Oscar Health, Inc. (OSCR) Earnings Call Transcript & Summary

Hello, all, and welcome. My name is [ Tousy Kobash ], and I'm an associate at JPMorgan. It's my pleasure to introduce Mario, Co-Founder and CEO of Oscar Health. And with that, I'll hand it over to you, Mario.

Thank you. It's great to be here, and it's great to see so many friendly faces. And that's a real commitment to show up at this time of the day for the presentation. So thank you, and thanks to those listening on the webcast as well. I want to take you through where we are in the company. You can read this yourself. Disclaimers here. I'm sure they're on the website as well. Cornelia can read them out to you afterwards. We started just about 10 years ago at this point. And the company started really in anticipation of 3 broad trends, we think, kind of rippling to the U.S. health care system, shift towards consumerization, shift towards digitization and shift towards value. And against that backdrop, it's been our strong belief that you need a digitally native payer to really take advantage of these kind of trends. And today, from where we sit, we're convinced that these really are the trends that the system -- the U.S. health care system is on an unstoppable path towards and that we, as Oscar, can thrive uniquely well in such a system because of the investments we've made into our technology stack and member engagement that makes us quite unique. On the flip side, we're quite aware that we have not yet demonstrated that we can do this as a profitable business. And one of the things I want to make sure I bring to you today is that we are delivering on this very crucial profitability milestone for the company. Because we're now a scaled health insurer. We now have higher member engagements than we think most others. And we have built all of this in our own technology stack, and those are 3 very unique pieces that others can't bring together. And that lets us affirm a couple of things. Number one, we landed a membership for 2033 rights against our goals, where we wanted that number to be. Number two, we believe and we expect our insurance business to be profitable in 2023. Number three is that we believe a lot of the actions we've already taken, and I'll take you through this later, that really are already baked into the P&L have not really been baked into the Street's estimates. And number four, that we've remained firmly on the path to total company profitability for 2024. And through the presentation today, I hope you will see we have a clear actual path towards all this with the building blocks already clearly in place. I will start with the track record and where we are as of now. We're now a company with over 1 million members out of the third quarter last year. And we're driving approximately 7 billion of direct and assumed policy premiums in 2022, and that's a 75% compound annual growth rates over the past 5 years -- actually 6 years now. And even with this, I'd call it momentous -- tremendous top line growth, we've been able to drive more than 10 points of MLR improvement over the same time periods. That, I think, we internally tie directly to the fact that we have insinuating member engagements and that we have built this all on our own technology stack, and that's really shown up in all kinds of ways. One tiny example, about 66% of Oscar members within accounts utilize our tools to find doctors. And in fact, I should say this right now, half of my presentation will be a couple of slides. The other half will be a demo. I thought, of either doing an expressive dance or a demo to entertain people at this time of the conference, but I'll stick with the demo here for now. The members love the experience. We added 45 points in the Net Promoter Score as of the third quarter, industry average still stuck around 3. And for those members, the technology and engagement is lowering costs as well. Members who go to a physician that we recommend, that we route them to, generate about 11% cost savings versus not following our advice. And the track that we now have that you think -- that I think you see in the slide here is one of strong growth with improved profitability, right, really improving at the same time, MLR, admin costs and then, of course, continuing to grow. I want to take a closer look at 2022 and how it sits on the pathway towards intra-co and then total co profitability. At the start of 2022, we set out to deliver 5 points of insurance company combined ratio improvements, taking us to -- for last year at 104 to 106 points -- percent combined ratio for the insurance companies. And again, that's against a backdrop of going into '22 80% year-over-year membership growth and 100% premium growth, top line growth. It was really very much down to tech in our system that we were able to effectively and efficiently onboard and serve these 1 million members last year that we were able to also manage medical costs along the way. And so we -- therefore, we put out the 8-K a couple of days ago that can affirm and confirm that we're going to be at the midpoint of the 84% to 86% medical loss ratio for 2022. And that's about a 400 basis point year-over-year improvement between '21 and '22. So despite that very significant growth going into last year, we, at the same time, have been executing on the expense reduction plan we've had, and we