Oscar Health Focuses on Member Experiences and Tech Solutions for Growth

Oscar Health Inc. membership retention and more personalization were highlighted during the healthcare insurance provider’s third-quarter earnings report released Tuesday (Nov. 7).

The company, which provides individuals insurance under the Affordable Care Act, said it expects to reach profitability in 2024 and updated its financial outlook for the remainder of this year.

During the call Tuesday, CEO Mark Bertolini highlighted the company’s strong membership retention and increased Net Promoter Score (NPS) of 60%. He also mentioned that their insurance business is performing well, with all core ratios improving year-over-year. The medical loss ratio improved by 610 basis points to 83.8%, driven by disciplined pricing and total cost of care initiatives.

Looking ahead, Oscar Health plans to bring new technology-enabled individual and family plans to 165 new counties in 11 states in 2024. They expect to achieve direct premium growth at or above the market and have several expansion drivers focused on accessibility, affordability, and member experience. They are also introducing more personalized plan designs, such as the Breathe Easy plan for members suffering from COPD and asthma.

In addition to their individual market plans, Oscar Health is also expanding its +Oscar program, which serves as a technology solution for the broader healthcare system. They recently announced a new agreement with Stanford Health Plan, leveraging their campaign builder technology to drive member engagement and interconnectivity. The +Oscar program has already grown to serve 500,000 lives and has shown success in improving access and quality of care.

During the call, Oscar’s Chief Financial Officer Scott Blackley discussed the company’s financial performance for the quarter ending Sept. 30,  and despite reporting a quarterly loss of $65.7 million, Oscar Health remains optimistic about its future earnings and expects to turn a profit in 2024. The net loss in the third quarter of 2023 is a significant improvement compared to the net loss of $193.5 million in the same period last year.

In a statement accompanying the earnings report, Bertolini expressed satisfaction with the third-quarter results, highlighting the significant year-over-year improvement across all core ratios. He stated that Oscar Health is well-positioned to deliver a profit of $155 million to $165 million in its insurance business in 2023 and expects to achieve total company profitability in 2024.

Despite the positive outlook for earnings, Oscar Health experienced a decline in membership. As of Sept. 30, the company’s membership dropped below 1 million to 983,160, compared to the previous year. This decline was primarily due to a decrease in Medicare Advantage customers and individual customers. Oscar Health ended the quarter with 912,761 enrollees in its core individual and small group business and just 1,840 Medicare Advantage enrollees.