Marissa J F. on LinkedIn: Congrats to Mario and the team!! 🥳🥳 (2024)

Oscar Health, for the quarter ended March 31, 2024:- Total Revenue of $2.1 billion, a 46% increase YoY- Medical Loss Ratio of 74.2%, a 210 bps improvement YoY- SG&A Expense Ratio of 18.4%, an 870 bps improvement YoY- Net Income of $177.4 million, or $0.62 of earnings per share, a $217.1 millionimprovement YoY- Adjusted EBITDA of $219.3 million, a $168.2 million improvement YoY- Reaffirming full year 2024 outlook=> Individualizing health insurance with tech works. Just took a little longer than we naively thought.

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Today’s Healthcare Policy Pop examines the current and future potential impacts of AI on health care. Plus, learn about a new way to buy insurance just in time for the next Open Enrollment season.Hear these stories and more right now: https://hubs.ly/Q0250PG00Mentioned in this episode: Jennifer Hinkel, The Data Economics Company (DECO)Brad O’Neil, The ICHRA Shop Insurance Agency | Individual & Family Health Care |

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The Irony of #BigInsurance: It’s the Creation of the #Dems Who Rail Against ItThis Axios article frames perhaps the most important question in #healthcare right now. It’s one that the #FTC is pondering even as I post this: have the largest #healthinsurance companies, with their massive vertical integration strategies, delivered a budget- and economy-busting stranglehold on our country? Vertical Integration Run Amok: It’s hard to overstate the effect of the consolidation and vertical integration wrought by the largest health care insurance companies in the world. Their vertical integration strategies have plowed through #pbms, #physician practices, national retail #pharmacy chains, specialty and #mailorder pharmacies, #ascs, and other segments.The Underlying Means and Mechanism: As the Axios article states, a huge part of why these insurance companies have been able to grow as they have is a function of government policy: “They've … expanded into government-regulated markets through the #AffordableCareAct exchanges, #MedicareAdvantage and #Medicaid #managedcare.” Those government markets have brought them control over the health care of more than 110 million Americans—roughly a third of the entire U.S. population. The profits from those contracts, replete with massive #governmentsubsidies, have been the engine of their #consolidation and vertical integration. Not in Our Stars: #Democrats, in #Congress and in the #BidenAdministration, have long railed against what they see as excessive reimbursem*nts rates to #MA plans. #Riskadjustment is the poster boy of those critiques, but that specific criticism, now playing out in #fca #healthcarefraud #enforcement actions, is just a part of a much wider critique, reflected in many a #MedPAC report. But, despite their adamant deniunciations of #BigInsurance”, #Dems need only look into the mirror to see where a good deal of the blame lies. Already critical of #MA, they nevertheless made insurance companies the big winners in passing the #ACA, now the fastest growing source of Big Insurance dollars to fund further vertical integration. Dems comforted themselves that their embrace of insurance companies could be mitigated by their imposition of caps on the profits and admin costs of plans. But those caps actually drove the plans towards vertical integration, leading inevitably to the stranglehold. The best way to evade those caps, after all, was to push profits from the plans down to captive PBM and provider affiliates—a strategy the companies pursued with self-interested vigor. As Shakespeare’s Cassius says in Julius Caesar: “The fault, dear Brutus, lies not in our Stars, but in ourselves”.

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WSJ Reports a Big Jump (6.5%+) in Health Insurance Premiums is ComingHold on to your briefcases—health insurance premiums are expected to have the biggest jump in years. Not because people are getting more care, but because of (a) high labor costs at hospitals and health systems; (b) drug spend, particularly on pricey new specialty drugs. What can you expect?✔ Health plans should expect to be back in the legislative and regulatory spotlight. The temperature is already high, with increasing complaints of high rates of insurer claim denials, unnecessary administrative hurdles and prior authorization complexity, etc., all while posting significant profits. ✔ Hospitals and health systems should not expect any sympathy. Instead, expect government stakeholders to adopt a "Robin Hood" mindset, looking to reallocate health care spend from systems with stronger balance sheets and healthy margins. Nonprofits need to keep their mind on the mission, and demonstrate a robust commitment to community benefit, expanding access, and improving health equity. ✔ As to drug spend, we have not yet begun to see the ramifications of the new GLP-1 drugs. Everything I have seen so far suggests they are incredibly effective. They are obviously incredibly expensive. More to come here I am sure. #HealthCare #HealthInsurance #Pharma #HealthPlans

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Couple of observations on the flash figures release by GI council in Feb- Health continues to drive growth for most insurers.I expect AI usage to percolate downstream and transform health insurance underwriting as well as claims settlement in the short term.This in turn should rationalize costs for the Customers in the mid-long term. Which I think is extremely important if health insurance is to sustain and grow as a product category. Most insurers, except for SAHI ofcourse, seem to have underwritten more health as compared to motor, the second largest LoB.But that could also be because we are at the fa*g end of the financial year where we wake up to the realization of tax exemptions.