expect that our adjusted admin expense ratio is also coming down by about 400 basis points year-over-year into 2022. And that, of course, all ladders up to a meaningful adjusted EBITDA loss margin improvements with about 700 basis points of adjusted EBITDA margin improvements as percent of premiums in 2022 as well. So that's 2022. That's obviously now in the rear view mirror. But of course, in insurance land, that's a very important jumping off points for our goals in 2023. And so there, we are really very proud and happy to reaffirm that we expect insurance company profitability in 2023, meaning combined ratio, medical costs plus admin ratio, under 100%. And I said this at the beginning, and I want to reiterate this here with a bit more details, it is easy to miss that in health insurance a lot of the cake gets baked before the year even starts. And this slide here is supposed to really bring that across. We've already taken steps for margin expansion for '23. We've already driven down admin costs by $120 million year-over-year, and we've already been able to slow the growth of our medical costs at the same time. And I'll take you through the specifics of these 4 different areas that we've been focused on here. Starting with the pricing there, we took a high single-digit rate increase between '22 and '23 on average across the insurance book. And that was above loss cost trends in the broad reagent in the marketplace. And despite that really, we wrapped up another -- or we are about to wrap up another successful open enrollment period, where the results are right in line with our goals. We expect '23 membership to be roughly flat year-over-year at approximately 1 million members. Really repeating what we did last year, they are in terms of overall membership base. We did, before open enrollment started, engage proactively some of our regulators, and we asked for a membership cap in Florida. That is our most capital-intensive states. We are not a so-called seasoned insurance company. In year 4 and year 5, that should flip over, have to therefore hold more capital like others and did not want us to potentially get too many members of players exiting the markets there. And so irrespective of the actions of others in the marketplace, that cap ensured that we would land the membership number where we wanted it to land. Second point here, market and product actions and optimization. We think those will drive improved performance in MLR and admin ratio in '23. Here, for example, we exited underperforming ACA states, Colorado and Arkansas, in particular, and we left the Oscar organic MA business in New York, in the Bronx and in Houston and Texas as well. We're also always optimizing our plan design portfolio to create more balance towards profitable plan designs and products that we think really work for members and for us on the MLR side as well. So both of these are baked, right? Pricing is in place. Open enrollment is virtually over. Products are optimized. States are left. And so that one we can put to 100% of the work that had to be done. Now in admin, for about 3/4 of the way there, I would say, in terms of the work we have to do this year. We've got line of sight into delivering $120 million in year-over-year total company admin expense improvements. And the majority of that is going to flow to the insurance companies. And that, for example, was driven by reducing member acquisition costs. We've reduced commissions by quite a bit across the markets we are in. We managed our fixed costs very tightly by looking very carefully at head count throughout the year. We did have a limited reduction in force in the fourth quarter as well in 2022. And heading into '23, now we think our run rate costs that we want, that we need are tracking right to plan. One benefit was certainly seen here is the benefit of scale. We're a scale insurance player now where, I think -- don't quote on this one, the second biggest ACA players still in the market now, somewhere along those lines. And that gives us quite a bit of sway in renegotiating, for example, vendor contracts and bringing down unit cost there. An example would be a chart retrieval costs that happens often to vendors who go into the practice and take pictures, photocopies or whatever, if we don't have an EHR integration, which we also have in many cases. And those are the kind of vendors who were able to press down on the costs. And that flows through, of course. So the admin ratio and so the overall profitability. And finally, total cost of care savings, a whole number of things the year. A big one is we're bidding out our PBM contract. Again, I think we're one of the biggest players again there as well. That's coming to market with a large book of business. And this is one of the outcomes of the newfound scale we have that we expect improvements there as well. Reducing medical costs take the shape of managing our network costs more intelligently. And we've been working with our provider partners to produce 1-day inpatient stays were medically appropriate and other things like that. There's one thing we haven't talked as much about, which is investment income. We do have $3 billion of cash and short-term investments and used to have 0% yield on those. And now that's not the case anymore. In fact, in the fourth quarter already, we've seen quite a bit of increase