Embracing Innovation in the Healthcare Industry

With over 30 years of experience, Alessa Quane is a seasoned veteran in the insurance industry, having served in leadership roles across property casualty, life, and health insurance, both domestically and abroad. Her current role as Executive Vice President and Chief Insurance Officer at Oscar Health involves overseeing the company’s various insurance lines of business for its approximately one million members. Previously, Alessa assumed many roles during her 25-year tenure at AIG, which included Executive Vice President, Chief Risk Officer, Chief Corporate Actuary, and Head of Global Actuarial and Value Management.

Please share with our readers about your current roles and responsibilities.

I am professionally trained as an actuary and have spent the majority of my career in the property casualty space. I have had the privilege of working in actuarial and enterprise risk management roles, both domestically and internationally. I gained extensive international experience during my 25 years at AIG as Chief Corporate Actuary and Chief Risk Officer. My decision to join Oscar Health influenced my views on insurance. I previously believed the only purpose of insurance was to help individuals during challenges and planning for the future, including retirement. But later, after interacting with the founder and other Oscar employees, I realized the profound nature of health insurance. It’s not just there to cover challenges, retirement, or emergencies, but it’s a preventative measure that enables individuals to live their healthiest lives –– even before something catastrophic happens.

The people I work with at Oscar share a genuine dedication to prioritizing the well-being of individuals and making the healthcare system more accessible and affordable. Another aspect that appeals to me about Oscar is its focus on the Affordable Care Act (ACA), which was designed to address significant issues in U.S. healthcare. Oscar addresses these issues head-on by striking a balance between mitigating unnecessary risks and embracing innovation.

Can you share some of the latest trends in the healthcare industry?

The healthcare industry is shifting towards consumerization, digitization, and a more value-driven system. The market for consumerized healthcare, particularly within the ACA, is continuously growing. Our founding was timed with the passing of the ACA, and we launched in our first market of New York City in 2014 when individual plans first became available on the exchange –– this, to me, embodies the concept of consumerization. The ACA allows individuals to have more freedom of choice when it comes to selecting the health insurance plans that best suit their needs. This puts the buying power into the hands of individuals and fosters healthy competition focused on meeting consumer demands.

"We use technology not only to enhance the member experience, but to support the rapid scaling of our operations"

Technological advancements also support these trends. Today, apps, including Oscar’s, facilitate communication, doctor selection, bill payments, and overall self-management of healthcare, enabling individuals to take better control of their health experiences and access to care. For example, Oscar has leveraged our technology to establish a Culturally Competent Care program that helps individuals connect with physicians with diverse values, beliefs, languages, races, and ethnicities that match those of the member, thus improving overall health outcomes. We make this information available in our app, which enables members to make informed decisions about their healthcare providers.

Considering the trend towards digitization, digital tools are becoming increasingly valuable. At Oscar, we use our technology not only to enhance the member experience, but to support the rapid scaling of our operations. This trend has also facilitated the shift towards value-based care and risk sharing. By analyzing the member experience, claims information, and utilization data, we’re able to share relevant data with providers, and can work collaboratively with them to ensure individuals receive the necessary care at the right time and in the right setting.

Can you share any project initiatives that you have been part of lately?

In 2022, we launched a product called Campaign Builder. It is a modularized tool that we are offering to provider groups in the market. Through Campaign Builder, we initiate campaigns ensuring members and providers receive proper communication and touch points throughout their healthcare journey. For example, we’ve run campaigns to prompt members to choose a primary care provider (PCP) after purchasing their plan. We then provide suggestions of PCPs within their network and encourage them to select one. If they haven’t gone for their annual wellness visit, we send reminders and emphasize the benefits of taking advantage of this free offering in their plan. Through these campaigns, we have observed a 15 percent increase in scheduled visits and a 13 percent decrease in ER visits. When members search for an ER, we reach out to them and assess their situation to recommend appropriate steps. This initiative is one example of how we’re maximizing the tool’s potential to support and benefit our members.

What would be your piece of advice to your fellow peers?

If you are leading an organization, focus on the mission, future goals, and the beneficiary –– in our case, it is our members. So in my view, it’s vital that we adopt a member-centric approach and constantly think about how our decisions and actions will impact our members. Whatever company or industry it is, consider the end user while making tactical and strategic choices.