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𝗜’𝗺 𝘀𝘂𝗽𝗲𝗿 𝗲𝘅𝗰𝗶𝘁𝗲𝗱 𝘁𝗼 𝗯𝗲 𝘁𝗵𝗲 𝗼𝗽𝗲𝗻𝗶𝗻𝗴 𝘀𝗽𝗲𝗮𝗸𝗲𝗿 𝗻𝗲𝘅𝘁 𝗺𝗼𝗻𝘁𝗵 𝗮𝘁 𝘁𝗵𝗲 𝗬𝗢𝗨 𝗣𝗼𝘄𝗲𝗿𝗲𝗱 𝗦𝘆𝗺𝗽𝗼𝘀𝗶𝘂𝗺!We’ll discuss not only why changing course together is so important and needed, but also specific strategies on HOW and the IMPACT it has for both employers and their employees when done correctly!Registration is still open; what are you waiting for?This is one of the leading conferences for contrarian thought leaders on how to fix employer sponsored health insurance to drive better financial performance and coverage for employees!Registration link is in the comments.#ceo #cfo #hr #humanresource #healthinsurance #health #medical #medicalinsurance #employeebenefits #BenefitsInsider Hotchkiss Insurance YOU Powered Symposium

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A leading global management consulting firm published a study in 2022 that identified patient centricity as one of 10 big shifts that will affect the future of healthcare delivery in the USA.For health plans, in whose business health insurance and healthcare delivery have converged, that future has already arrived. A platform approach to health insurance member engagement unleashes the power of data, analytics, and AI to enable smarter business decisions at scale that improve outcomes and reduce costs. FICO® Platform provides a complete, end-to-end set of composable capabilities, including intelligent omni-channel two-way communications for member engagement at scale and at low cost, that empower you to effectively promote wellness initiatives and member care and health management. Reach out to me if you'd like to learn more. #healthinsurance #healthcare #patientcentricity

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The #Cigna org and ownership chart is indeed impressive, but neither intimidating nor concerning. Same can be true of #Aetna/CVS and #UHC/Optum. We should celebrate the number of players and investors who believe there is value in putting time, effort, and money into healthcare. I don’t see it as monopolizing the industry as much as it forces it to be more pragmatic and competitive versus idealistic. The competition should bring out the best from all parties involved. The results will bode well for customers and patients. It’s a win-win.I’m neither afraid nor concerned that insurance companies, retailers, and disruptors are increasingly growing their health brand and market share by controlling aspects of healthcare delivery that govern where and from whom we receive our care. For these capitalists to be interested means there is significant opportunity and investment returns. They are also taking on serious risk. I continue to emphasize in my posts, it’s not who, when, where, why, and definitely not how, but it’s the “what” that matters. The most important deliverables areimproved healthcare outcomes at a reduced cost. This kind of interest and attention in healthcare is long overdue. The COVID-19 pandemic was a global wake-up call. It forced us to realize that nothing was more important than our health. Especially on a population and global scale.We believe and proudly boast we are the prime species, yet many “lower” species collaborate effectively to preserve their lives even without the “higher learning” brain capacity possessed by humans. Let everyone who wants to contribute support the effort to better health outcomes and improved quality of life. I believe we have a better chance of solving our health challenges collectively than individually. We still have a lot to learn and a long way to go. No matter how big health insurance companies get, they will only survive if they live up to our expectations. We are the customers hoping we never see the day we become patients. We are also the consumers of care with power of the purse. Thanks for sharing Ron.

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Makes you wonder what their net consolidated financials say.

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🔊 Attention Agents! 💼 Are you aware of the significance of health insurance for many employees? What if we shared a valuable strategy to combine Group Medical Gap insurance with high out-of-pocket medical plans? This approach provides an additional layer of security for employees while maintaining cost-effectiveness. This combination can be a transformative move, ensuring that top talents remain engaged and appreciated, and don’t leave workforce.Interested in discussing how this can enhance your group's benefits program? Reach out to NAS, and let's collaborate on this opportunity. #InsuranceChallenges #InsuranceIndustry #EmployeePerspective #NationalAgencySolutions #GapCoverage #PartnerWithNAS

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