Rethinking the Member Experience for HMO plans 

In 2025, Oscar introduced a new Health Maintenance Organization (HMO) plan type as part of our product offering. We set out to create a differentiated HMO (or HMOscar) experience for our members, one that aimed to dispel the commonly perceived HMO-related pain points, tackling negative HMO perceptions through increased transparency, ease of management for pre and post-care related needs, and streamlined access to care.

For those unfamiliar with HMOs, this type of plan funnels all care through one’s Primary Care Provider (PCP), meaning that patients rely on their PCPs to refer them to specialists and other necessary care. With HMOs, PCPs provide longitudinal, comprehensive care, and coordinate all specialty care for their patients. While this concept promotes positive health outcomes for patients¹, it has historically been perceived with mixed feelings by shoppers and utilizers of such plans. Most of the negative connotations around HMOs refer to the gate-kept nature of such plans, and the fear of experiencing delays in getting care. While we noodled on ideas towards reducing this friction, our first action was focused on hearing directly from our members. 

Discovery mode

As we embarked on the discovery phase, we were faced with a challenge: how could we learn about real member experiences with HMO plans, without having yet offered HMO plans in the first place? We got creative—we sought out existing Oscar members who have participated in HMO plans  with other insurance companies in recent years so that we could understand their perceptions and past interactions with such plans. While recruitment was challenging, we learned what drew members to HMOs in the past, how they navigated their plans, and why they ultimately decided to leave. This study confirmed some of our hypotheses around these questions, and identified clear points of friction we knew we had a chance to address through our member experience. Information from this study, alongside a literature review & competitive analysis, fed into early ideation and explorations around the member experience. We quickly realized that we had the opportunity to rethink several aspects of our digital member experience to suit the needs of our new HMO members more specifically, and create a future vision for this product.

Exploratory mode

Following a team mapping exercise where we laid out the potential impact of HMO across the end to end member experience, we saw an opportunity to first explore what a future vision of HMOscar could hold, before scaling it back to an achievable experience for year one. Combining our research insights with a literature review, and leaning on design psychology principles, we ran a design sprint to address the opportunities around onboarding to an HMO plan, PCP selection and assignment, and management of referrals. This effort allowed us to identify the primary set of member needs and opportunities of this new offering, while laying out a longer term vision for continuous delivery of the differentiated experience we set out to create, for our members.

Focus mode 

Moving full steam ahead towards our summer testing deadlines, we pushed on the following areas of the member experience: 

1. Simplifying onboarding

Healthcare onboarding is seldom memorable. We wanted to make onboarding easy, informative, and focused on the most critical member actions for this moment. We observed that with our previous multi-step onboarding flow we saw a 35% completion rate (within 30 days of enrollment). Our focus turned to simplifying this process into a single step, reducing the cognitive load and time to completion, bringing members to their home base faster. Drawing from theory (like Zeigarnik effect² and motivations research), we created a checklist and progress bar to encourage completing onboarding tasks, directly from the member’s homepage. To ensure consistency of messaging, we collaborated closely with the marketing team to align on cohesive visuals across our communication channels. With this set of changes, our new onboarding process saw an 87% completion rate - that’s an improvement of ~50 percentage points!

Still, when it comes to learning about an HMO plan, experience is the best teacher. Onboarding doesn’t stop at the point of enrollment or creating one’s digital account—it follows each and every care need that a member might have throughout their time with Oscar. We continue to support Oscar members throughout their care journey with Oscar, and aim to provide guidance prior, during, and after receiving care, learning and iterating along the way. 

2. Making PCP selection easy-peasy

Primary Care Providers (PCPs) are the quarterbacks of one’s health and drive behavior as it relates to navigating HMO plans. For members enrolling onto HMO plans, having a say in PCP selection is important. We learned that while some members have a long standing relationship with their PCP, others are eager to explore new options, and others may not want to be bothered with selection until a need arises. So, we wanted to offer a PCP selection experience that would work across a variety of scenarios, such as (1) searching for and selecting a specific provider, (2) browsing provider options based on preferences, (3) seeing recommendations of providers that are personalized to me, and (4) being automatically matched with providers based on identified criteria. Beyond the basics of building out a native mobile and web experience to match these needs, we also enabled selection for dependents / families.

With the PCP at the center of members’ care in HMO plans, we knew that driving healthy behavior does not stop at successful PCP selection. As part of this effort, we evolved the member’s homepage to respond to pcp selection / matching, offering the most appropriate ways of getting in touch, receiving care, or requesting a referral. In the future, we plan to enhance the richness of provider profiles, and allow smarter matching to continue to make self-selection an appealing and easy option. For now, we’re observing ~ 30% increase in our digital PCP selection rate for HMO plans compared to our baseline selection rate for EPO plans.

3. Crystal clear referrals

We knew from research that long wait times for referral approval drives consumers away from HMO plans. As we set out to bring transparency to this confusing portion of HMO plans, we learned that member perception around referrals is similar to prior authorizations, meaning, both are perceived as approvals towards receiving care. We used this as an opportunity to align with members’ mental models and take a more holistic approach to how we show this new information, providing clarity and control across both referrals and prior auths from a single place in the app.

4. Connecting to virtual care

The referral process can be cumbersome for members on HMO plans. If someone is in need of specialist care but is unable to get in touch with their PCP, we did not want to leave them stranded. As part of HMOscar plans, we are able to connect members to Oscar’s Virtual Urgent Care, a backup option for obtaining a referral. With some utilization guardrails in place, members can enjoy uninterrupted access to care in times of need. 

Validation & launch mode

With key features built and ready for QA ahead of Open Enrollment season, we kicked off an end-to-end usability study with our members, to make sure everything was up to snuff. This allowed us to uncover any remaining inconsistencies and opportunities which we were able to prioritize ahead of launch time. We’re committed to continuing to make this a frictionless and dependable experience for our members.
It might be hard to envision all of these pieces fitting in together. So, we invite you to check out this press release video for a narrated walkthrough of Oscar’s new HMO plan experience. This work represents the efforts of individuals across many teams - from product and design, to brand, research, engineering and data. We hope you enjoy. 

1 The Impact of Primary Care: A Focused Review - PMC  2 Zeigarnik Effect | Laws of UX