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  #71  
Old 01-29-2016, 09:36 PM
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Originally Posted by Dr T Non-Fan View Post
Next phase should be integrated insurance/health delivery systems. No one seems to want to make the first move, though.

optum has been buying provider side companies
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  #72  
Old 01-29-2016, 10:27 PM
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AAaarrgghhHH!
Socialized medicine?
More like a couple of Kaisers.
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  #73  
Old 02-02-2016, 01:20 PM
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optum has been buying provider side companies

http://www.forbes.com/sites/davechas...-the-exchange/
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  #74  
Old 03-04-2016, 11:56 AM
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Startup Oscar Posts $105 Million Obamacare Loss in 2015

Wow - the company had revenue of $118.2M in NY and reported a LOSS OF $92.4M on the business...seems sustainable...

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Originally Posted by Bloomberg
Startup Oscar Health Insurance Corp. lost $105.2 million in its New York and New Jersey businesses last year, a sign that insurers of all sizes are struggling in the new markets created by President Barack Obama’s health-care overhaul.

The losses, $92.4 million in New York and $12.8 million in New Jersey, were disclosed by Oscar in filings with state regulators. Chief Executive Officer Mario Schlosser said some of Oscar’s losses stem from the cost of starting a new health insurer. Others are tied to the same problems befalling bigger health plans: costlier customers and a shortfall in a key government program.

Schlosser said last month that Oscar is adjusting its strategy to limit costs as it enters new markets in California and Texas. The insurer -- valued at $2.7 billion in its latest round of funding, according to a person familiar with the matter -- has struck deals with limited groups of hospitals and doctors, rather than offering broad networks like traditional insurers. Oscar has also been narrowing its network in New York, and Schlosser said the company is getting better prices for some services as its membership increases.
...
By one common measure of health insurer margins, known as the medical loss ratio, Oscar struggled in New York, where the company ended 2015 with about 52,800 members. The company spent more on medical costs alone than it took in in premiums. Insurers typically target spending about 85 percent of their premiums on medical costs, leaving the rest for administrative expenses and profit.

In New Jersey, where Oscar had about 2,800 members, the company’s medical-loss ratio was in line with that target. Losses in that state stemmed from administrative spending and startup costs.

Oscar expanded into Los Angeles, Dallas and San Antonio this year and has said it signed up about 145,000 customers across all of its markets. Schlosser estimated that the cost of entering a new market is about $10 million to $20 million.

The health insurer suffered from the same shortfall as other insurers in the Obamacare stabilization program known as risk corridors. That fund, designed to cushion losses, paid out 12.6 percent of the amount insurers requested.

Adding to the company’s losses, Oscar also is paying into Obamacare’s risk adjustment program, contributing $28.3 million from New York alone. That program is designed to transfer funds from insurers with healthier customers to those with sicker ones.

Even with the loss, Oscar has funds available. The health insurer said last month that it raised $400 million from backers led by Fidelity Investments.
How the hell can a company spend more on medical claims than the premiums collected (in NY) while simultaneously paying into the risk adjustment program? Sounds like a disaster...
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  #75  
Old 03-04-2016, 12:03 PM
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Originally Posted by Dismal Science View Post
How the hell can a company spend more on medical claims than the premiums collected (in NY) while simultaneously paying into the risk adjustment program?
Setting rates way too low.
F'ing up edge server data submissions.
Not having any history on members to use in risk score improvement work.
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  #76  
Old 03-04-2016, 02:43 PM
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How the hell can a company spend more on medical claims than the premiums collected (in NY) while simultaneously paying into the risk adjustment program? Sounds like a disaster...
They aren't the first disaster for the NY market either...
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  #77  
Old 03-04-2016, 02:57 PM
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Oscar is another Co-op with cash cow. They faced many of the similar problem such as no market share, expensive network, no historical experience.
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  #78  
Old 03-08-2016, 06:37 PM
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Oscar is a tech startup trying to play insurance. It will not end well.
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  #79  
Old 04-19-2016, 09:53 PM
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UHC deciding to leave most of the individual exchanges, Aetna says the business was unprofitable for them in 2015, BCBS Association says individual insureds cost more than 20% what a person with employer coverage costs all point to a bad ending for Oscar - who seems to exclusively play in the exchange.

Countdown to this company blowing up.
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  #80  
Old 04-25-2016, 06:44 PM
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Originally Posted by Dismal Science View Post
UHC deciding to leave most of the individual exchanges, Aetna says the business was unprofitable for them in 2015, BCBS Association says individual insureds cost more than 20% what a person with employer coverage costs all point to a bad ending for Oscar - who seems to exclusively play in the exchange.

Countdown to this company blowing up.
But...but...apps!
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