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Cleveland Clinic risks entry into health insurance market with plan co-branded with Oscar Health

The health plans are expected to be sold on the Ohio health insurance exchange as well as off the exchange starting in 2018.

Susan Morse, Associate Editor

Cleveland Clinic is venturing into the health insurance business for the first time with Oscar Health.

The organizations announced this week they will offer co-branded health insurance plans to consumers in northeast Ohio, marking Cleveland Clinic's first entrée into the payer market with a product bearing its name.

The health plans are expected to be sold on the Ohio health insurance exchange as well as off the exchange starting in 2018.

Cleveland Clinic will continue to work collaboratively with other health insurers.

Oscar Health was launched in 2012 as Oscar Insurance Corp. by Josh Kushner, the younger brother of Jared Kushner and two Harvard Business School classmates, Kevin Nazemi and Mario Schlosser, according to Bloomberg Businessweek. Oscar reportedly lost more than $300 million selling exchange plans in the Affordable Care Act market.

The pairing is looking to buck a trend recently reported by the Robert Wood Johnson Foundation that said of 37 provider-sponsored health plans formed since 2015, only four have been profitable. Another five have gone out of business.

[Also: Majority of provider-sponsored plans losing money, report says]

Cleveland Clinic Chief of Staff Brian Donley, MD said by statement that the relationship with Oscar Health goes beyond the traditional approach of care.

Patients will have the option of a virtual visit, at no co-pay.

This will avoid unnecessary trips to the doctor or a stay in the hospital whenever possible.

Cleveland Clinic's express care online and Oscar's virtual visits will use smartphone technology to analyze health needs and help members understand their care options and costs.

[Also: Telehealth may increase overall health spending and utilization despite lower cost per episode, says Health Affairs]

Cleveland Clinic and Oscar Health will integrate their clinical and  consumer care approaches. Every member will be matched with a Cleveland Clinic care team comprised of a primary care provider, physician assistants and other allied health professionals, and an Oscar Health concierge team made up of a nurse and three care guides.

"Together, Cleveland Clinic and Oscar Health intend to offer a different approach, one that breaks down the complexities between providers and insurers, allowing our patients to easily navigate the healthcare and health insurance systems, get the highest quality care at a reasonable price, and improve their overall health," said Cleveland Clinic CFO Steve Glass.

The collaboration is slated to begin this fall. Consumers in five northeast Ohio counties – Cuyahoga, Summit, Lorain, Medina and Lake – will be able to purchase Cleveland Clinic | Oscar individual health plans.

[Also: Lack of CSRs one reason Anthem BCBS to leave ACA market in Ohio]

"By linking Oscar's member engagement platform to a world-renowned, physician-led health system like the Cleveland Clinic, we can align incentives and focus on the things that matter most: keeping members healthy; making it as easy as possible for them to find care when they need it, in the right clinical setting; and driving healthcare costs down," said cofounder Schlosser, who is Oscar Health's CEO.

"Cleveland Clinic's guiding principle of 'Patients First' shapes everything we do, including our relationships with insurers, which is why we look for insurance plans with innovative, patient-centered policies," Glass said.
 

Twitter: @SusanJMorse

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