Oscar Health is an American health insurance provider that operates a product business model.

The company was founded in 2012 to take advantage of the new markets and millions of people that gained access to insurance under the Affordable Care Act.

The company’s plans are EPO-based (Exclusive Provider Organizations) – hospitals are paid when patients use their services as opposed to receiving yearly subscriptions. Insurance is available to individuals in parts of New York, New Jersey, California and Texas. Oscar Health has a network of partners that provide the healthcare for its customers and does not provide the care itself. Patients can choose which provider they use in the network and doctors are paid as a function of the care provided. Patients can search to see if their doctor or hospital is registered with Oscar Health by searching on their website. If a customer is currently uninsured they can find their new doctor or medical practice in the same way.

The company’s differentiates itself to consumers by offering a simple, fast application process and a high quality of user experience. The company aims to reduce the complexity of accessing healthcare by utilising mobile technology. The primary differentiator is the Oscar Health app that allows customers to manage their appointments, monitor their health and access medical care via their smartphone. The healthcare providers that partner with Oscar Health can gain access to tools that can help simplify workflow and appointment scheduling.

Mario Schlosser, Kevin Nazemi and Josh Kushne, who met at Harvard Business School, founded Oscar Health in 2012 in response to the Affordable

Care Act. The company aimed to simplify health insurance for the millions of Americans not covered by employer or government plans. The business secured seed funding of $40million in 2013 and began insuring individuals in the New York area in 2014. The company continued to expand and now coverers 145,000 customers across four states. In total the company has raised over $700million in funding, the most recent a $400million private equity investment from Fidelity which valued the company at $2.7billion.

Oscar Health has two customer groups:

* Individuals seeking health insurance who are not covered by their employer or the government’s Medicaid program, which are estimated to be 145,000 customers

* Healthcare providers that Oscar Health wishes to partner with

Learn more about the Product Business Model

A dyadic transactional relationship where your good or service can be designed and delivered without prior interactions with the customer.

Engagement  — Value Creation Proposition
Oscar Health generates value for customers through its simplified application process and the enhanced customer experience it offers. This results in customers saving time and effort when dealing with issues relating to health insurance.

Oscar health is an health insurance company and the benefits of health insurance are primarily access to healthcare.

Hospitals and healthcare providers benefit from Oscar Health’s supply of patients and the workflow and scheduling tools they provide.

Delivery — Value Chain
Consumers can access Oscar Health’s products through its website or the healthcare marketplace of each of the states it operates in. If individal is not already associated with a doctor or mediacl practice they can choose one throught this fucntioal also. Healthcare providers can apply to become a partnered organisation via the Oscar Health website.

Monetisation — Value Capture
Oscar Health does not publish detailed financial reports but industry sources estimate revenue at $750million with an average of $5,000 generated per customer. The company made a loss of $120million in 2015.



Thrive Capital Founder Josh Kushner On The Power Of Oscar



Disclaimer — Written by Thomas Murray under the direction of Prof Charles Baden-Fuller, Cass Business School, in September 2016. This case is designed to illustrate a business model category. It leverages public sources and is written to further management understanding, and it is not meant to suggest individuals made either correct or incorrect decisions. © 2016