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Newer players making mark as 288K-plus sign up for Obamacare in N.J.

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New Jersey's numbers continue to climb in the health care marketplace, and newer faces are succeeding in grabbing a slice of the membership pie.

Overall, 288,573 individuals in the state signed up for individual plans in 2016 through the Affordable Care Act, according to numbers released by the Centers for Medicare and Medicaid Services.

And while the traditional players tell NJBIZ they have yet to analyze their data, two relatively new faces saw a significant increase in members.

Among the individual plans, there is Oscar, the billion-dollar startup based in New York City that has since spilled over the river into New Jersey.

The company previously reported more than 100,000 members, of which 4,000 were in New Jersey.

This year, after open enrollment, there are more than 25,000 members in New Jersey, Oscar told NJBIZ.

Oscar, which has a robust online platform, continues to grow as it gets more funding, and has already attracted more than $1 billion from investors such as Goldman Sachs and Google.

On the Medicare Advantage side, Clover Health has seen a doubling of its enrollees, to 16,000 in nine New Jersey counties.

The data-driven insurance company was born in Hudson County when co-founders Kris Gale and CarePoint Health co-founder Vivek Garipalli teamed up in August 2014.

The doubling of enrollees, and thereby revenue, also means hiring new staff to handle more members, Gale said.

Since 2014, Clover — now based in San Francisco — has received a few rounds of funding from investors, totaling more than $100 million, as well as a recent $35 million infusion for technology expansion.

Clover began as a Medicare Advantage plan branded under the CarePoint name, but has since broken off and is now headquartered in the Bay Area.

The move to California has proved beneficial to further its goal of expanding the “made-from-scratch” software and tech advances Clover has in mind, according to Gale.

Interest in Clover in New Jersey has seen an increase mostly due to the plan design, according to brokers, Gale said.

“People responded pretty well to it,” Gale said.

The secret sauce is charging the same copay whether the provider is in or out of network, as well as not requiring referrals to see specialists, Gale said. “It simplifies the process for seeing a cardiologist or an endocrinologist, for example.”

“The thesis here is, as an insurance company, we pay for very expensive, negative, health outcomes of poorly managed chronic diseases,” Gale said.

The business model focuses on outcomes and, as a result, it needs targeted software and data science.

A recent from-scratch project was completed to predict complications of diabetes in individuals who have already been diagnosed. Riskiest members are prioritized for follow-ups, Gale said.

Lots of software and data analysis goes into this, to identify opportunities to make meaningful health outcomes.

And Clover hopes to continue to roll out tools like that, as well as expand its footprint in the state.

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Anjalee Khemlani

Anjalee Khemlani


Anjalee Khemlani covers health care. You can contact her at anjaleek@njbiz.com.

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