Oscar(OSCR) - 2025 Q1 - Earnings Call Transcript

Financial Data and Key Metrics Changes - Oscar Health reported total revenue of $3 billion in Q1 2025, a 42% increase year over year [5] - Net income was approximately$ 275 million, a significant improvement of $98 million over the prior year period [6][20] - Earnings from operations grew by$ 112 million to $297 million, with an operating margin of 9.8%, an increase of 110 basis points year over year [6][18] - The medical loss ratio (MLR) increased by 120 basis points year over year to 75.4% [6][15] - The SG&A ratio improved to 15.8%, a 260 basis point improvement year over year, marking the lowest in the company's history [6][17] Business Line Data and Key Metrics Changes - The company closed the quarter with approximately 2 million effectuated members, a 41% increase year over year [7][14] - Membership growth was driven by strong retention and above-market growth during open enrollment [14] Market Data and Key Metrics Changes - Oscar Health is deepening its market presence with new partnerships, including the launch of Oscar Community Resources with Find Help, connecting members to local services [8] - The company is experiencing high levels of digital engagement across its IFP and ICRA membership [7] Company Strategy and Development Direction - Oscar Health's strategic plan focuses on top-line growth, bottom-line performance, and margin expansion [6][12] - The company is advocating for constructive solutions to strengthen the individual market and is engaged with policymakers [10][11] - Oscar aims to create a marketplace that meets consumer and employer expectations for choice, quality, and affordability [12] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in achieving 2025 targets, citing disciplined execution and strong growth [12][22] - The current policy environment, including proposed CMS initiatives, is viewed as positive for long-term market sustainability, despite potential enrollment constraints [10][11] - Management anticipates membership trends to increase in the first half of the year but expects a decline in the latter half due to policy changes [29] Other Important Information - The company reaffirmed its full-year guidance metrics, expecting total revenue in the range of$ 11.2 billion to $11.3 billion for 2025 [21] - Oscar Health's capital position remains strong, with approximately$ 4.9 billion in cash and investments [20] Q&A Session Summary Question: Membership expectations for the second quarter and the rest of the year - Management expects membership to trend up in the first half of the year but anticipates a decline in the latter half due to policy changes [28][30] Question: Context around grace period membership and its impact - Management indicated that the gap between effectuated and paid membership is expected to normalize, with a portion of members ending their grace period [34] Question: Utilization patterns between new and retired members - Management noted higher inpatient utilization with favorable pharmacy trends, but no specific condition was driving the inpatient increase [39] Question: Opportunities and risks around competitor exits - Management views competitor exits as an opportunity to attract members and maintain disciplined pricing in the market [42][58] Question: Regulatory environment and enrollment changes - Management supports CMS efforts to strengthen the ACA but expressed concerns about the shortened enrollment period affecting consumer shopping [48] Question: Risk adjustment expectations for 2025 - Management indicated no significant adjustments to risk adjustment payables at this time, but elevated claims could impact future percentages [60] Question: Drivers of SG&A performance - Management attributed SG&A improvements to fixed cost leverage, variable cost efficiencies, and lower exchange fee rates [70][71] Question: Valuation concerns and fraudulent member estimates - Management is conducting its own analysis regarding fraudulent members and remains committed to long-term targets despite market challenges [75] Question: CSR refund proposal and its implications - Management expressed concerns about the practical implementation of CSR refunds and recommended against moving forward with the proposal for 2026 [80]