in investment income. And that, of course, will continue as we think throughout this year as well. And all of that, including in '23 being very focused on further optimization along these 4 lines, admin, total cost of care and so on, we think, positions us very well to -- even on the EBITDA for the total company produce a dramatically lower EBITDA loss in '23 year than what we had or guiding towards in 2022. And so, of course, that also puts us on the pathway towards in 2024, having a total company -- the total company breakeven. We'll take you through the full '23 guidance in the earnings call on February 9. We just announced that in the press release. And so hopefully, you're going to be able to listen in there as well. So that's clear now as an insurance company here, and so I think the profitability -- profitable insurance business with all the upsides of that is coming into full view now, but we're also very confident that we're doing this position very well among the larger market trends. And I said at the beginning, right, we wanted the company to do well in environments that is more consumerized, that is more digital and that is more shifted towards value. And that's exactly what we're seeing in the system in all kinds of ways. And that means for us 2 things. One is, I think it validates our strategy. I think we've been positioning ourselves well there. But we also think the more the market flips in these directions, it's a first move advantage of -- for us to be able to do that well. So I'll take you briefly what we're seeing there, both externally and internally. First, of course, a clear focus on the consumer. It's always been the DNA of Oscar. In an environment where the consumer has greater choice, greater visibility, I think that's a great environment, that's one we can thrive in. I don't have to tell you this. CMS said this morning, ACA, I think, is now about $60 million in sign-ups for this year. I think we're heading to the $20 million there. And before long Medicaid redetermination will start. Another at least 2 years of growth just from coming from that. And that makes this market pushing up against Medicare Advantage. And how short was that, right? 8 years were almost at the level of MA. After that market is 25 years or so at this point. And again, I think that will continue. I think a very interesting shift to watch, and I hear that in the rhetoric from other insurers now as well, is the shift of employers towards individual potentially. There's now a regulatory tool called individual coverage HRAs where employers could just give you stipends, pretax, and you buy your own plans. And we're starting to hear that from brokers in certain marketplaces. I think that's a powerful move. Define contribution style health insurance, right, long in the -- among the talking heads to discussion, now it could be a real thing. And anything that makes the ACA grow, one of the largest carriers there, will obviously be a good thing for Oscar. The second thing, digitization. Again, obvious, the markets will get more digital, right? Pandemic has further pushed us forward. We see a real value in that. The fact that we can very easily rejigger our systems is driving about $20 million in increased savings on the admin side going into 2023. Another example here is we have virtual primary care plan designs in now 5 states. About 0.5 million members have access to these. And when members of Oscar attribute themselves to an Oscar virtual primary care physician, there's about a 5% total cost of care reduction that comes from that in these plan designs. And I think overall, the industry has clearly woken up to power of digital and everything else, but -- whereas others have to either start from scratch there or stitch together a lot of different solutions. We really have built this with a very long-term architecture in minds and can connect the dots there nicely in full stack platform we have. Finally, value, of course. We have now 48% of members of Oscar attributed in some form of value-based care deal. And a bunch of these are upside only or some additional rewards and so on. But we have a good chunk now also in really fully capitated global risk upside/downside deals and really think are pushing the envelope there and are constantly working with provider partners, provider groups, health systems to push members further into that better outcomes, lower costs. Nothing to complain about there. And in fact, that is what I want to do my demo about as well. We can, I think, in a nice way, now use our technology stack to enable provider partners in risk deals. And that's a whole another growth story, I think, we have ahead of us. So the more individual, the more digital, the more value driven this market gets, I think the more well positioned we are for both members and for providers as well at the same time. One last slide before I pop into the demo. We talk a little about technology, and I sprinkled in a couple of examples for how the tech stack has really been able to help us. And again, I just really want to state this again, right? We doubled into last year, onboarded or re-onboarded 1 million members and still were able to get admin savings and MLR savings. I think that's not an easy feat. And if we didn't have that tech stack in-house, that just wouldn't have happened. I mean thinking of having to