Summary

Oscar Health’s CEO — and former Aetna Chairman & CEO — Mark Bertolini breaks down how incentives, technology, and market design are reshaping the future of U.S. healthcare. From reengineering Oscar’s operating model to exposing structural flaws across payer economics, Bertolini unpacks why consumers lack meaningful choice, how ACA marketplaces actually function, and why AI-native platforms are redefining what an insurer can be. In this episode of Analyzing Healthcare, host Roy Bejarano sits down with Mark Bertolini, CEO of Oscar Health, to explore the transformation of payer strategy, the economics behind insurance competition, and how Oscar’s platform leverages AI and unified data to reduce operating costs and build personalized member experiences.The conversation spans payer incentives, ACA dynamics, organizational redesign, network strategy, consumer choice, and why AI-driven infrastructure will define the next decade of healthcare modernization.

Title Can Oscar Health Redefine the Future of U.S. Insurance? — Mark Bertolini, CEO Oscar Health x SCALE Community

What You’ll Learn

✅ Why legacy healthcare incentives block true competition and cost control

✅ How Oscar rebuilt its cost structure through AI and unified data architecture

✅ Why individualized plans outperform employer-designed insurance

✅ How ACA marketplaces create real consumer choice — and what still needs fixing

✅ Why value-based care often fails to change clinician behavior

✅ What the future of payers looks like in an AI-driven environment

Subscribe

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Timestamps

• (00:00) Introduction to Mark Bertolini & Oscar Health

• (01:40) Mark’s engineering mindset & leadership approach

• (03:20) Why healthcare hasn’t improved in 30+ years

• (06:00) Culture lessons from Aetna, Cigna & Oscar

• (07:20) Trust, leadership, and organizational change

• (12:20) How payer competition really works

• (16:00) Why U.S. healthcare incentives collide

• (18:20) Why Mark joined Oscar & the turnaround thesis

• (21:50) Rebuilding Oscar’s operations & cost structure

• (23:30) Why personalized networks outperform broad networks

• (27:40) ACA trend reality vs. public perception

• (31:30) Consumer choice & individual plan selection

• (36:00) AI, LLMs & the future of payer infrastructure

• (39:50) Why value-based care rarely changes behavior

• (41:15) The future: account-based insurance for all

Key Takeaways

• 💎 The ACA’s per-capita trend is stable — contrary to public perception

• 💎 Consumers make better insurance decisions when choosing for themselves

• 💎 Oscar’s AI-native infrastructure reduces admin costs and improves accuracy

• 💎 Narrow networks work best when built around individual preferences

• 💎 The U.S. system struggles because economic incentives collide

• 💎 Value-based care only works when excellence exists before contracting

• 💎 The future is account-based coverage where every American selects their own plan

Resource Links

Guest: Mark Bertolini – ⁠linkedin.com/in/markbertolini⁠

Host: Roy Bejarano – ⁠linkedin.com/in/roy-bejarano-a5669ba8⁠

Organization: ⁠www.scale-community.com⁠

Podcast Hub: Analyzing Healthcare by SCALE Community

Guest Bio Mark T. Bertolini, CEO of Oscar Health and former Chairman & CEO of Aetna, is widely regarded as one of the most influential leaders in U.S. healthcare. He is known for redesigning payer models, elevating consumer choice, and steering Aetna’s transformation into a technology-enabled, integrated care organization. A former Co-CEO of Bridgewater Associates, he brings deep operational and strategic expertise. At Oscar, he is leading a focused turnaround centered on AI-native systems, personalized networks, and modern operating infrastructure.

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