Payers

Oscar Health: The new payer that’s rethinking population health with Cleveland Clinic

This year, Oscar Health and Cleveland Clinic started offering health insurance plans in Ohio. "We are at the beginning of [the] consolidation of payer and healthcare provider," Tom Sudow, director of business development at Cleveland Clinic Innovations, said.

Headquartered in New York City and founded in 2012, Oscar Health bills itself as “a new kind of health insurance company.” At one time, it chose to exit the New Jersey and Dallas-Fort Worth markets. But the startup now offers plans in New York, New Jersey, Ohio, Tennessee, Texas and California.

“Our and the whole reason of being in the genesis of Oscar is to make sure we help people navigate healthcare,” Thorsten Wirkes, vice president of Oscar Health, said in a phone interview.

He will be speaking at the upcoming MedCity INVEST conference in Chicago in May.

With that focus on navigation comes an interest in engaging members, Wirkes added. Currently, the startup is getting a little closer to consumers through a collaboration with Cleveland Clinic.

Initially announced last summer, the Cleveland Clinic | Oscar individual health plans are available on and off the exchanges in Ohio. Coverage began in January.

“The Cleveland Clinic work is very exciting,” Wirkes said. “The goal is to really develop a deep payer-provider integration and figure out how we can break down barriers between payer and provider.”

The alliance allows members to engage with the insurer’s product in a new way in Ohio. For instance, consumers are able to select a Cleveland Clinic primary care physician through the Oscar platform. Going forward, the startup hopes to integrate its technology with Cleveland Clinic providers’ schedules as well.

This type of integration is made possible through FHIR, or Fast Healthcare Interoperability Resources, according to an Oscar blog post on Medium. A feature like this has helped Oscar and Cleveland Clinic move toward population health, Wirkes noted.


Attend MedCity INVEST to hear from healthcare innovators like Thorsten Wirkes, Tom Sudow and other experts. Use promo code MCN50 to save $50. Register now.


“What’s the goal of population health? To create a better member experience across the care and administrative processes to make sure care outcomes are positively impacted and also to make sure that it’s economically viable for all stakeholders,” he said.

As Tom Sudow, director of business development at Cleveland Clinic Innovations pointed out, data is a crucial part of working toward the better outcomes that are part of a population health strategy.

“Using data and genomics, we have the power today to intervene before there is a problem and potentially intercede for healthier outcomes,” he said via email.

Sudow is also speaking at MedCity INVEST.

Utilizing data in this manner, he added, alters the way care is delivered. It’s a shift toward incentivizing patient behaviors and pinpointing potential risk factors.

Collaborations like the one between Oscar and Cleveland Clinic will play a role in improving healthcare for patients.

“We are at the beginning of [the] consolidation of payer and healthcare provider,” Sudow said. “Costs and efficiency are driving this consolidation. Further, when you blend in data and the use of data, we are striving for a system that can serve patients better while controlling healthcare costs.”

Photo: mattjiecock, Getty Images 

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