Data Provocation: Hospitals are broken and ripe for technological disruption. I have been following General Catalyst’s bold moves lately, including helping found several healthcare companies and most recently acquiring an entire healthcare system in the United States. My hope is that this leads to a vertically integrated re-imagination of healthca
Bright, Devoted, and Oscar have all structured their plans to financially align themselves with providers: when providers provide cost-effective care, both parties gain.
These arrangements differ from the more common ‘fee-for-service’ model, in which the insurer is billed for each service rendered by the provider. Under this arrangement, the insurer is the one bearing nearly all financial risk.
The large incumbent players (e.g. United, Humana) are largely built for a fee for service environment, and they’re best positioned to succeed in fee for service.