healthcare analytics tools, believes success will require a truly integrated experience for patients. “This means leveraging shared technology and data to help patients navigate the healthcare system, help patients gather health information, understand costs, and generally improve patient communication beyond the typical fragmented process in a traditional payer-provider-patient relationship,” he says. “Both Cleveland Clinic and Oscar have a reputation for using technology to be patient centric, which is a good sign that this arrangement may be more successful than other payer-provider owned health plans.”
Hansel says the plans will likely be popular, primarily driven by Cleveland Clinic’s brand name and high-tech collaboration tools to improve the patient experience. “Of course, popularity will depend on plan pricing in the individual/exchange market,” he concludes.
Karen Appold is a medical writer in Lehigh Valley, Pennsylvania.