The executive identifies pivotal strategies and trends for 2024 and beyond.
In her two-plus years at Oscar Health, Executive Vice President & Chief Insurance Officer (CIO) Alessa Quane is helping the insurance company target profitability and grow responsibly.
In this exclusive with HealthLeaders, Quane identifies three growth strategies, how key marketplace trends highlight both competition and collaboration, and how Oscar’s "Never Build Alone" and "Make It Right" approaches create a member-centric culture and plan designs.
HealthLeaders: If you could sum up Oscar Health’s market strategy in a single statement, what would it be and how does that differentiate you from your competitors?
Alessa Quane: For 2024, Oscar is really gearing up for growth. We've been very focused over the last few years on getting the fundamentals of our business right and moving the company to profitability. We feel really good about our progress on that path, so we’ve spent our time making sure we could use that as a springboard to get back to a larger growth narrative. From 2020 to 2022, we doubled in size. And while we’re not looking to do that again, we definitely want to grow profitably and serve as many people as possible in the growing ACA market.
HealthLeaders: Can you provide details on what it means for Oscar to gear up for growth?
Quane: Oscar has implemented a significant amount of expansion. First — while we're not entering any new states in 2024 — we are expanding to 165 new counties. This includes approximately 100 that meet the definition of a rural county. Often, there is less competition and less accessibility for people in those counties, so we’re hoping to offer more affordability and more options.
[Note: Oscar Health operates Marketplace plans in 11 states. Across all lines of business, as of March 2023, the company operates in 20 states.]
Second, we are enhancing our existing diabetes care plan and are introducing a chronic care plan for individuals with asthma and COPD called Breathe Easy. This plan offers a much lower cost share for benefits directly related to these illnesses to help members manage their chronic illnesses themselves.
The last thing we're doing, for our Spanish-speaking members, is offering an experience called Hola Oscar. A large part of the growing ACA population are Spanish speakers, so this program really allows us to deliver socially and linguistically authentic experiences when they call our concierge service — like matching members to providers who speak and can provide documentation in their language.
HealthLeaders: How are traditional benefits affected in specialty health plans — what is the impact, if any?
Quane: The other benefits pretty much stay the same. What these plans try to do is provide financial incentives for members to manage their disease in a way that is more specific and more affordable overall. For example, these plans put a member’s specialist copay [e.g., a frequently seen pulmonologist] on par with their PCP copay. For patients with asthma or COPD, a specialty plan lowers the cost of oxygen services and covers nicotine replacement [to discourage smoking].
Oscar Health's EVP and CIO, Alessa Quane. Photo courtesy of Oscar Health.
HealthLeaders: What is most important about the Marketplace, in 2024 and in coming years?
Quane: The continued growth in the market is a big topic: where that growth is coming from, including Medicaid Redeterminations and beyond that for populations that were previously uninsured. We've seen smaller employer groups — not in a material way at this point ACA — turning to the individual market. I think that's a real potential tailwind over the longer term.
I also think there's more stability in the market this year. We don’t have big insurer exits like the year before. We also have new entrants that are continuing to expand their footprint in new markets or engage in strategic retrenching in other markets. What I’m really looking for in our markets is: Are they doing what they need to do? Do our products meet members’ needs? And you know, from a business perspective, is this doing what we need it to do?
And so, the rationality of the players is good. I think that bodes well for the future of the market and to reduce overall volatility.
HealthLeaders: What are your thoughts on whether expanded subsidies will continue beyond 2025?
Quane: Quane: The last thing you want to see is a mass exodus from the market from an affordability perspective. That's an important topic for the industry to be thinking about, but beyond that Congress will have to take action. The expanded subsidies will expire if no action is taken. I think the Presidential election is key. There’s really no way to know what will happen until then.
HealthLeaders: An interesting component of Oscar’s values is “Never build alone.” How does that apply to your Marketplace strategy, as well as your own leadership style?
Quane: Never build alone is a subset of one of our values, Make It Right. Do your best work. When you make a mistake, admit it, and share what you're learning — whether it's through mistakes, innovation, or just your day-to-day.
No one is super successful on their own. When I think about how to go to market, Make It Right and Never Build Alone touches on every single part of the organization. Collaboration is super important. When we bring +Oscar and our technology to others in the market, it's to make the healthcare ecosystem more efficient, more affordable, and more accessible. That’s our mission.
HealthLeaders: What else is top of mind as we close, Alessa?
Quane: The one thing that I would want to say about Oscar generally is that we're not trying to get more members by just having a lower price. We strive to offer innovative plans and go after different markets — which is really for our members and to be a very member-centric company. The member is really the North Star. We have a Net Promoter Score, or NPS, that is substantially higher in the market, and we want to continue that. [NPS measures the loyalty of a customer to a company.]
Whatever we're building, wherever we're going, however we're innovating, the way in which we partner with or use our technology to support others is really all in service of the member. That’s an important point and differentiator about Oscar. It’s what drives me as a leader and what drives the teams we have at the company.
Laura Beerman is a freelance writer for HealthLeaders.