go to vendors to ask for charts and risk quotes and so on, I think it would have been nightmare there. And some key differentiator for technology stack, we chunk this up into 3 different categories what we've built. There is the engagement and growth platform we have. There was a payer admin and some automation platform, and there's everything we're doing on clinical engagements and analytics as well. Engagement growth includes obviously member experience, includes the broker experience actually as well. We've got a very nice broker web application, but also our CRM that we've built to engage members and providers alike. Hence, these tools help drive retention. We're seeing about 6 points higher retention of members who are digitally engaged versus those who are not year-over-year. And that's obviously deconfounding for all kinds of other influences like age and geography and things like that. So there's a really impact there. On the payer admin side, that's where that $20 million in savings comes in between last year and this year and just automating more, getting more engagements. Now we can do a lot more just through even -- just online nowadays, what I was -- one of my friends sent me this chart being with another unnamed insurance company where they asked for a cost estimate, and they said they can generate in 3 days, which is interesting. It's enough to fax probably something to the claim system, run it through. So -- and of course, we can do that in real time. And then finally, clinical enablement analytics platform. These are actually the tools that we use in our provider risk-based yields, and I'll take you through this. We think there's a lot more MLR points and growth we can get in just that part on the right side. +Oscar is our attempt to monetize this technology in different ways beyond the own insurance business. And so as you watch through the demo here and keep that in the back of your minds. The campaign builder tool, I will show, is a tool that right now we're selling as a module to provider partners and health systems and so on. Okay. So let's go into demo here actually, and then we can take some questions afterwards as well. It's always the best way to bring the technology to life and the experience to life. I think when we thought about what should we do here in the demo, we think about the 3 trends again. I think there's good evidence. We've got great member engagement. So I don't have to tell you that again. There's good evidence that we've got good digital tools. I don't have to show you that again. But how do we use the tech stack in the value-based deals? And that's a really interesting one. We haven't talked that much about. And that is a really important part of our strategy to push more towards value-based deals there for, of course, the MLR, but actually also the growth sites. In the ACA in particular, our network still rule the day, and the more you can incentivize the provider partners there to use their own brands to advertise the kind of plan that they're in with you, the better that is really for the overall book of business there, obviously, within the realm of what's regulatory possible there. So I will show what we are doing in that space. And I want to take 3 different perspectives. First is the perspective of the provider partner and what we let them look at from a data and insights perspective. That's sort of where we generate the insights. The second part is how we then use those insights and take action and run campaigns, do outreach to providers and members and so on and really just run that over and over again. And the third one is then how does that look through the eyes of the member because the member, of course, needs to be convinced in the end to take action on their own health care, and we can really help with that. Starting with this year, this is an actual but blinded dashboard that we get, that little demo thing there at the left. So there's no -- it is real data, but it's not -- but it's a blinded basically that we use in conversations with provider partners. And I'll show you a couple of things here. This, in particular, is a dashboard we look at. We use with provider partners, to look at how successful are we in step one, driving members into attribution with primary care physicians. And then step two, getting members to actually engage with the physician, right? Attribution is one step. Second step is you got to get them in for the annual wellness visits, follow-ups and things like that. We have a lot of control over that in some -- I saw a tweet the other day that's -- another insurer, that's a different one. And the other one I mentioned before, a member attributed to them to, I think, a pathology clinic as a risk-bearing PCP, and that does not bode well, I think, for the outcomes there. Maybe it's a coded message. So starting at the top here with how do we attribute members, and this is what we show the providers of the panel that we are giving to them, how many members are coming through just claims-based assignments, right, who do we see this with claims, who's going to which PCP, how many members do we assign demographically, where they live, who they are, things like that and how many members do we actually get into private practice because they go to the Oscar onboarding tools. And they select PCPs to us, and I'll show you that