Oscar Program Structure

04: Shaping Care

How we reduce healthcare costs and improve outcomes by nudging everyone towards the best care.

7 AI use cases

Guide Providers

Engage and support our providers to help them keep our members’ healthcare on track.

Equip Providers With Data, Tools & Insights

Let providers use our data, care management and engagement tools and insights to drive outcomes like better referrals, care reminders and affordability.

Guide On Benefits & Financials

Give providers cost estimates and other relevant information.

Engage Providers

Engage our providers in our digital channels, inbound and outbound campaigns to have their attention in the moments that matter for the member.

Engage Members

Convince members to start their care with Oscar.

Generate Digital Engagement

Earn and keep our members’ attention through all digital channels, in the moments that matter for their health.

  • Status: Pilot / Prototype

    We spend a lot of time thinking about ways to proactively engage members—on everything from way so to improve health to tips on how to get the most out of their coverage. We already use GPT as an ideation tool for campaign concepts and content, and are exploring ways to integrate this functionality more directly campaign creation workflows, for example, by generating email copy variations programatically.

Explain Healthcare

Eliminate confusion and errors when members navigate healthcare.

  • Status: Idea / Exploration

    Healthcare is full of jargon and we’ve always made a point of explaining healthcare esoterica in terms anyone can understand. To that end, we’re exploring allowing members and other users to mouse over a word or phrase in one of our apps to get a conversational explanation of any healthcare concept.

Enable Engagement Through/For Partners

Enlist the help of others in the healthcare system, like our providers and brokers, to engage our members with us.

Provide Culturally Competent Care

Get our members to providers and healthcare that’s uniquely personal and helpful.

Provide Excellent Member Service

Solve our members’ issues quickly, helpfully and profoundly.

  • Status: Pilot / Prototype

    Similar to providers, when members call us with questions, our top priority is helping them to get answers quickly. After each call, our care guides spend time typing up notes for their interactions that can be reviewed later both for quality improvement purposes and as part of the member’s profile. This last step is a great candidate for automation through a combo of automated transcription and LLM-powered summarization—our prototyping has confirmed that this is a viable and valuable use case.

  • Status: Pilot / Prototype

    While we believe strongly in the inherent humanity of healthcare, we also believe that technology can give our members the best of both worlds—instant answers for common questions, high touch navigation from care guides for the thornier ones. We’re investing in a range of capabilities that will allow us to automate voice and messaging interactions to provide faster answers when relevant and desired.

  • Status: Pilot / Prototype

    We survey members on member satisfaction and agent satisfaction after interactions. We can use LLMs to automate those ratings. We get member ratings for around 10% of our interactions. LLMs enable us to produce them automatically for 100% of our interactions. The write-up is here.

Encourage & Guide Members

Use incentives and rewards to influence and invest in our members’ long-term healthcare outcomes.

Invest In Members For The Long-term

Deepen our brand loyalty and earn members’ trust so that we can align alongside them when their long-term outcomes improve.

Deploy Rewards And Incentives

Use incentives and rewards to influence and invest in our members’ long-term healthcare outcomes.

Influence Utilization

Keep members on track in their healthcare journey by routing their care and managing their care journeys.

Route Care

When members need care, route their choice of provider.

  • Status: Idea / Exploration

    There are many potential applications of LLMs in search. One example we’ve experimented with is using a conversational interface to help translate a set of symptoms or health issues (as articulated by the member) into a structured set of clinically appropriate doctors for them to make an appointment with.

Enable Partners To Manage Care Journeys

When members receive care, help partners such as providers with our technology to remind them of the next best step.

  • Status: Pilot / Prototype

    One of the most important elements of managing a patient’s care is timely and relevant tips and guidance to help them manage their conditions. But providers often struggle to find the time to do this proactively. LLMs can help by generating first drafts of condition management suggestions to be reviewed and edited by the clinician, improving the scalability of value-based care.

Manage Care Journeys

When members receive care, remind them of the next best step.