US Healthcare Industry: Broken, According to Oscar Health CEO

The US healthcare industry has long been criticized for its complexity, high costs, and uneven access. Now, even the CEO of a prominent health insurance company is weighing in, calling the system "broken." Mark Bertolini, CEO of Oscar Health, recently shared his thoughts on the state of the US healthcare industry and what needs to change.



Bertolini believes the current focus on disease and specialty care contributes to the industry's issues. He argues that the system overemphasizes procedures and drugs, neglecting preventive care and primary care. This approach leads to higher costs and lower patient satisfaction. The system's emphasis on technology and specialty care also contributes to misdirected investments, stifling innovation, and fragmented care.

Bertolini suggests that the US healthcare system's emphasis on technology and procedures over preventive care exacerbates its issues. He argues that the system emphasizes disease treatment and specialty care, rather than preventive measures like nutrition, exercise, and mental health. This approach leads to higher costs and avoidable healthcare disparities. Bertolini suggests that the system's emphasis on procedures and drugs, such as preferring cortisone injections over shoe inserts for tendinitis, further contributes to these problems. He also notes that payment structures can stifle innovative healthcare delivery, such as home-based treatments and telehealth, which could be more cost-effective and preferred by patients.

Oscar Health's focus on technology and personalized support sets it apart from traditional healthcare providers. By leveraging seamless technology and providing tailored support, Oscar aims to help over 1 million members navigate their healthcare more effectively. This approach has earned the company recognition as one of Fast Company's most innovative companies in health, one of CNBC's top 50 disruptors, and one of TIME's most influential in health care. Oscar's unique strategy, which includes offering specialized plans for specific chronic conditions, has proven appealing to members and could potentially address overpricing and over-insuring in healthcare.



Oscar Health's approach to individual coverage health reimbursement arrangements (ICHRAs) contributes to its business model. By offering specialized plans tailored to specific chronic conditions, Oscar can attract more members and reduce overpricing and over-insuring. This personalization also addresses employer solution fatigue, as they no longer need to manage multiple vendors for specific conditions. Moreover, ICHRAs enable long-term member continuity, allowing Oscar to monitor trends and optimize care. This approach aligns with Oscar's tech-driven, personalized support model, driving growth and profitability in the individual market.

In conclusion, the US healthcare industry's focus on disease and specialty care, overemphasis on procedures and drugs, and neglect of preventive care contribute to its 'broken' state, according to Oscar Health CEO Mark Bertolini. Oscar Health's focus on technology and personalized support, along with its approach to ICHRAs, sets it apart from traditional healthcare providers and offers a potential solution to the industry's challenges. As the healthcare industry continues to evolve, innovative approaches like Oscar Health's will be crucial in addressing the system's issues and improving patient outcomes.

Action AlertsPLUS, managed by the article's co-writer, holds no positions in any mentioned securities.