later on as well. And that 28% of the members who come to our tools, I have a -- we sort of have good evidence there that they might not have otherwise attribute themselves to that particular PCP, maybe not at all or maybe just our network somewhere or not -- or to a different PCP altogether. So we have just good control over driving one more assignment there. We score down here. The providers can pull this up and look at this, right, where membership is, where attribute -- how successful we are in different parts, in this case, Florida and attribution. But I want to show -- look at this chart down here. You see a particular provider group's -- doctor-level performance over here on the right side. And they can go and dig into that with us. But here on the left side, interesting charts where each dot is a provider in that particular group, and we can look at physicians who are in this bottom right quadrant here. These are doctors who have a lot of members -- present with members assigned to them, but they're not driving the annual preventative visits, right? So they have members assigned to them, but members are just not coming into the office. And that's clear just health care outcomes and money left on the table because you don't get the risk score, you can't put cap in some place and things like that. And so there's a real example now, what I'm going to show now. And the campaigns we run for these providers are campaigns that we say let's attribute first and then let's get members into -- in for annual wellness visits. And so how do we do that? That's where this campaign builder tool of Oscar comes in. And so again, that is a tool that we actually can sell and use commercially, not just for our own book of business, but for provider groups and health systems, other insurance book of business as well. It's an internal tool that lets us take any input data and drive really any output action. For example, we use this for bill payment reminders and for attribution obviously and for gap closure and for other things like that, appointment reminders as well. If you look at just this chart over here, right now, we run about -- there's about 182 active campaigns running against the overall Oscar membership. This is actually just looking at my -- at our own book of business now in January 23, right? And look how that came up through just last year as well. Even a year ago, we were only running 86 campaigns. We just have a lot more stuff running through the systems. And you can see there's a relatively recent development here as well. And so members have high engagements. If you go kind of further down here, which I won't do now, you see lot of members click through to the messaging we send and things like that. And I'll show this with the example of the campaign we're going to now look at. So this is now one of these campaigns. And this is again a real campaign that we run with certain provider groups across the country. And the idea of this campaign was drive annual preventative visits. And again, this is a copy and paste of that campaign, so I can mess with it a little bit without any danger here of messing anything up. But this campaign idea is members who haven't been to the doctor in a given year, get messaging, go to the doctor and why they should go and things like that. Right here from the get-go, right, you can see we can move this around here, obviously. We distinguish between chronically ill members and healthy members. And that is part of our insights. That's clinically ill folks tend to respond better to messaging around their relationship with a provider, long-term relationship, whereas healthy people respond more towards messages around convenience. And so you really want to squeeze out every bit of response metric on the member you can by tailoring the messaging in this way. Then in this case, we branched by geographic region for these different segments, just all -- these are all Florida rating regions or counties. And we branch further, and we said, some people should get an e-mail, obviously get a secure message. And obviously, we can do other things like that. Here's a fun one, we can send the fax if we want to, not recommended, but it is in there as well or a letter, leave that to the other insurers. So it's very easy for the providers to customize this with us, right? Here, you can see the sort of very tailored messaging. Have you booked your visit with your doctor? Fill in the blanks, yes. And the systems can fill this in automatically because again, we know the members attribute a doctor. And by the way, if you go to a different doctor, we see that in the claims, and we can reattribute you automatically. You see the messaging around provider [indiscernible] dollars, right, and things like that. So that's running in this campaign. And once we go here, which I shouldn't do now. Down here, we view and launch. This thing will just run. It will pick up on members who in the claims haven't seen a physician, and they'll start pushing up messaging and follow up and things like that. Okay. Now I want to flip over to the member's view. And of course, I got locked out. Sorry for that. Let's see if I can see log in here. No. Okay. So I got to briefly flip over. Sorry. That's the issue with the demo. But you can see it's all real at least. Getting to this member account here. So this is a member