- analytics key to delivering better customer journey and experience and gain competitive advantage over other insurers
"Oscar’s next move was to combine its new classification system with patient data. Using purchased Medicare data and Oscar’s own claims data, Reber’s team built a predictive model based on how often people accessed certain services. Then they layered on information about where people lived, where doctors were located, and what services they provided. They had identified the doctors who could optimize their network."
Megan Molteni Wired - 12 May 2017
For the most part, that’s where the hard data science ends. After verifying doctors’ specialties, locations, and availability, Kopko went out and negotiated. Throughout the fall, his team signed more than 5,000 contracts. Oscar launched its optimized network on January 1, 2017.
Lesson- tear up the old processes and legacy system constraints and plan the insurance for future and not past/current needs and customer behaviour. Then identify and access all the data you need both internal and external- structured and unstructured.
The result was a novel taxonomy of health care providers: 400 buckets based on what doctors do, rather than the title on their office doors. “We boiled the ocean of health care billing into something clinically relevant,” says Nick Reber, Oscar’s vice president of network construction. Starting with doctors instead of just blind data mining, he says, made for a richer model.