Last year, Cleveland Clinic and Oscar Health announced that they were teaming up to sell individual health plans both on and off of the Affordable Care Act's exchanges for the 2018 coverage year—and the effort appears to be off to a successful start.
Details on the collaboration
Under the collaboration, Cleveland Clinic and Oscar sold individual health plans in northeast Ohio's Cuyahoga, Lake, Lorain, Medina and Summit counties. Oscar under the venture is providing a member engagement platform and insurance management skills, while Cleveland Clinic is providing clinical health care services. According to the companies, the overarching aim is to curb costs and improve outcomes by coordinating care around the individual patient.
The narrow-network plans cover only care provided by Cleveland Clinic's network. Under the plans, beneficiaries are assigned a team of medical providers at Cleveland Clinic, including a primary care physician, physician assistants, and other health care providers. The plan member also gets access to a "concierge team" at Oscar—comprised of a nurse and three care guides—to help guide the patient through the health care system. In addition, members receive 24-hour access to telehealth services.
Enrollment exceeds expectations
According to Crain's Cleveland Business, the companies estimate that their health plans accounted for 15% of those sold on the individual market during the open enrollment period for the 2018 coverage year, with 11,000 total enrollees. Kevin Sears, executive director of Cleveland Clinic Market & Network Services, said enrollment was 30% to 40% greater than the companies had anticipated.
"I think a big part of it is just how easy and simple Oscar is to understand and to use," Sears said. He added, "I think the second part of it is the Cleveland Clinic brand. I think that people … recognize that brand as a high-quality care brand and are excited to have access to the Cleveland Clinic network."
J.B. Silvers, a health care finance professor at Case Western Reserve University, said of the enrollment figures, "As a startup plan going from ground zero with no former enrollment at all, that's probably pretty good."
Moreover, members have been engaging with the platform the companies are offering, Crain's Cleveland Business reports. According to Crain's Cleveland Business, one-third of the plans' members have used Oscar's online onboarding platform to pick a primary care physician, and 70% of members have created a health profile on Oscar's web app.
Sears said Cleveland Clinic and Oscar are "evaluating very carefully" whether there are any opportunities to expand their offerings, adding that he believes narrow network health plans will continue to take up an increasing share of the individual health insurance market. "I think that trend will continue for the foreseeable future," Sears said. He continued, "And I think what it tells us is, for the right network, for a network that is adequate both in terms of geographic presence and access, and that is composed of high-quality providers, people are willing to choose narrow network products."
Thorsten Wirkes, vice president of strategic operations at Oscar, said he expects the companies "certainly" will grow next year.
Silvers said he believes the companies could expand their health plan offerings, but whether they pursue that growth might depend on their current enrollee risk pool. "The scaling of it would be pretty easy to do. It wouldn't be hard to expand it to a larger population," Silvers said, adding, "The big issue that they're going to have to wrestle with is did they get a good, sort of adequate distribution of signups or did they get people that are lower health status, higher need?" (Coutré, Crain's Cleveland Business/Modern Healthcare, 2/5).
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With MACRA, HIPAA, the ACA, and countless others, the health care landscape has become an alphabet soup of legislation. To help you keep up, we've created a series of cheat sheets for some of the most important—and complicated—legal landmarks.
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