account from a member who -- it's not a real member in this case, of course. But the plenty of members exactly like this going through onboarding, really write this moment. I think this is a member we placed into Florida in this case. And so I want to show you 2 things very quick and how this looks to the member, starting with how it looks to choose your PCP, right? Again, this is sort of where you can let us stray very, very quickly. You come into the -- this is the member's websites. You come in here, obviously, see them in the mobile app, says choose your primary care provider, required in this case. So we can do that differently. We can just -- either you search a provider, of course, if you already know where you want to go, or we say your provider is near you. And we take you into the Oscar care router. That's a long-standing piece of technology we built over the years. And this care router ranks these physicians on the left here based on quality of outcomes, based on member experience, based on cost of care efficiency, based on availability and stuff like that. And you see [ Dr. Robles ], for example, gets a badge for being great at preventative screening. And so I can click through here now and see that I think we're in the Orlando area here in this case. And so right then and there, you see how easy it was for me as a member to get attributer and go for this onboarding process. Now again, as I mentioned before, attribution is only part of the battle here. The annual checkup becomes the second important step. And then this, in this case, is one of these campaigns that we've been running there. This is yet another communication channel. This is not an email or a secure message. This is a banner in the app, but it's all driven by the same campaign or a logic. And look what happens when I click on here now, book you visit now. It opens this thing here. It's an applet actually. And what that means is that it will open anywhere, meaning if you get this link in, let's say, WhatsApp message, very popular, obviously, in South Florida, in particular, it will still open in the same way. I mean you don't have to log in. This is totally customizable. I think I asked the team earlier. It takes us 15 minutes to put this together. So if we want to slap some logo on or whatever or something else, very easy to do. And here, same message as you saw before, right? But even better, go in schedule now here. I get this appointment slots recommendation. And then -- I don't know why this is thinking here, but I should be able to then complete the appointments. And once I do that, then I get a little animation that rewards me for that. Maybe some available here, demo stuff here. But anyhow, this actually does work in person. It worked for me earlier as well. I mean that's how we're getting this engagement here, but it doesn't have -- it doesn't work -- yes, there we go. See, okay. Great. There's the animation and all that stuff, right? And again, this is all -- nothing up here demo URL, is a demo campaign, but it's really running at all points in time. So member experience very easily doable there, and we can use this for any kind of other campaign design as well. Then, of course, we sit down with the provider partners, and we look at the results on a regular basis. We have typically monthly joint operating committees with these providers. We can really take them through how the campaign is working. This is now, again, one of these real campaigns where they were about 2,900 members that we send this communication to. I think the rest here had already seen a PCP. That's why we didn't send it to them. And then 51% actually opened the e-mail or opened the message and went in there in read it. And then 17% actually we then saw within a month then go into the physician we recommended. And so that, from all we can tell is an incremental -- and we test against control groups, and we just drive incremental attribution and wellness, which is there as well. Provider partners love this because they just typically don't have the infrastructure to do this themselves. And we could just make this part of the risk deal there. And this is, of course, also a good proof point for them eventually going and saying, you want this for the rest of your book of business as well. One more thing before we go to questions here that I also want to briefly show. Here is another dashboard. Again, same kind of thing. We use this in exactly the shape and form for provider partners as well. This one looks at care gaps in this case. Again, you get NPIs here blinded. That's why it's the demo part here, and you see cervical cancer screening rates for these members. And the neat thing here is that you can compare low engaged members of Oscar with medium to high engaged members. So this is an engagement level that we ingest based on how are they using the app, the website, are they talking to us on the phone, to us in this case. And you actually nicely see that it drives up these care gap closures in a very nice way. And so this raises the question of what do we going to -- what do we do if we want to drive, let's say, colorectal cancer screenings? And then I want to briefly go back to the member up here again. And I should have blown this up a little more so we can see this better. So of course, we are going to design a campaign there that drives colorectal cancer screening. And that message came from the concierge team here in this case, right, down there. This is the messaging app with the customer service concierge team. And then you get this kind of a message here that says, "May, colonoscopies aren't so scary. Pretty quick and good for you." And -- but also, you can do a call test for free at home for $0. So get yourself checked. And you can just respond to this message, and we will send you these tests. So very powerful as well. And we had about -- I think, in this case, it was also about -- we should take a look here, this campaign here. About 68% actually engaged with this communication. And in this case, we had a control group. And the target group had 34% higher utilization of these at-home colorectal cancer screening tests than the control group. And so a really big lift in just closing those care gaps. And by the way, I do want to click on this link as well real quick. Back in the member app here. That's where we then say, "All right, if you want to see a gastroenterologist in the area, click here." And then the app goes in and will just -- in the meantime, as the thing is spinning here, generate cost estimates. And this is not something that's sort of prestored or precomputed or whatever. It actually calculates the customer by going through the claim system. And just literally -- just what happens is the claim is replicated and it comes back with a diagnostic colonoscopy will cost this member right now $100 with Dr. Molina, who is a real doctor in Orlando and Oscar pays $443 of that, right, don't use these indications, and whatever. So that's another really nice part of how we can tie this all together. So with that said, it's kind of the arc I wanted to show, right, and generate the insights, share lot of data with the physicians we have in risk deals and drive campaigns and sit side by side to design those in a good way and then look at how they perform and really drive the engagement to the member layers interfaces we have there. That's, I think, the sort of flywheel we like to think about in Oscar terms. That leaves one thing, which is to close out the presentation overall with some closing takeaways here. Again, as I said, I think the most important aspect of the company for this year is 2023 insurance company profitability. We reaffirm this. I hope I gave you some additional data points as to why we feel so confident about this, partly because of the fact that we just did a lot of the work already coming into the year. And that's the steppingstone towards total co profitability in 2024. The second thing is once you have a functioning insurance business that throws off EBITDA. We think that can just get better and better in inflationary times, probably not a bad thing there in a sense because rates will produce investment income rates -- premium rates in the marketplace, continue to drift up there. And I think we're just as a strong play in the ACA continue to benefit from all that. The third one is -- you hopefully saw this. This is really very much driven by tech rebuilds in very concrete ways, and there's opportunity of monetizing much more of this to +Oscar in the future as well. Once we've hit the insurer profitability, I think we have more -- even more proof points and more opportunities there. And the more the market shift towards consumerization, digitization, value-based care, I think the better positioned we will be because we don't have to go too many -- too much the outside world to ask commission to build something. We've got this internally on our own stack and feel great about this. So that's our confidence outlook on the next -- on this year, next year. February 9 earnings call, we'll do the guidance for 2023 and close out 2022, and looking forward to your questions.

Well, thanks very much, Mario. We have around just over 5 minutes left for Q&A. I'll start with one question and I'll open up to the floor. You mentioned +Oscar in your presentation. What's the latest strategy there? And how are you thinking about monetizing the tech?

Yes. I think what we're doing right now is we spent a lot of time in the last 18 months going through and saying what do we have there. And the conviction we really have is we have many components of our technology stack that have real economic value. And they have tremendous value if you apply them against bigger books of business that exists, whether it's in paying claims faster or in closing care gaps and other things like that. So that's really step 1. Step 2 is now how do we bring this to the markets. And so this year, we're focused on the campaign builder. You saw the tool. So a smaller PMPM play, but it is easy to deploy for us. It can get us into many more doors than otherwise with the bigger rollouts. And Scott Blackley, who was CFO until more recently when Sid came back, is now Chief Transformation Officer, is really fully focused on go-to-market there with partnerships, with other levers we can pull there, focus there. The bigger deals we want to make -- we continue to want to make, but we want to make sure we have the right, both enterprise sales function there and implementation as well, and that will just take us through this year to make sure that we have that in place.

Got it. Let's see if anyone in the floor has any questions. We have a microphone going around.