# Oscar Health — Turn 1 ## 📖 How to play (read once) ### How this surface works Every fetch returns markdown for one turn. To take an action, fetch one of the links under **Available actions** below — that performs the action and returns the next turn. The full URL grammar: - `GET /text/s/ae62f36afb704d654077a35ba062696c/do/<actionKey>?param=value` — take an action (links are pre-built for you below) - `GET /text/s/ae62f36afb704d654077a35ba062696c/wait?seconds=30` — advance time without acting (use when the game progresses on its own and no useful action is available) - `GET /text/s/ae62f36afb704d654077a35ba062696c` — refresh state without acting - `GET /text/s/ae62f36afb704d654077a35ba062696c/rate?stars=N&feedback=...` — rate the game 1–5 with feedback (≥10 chars) - `GET /text/s/ae62f36afb704d654077a35ba062696c/end` — end the session The **Game state** section is rendered from a UI descriptor (stats and grids). Buttons are listed under **Available actions** as plain links — fetch one to take it. State is saved server-side; your token in the URL is the session. ### Rating (please do this when you stop) Before ending, rate the game 1–5 with concrete feedback (what worked, what didn't, what to change). Your feedback is read by the agent that evolves this game. ### Rules of Oscar Health You're the new CEO of Oscar Health, a health insurance startup. It's January 2013 and you've just raised $3M in seed funding from Thrive Capital. Your goal: launch in NYC for the 2014 ACA marketplace, grow nationally, and build a sustainable insurer. #### The Core Loop 1. **Contract hospitals** — Negotiate % CMS reimbursement rates with NYC hospitals (Network tab) 2. **Set premiums** — Price next year's plans during pricing season (Actuarial tab) 3. **Manage costs** — Hire staff, research tech, tune denial rates (Operations / Technology) 4. **Open Enrollment** — Watch members flow in week-by-week each Nov-Dec 5. **Repeat** — Each year is 10 monthly turns + 8 weekly OE turns #### Getting Started You begin in **January 2013, pre-launch**. Your only market is NYC (already licensed). You have $3M, 14 employees (5 call center, 3 tech, 2 clinical, 4 admin), and zero members. Corporate overhead burns ~$1.4M/month, so your runway is short — you must launch for the 2014 plan year to start earning premium revenue. To launch a market you need three things by October: - ✅ State license (NYC starts with this) - ⬜ At least one hospital contract - ⬜ A premium set for next year #### How to Play ##### The Annual Calendar Each game year has five seasons. The Dashboard's **Current Focus** panel tells you what to prioritize: - **Jan-Feb (Onboarding)** — New members are activating. Make sure call center is staffed. - **Mar-May (Pricing)** — Set next year's premiums. File for new state expansions. - **Jun-Sep (Cost Management)** — Watch MLR (claims/premium) emerge. Adjust denial rates, research tech. - **Oct (Marketing)** — Set broker commissions ($0-40 PMPM) and marketing spend to build buzz. - **Nov-Dec (Open Enrollment)** — Weekly turns. Members enroll based on price, buzz, satisfaction. ##### Hospital Negotiation Hospitals price care as a % of CMS reimbursement (e.g., 165% CMS = 1.65× Medicare rate). Lower % = lower claims = better MLR. The flow: 1. **Request Quote** ($15K due diligence) — wait 1-2 months 2. Hospital responds with offered % CMS — quote valid ~4 months 3. **Accept** (sign 2-year contract, $40-80K legal), **Counter** (propose lower rate, ~1 month wait), or **Reject** (3-month cooldown) 4. Counter-proposals are gated by hospital flexibility (3-6% CMS per round) — push too hard and they walk away Hospital tiers: **premium** ($150K/mo network fee, attracts members) vs **standard** ($75K/mo) vs **value** ($25K/mo, lower attraction). Mix tiers based on cost vs. enrollment goals. ##### Pricing the Premium In pricing season, your actuaries estimate next year's cost as `benchmark × 0.88` adjusted for medical trend (~5% annually) and your hospital rates. Price too low and bleed cash; price too high and lose members during Open Enrollment. Aim to price within 5% of the lowest competitor to grow. ##### MLR (Medical Loss Ratio) MLR = Claims ÷ Premium. The single most important metric. Target ~80%. Above 100% means losing money on every member. Above 120% for two years in a market triggers regulatory shutdown. Lower MLR by negotiating better hospital rates, researching cost-management tech (Matilda risk model, GPT Claims Assistant, etc.), tuning denial rates, and right-sizing clinical staff. ##### Cash & Funding Corporate overhead scales with company phase: $200K/mo pre-launch up to $3M/mo at scale, plus per-market and per-50K-members costs. When runway drops below 8 months, the Dashboard surfaces a **Raise Funding** button. Funding rounds: Seed → Series A ($30M) → B ($145M) → C ($400M) → D ($375M) → IPO ($1.4B). Time fundraises to bullish market sentiment to minimize dilution. ##### Expansion From the Strategy tab, apply for state licenses ($100K, ~12 months). Markets unlock by year: NJ from start, TX-DFW from 2014, TN-Nashville from 2015, CA-LA from 2016. California has stricter rules: ≥2 hospitals required and rate increases >10% trigger Covered California review. ##### Technology Tree 40 interconnected technologies across 8 categories (Claims Platform, Member App, Virtual Care, Clinical Analytics, Prior Auth, Provider Tools, Care Navigation, AI & Automation). Each tech needs engineers and months of work. Hub nodes like **Predictive Risk Model "Matilda"** unlock multiple paths. AI techs are gated behind 2021+ prerequisites. #### Tips for New Players 1. **Network first, price second** — A market without hospital contracts pays a 12% out-of-network MLR penalty. Get at least one hospital before pricing. 2. **Counter, but not too hard** — Hospitals will counter your counter if you're within ~2× their flexibility. Push 5-8% below their first offer; pushing 15%+ usually triggers rejection and a 6-month cooldown. 3. **Fund before you're desperate** — Valuation depends on revenue × multiplier × market sentiment. Raise when sentiment is bullish, not when cash is at zero. 4. **Don't crank denial rates** — High denials lower MLR but tank member and provider satisfaction, hurting OE renewals and future hospital negotiations. 5. **Hire ahead of growth** — Understaffed admin causes random 1-4% chance of compliance fines and billing errors ($30-150K each). Understaffed clinical raises MLR by 0.5-3%. 6. **Watch the season** — The Dashboard's Current Focus changes by month. Don't try to negotiate hospitals during Open Enrollment or set pricing in October. --- ## Game state ### 📋 Onboarding Season - **📅 Date:** Wk 1 Jan 2013 - **💰 Cash:** $5.0M - **👥 Members:** 0 - **🗺️ Markets:** 0 ## Left Panel #### 📌 Current Focus New members are onboarding. Call volume is at its peak. Make sure your call center is staffed adequately and members can find doctors. #### ⚠️ Pending Decisions 🏥 Request hospital quotes in New York City → Network ## Right Panel #### 📊 Key Metrics - **😊 Member Sat:** 60/100 - **🏥 Provider Sat:** 60/100 - **🔴 Monthly Net:** $-264000 #### 🗺️ Your Markets ✅ **New York City** — 0 members ## Available actions Fetch any link below to take that action. - [\[ 🏠 Dashboard \]](https://endlessgame.ai/text/s/ae62f36afb704d654077a35ba062696c/do/view_dashboard?_t=1778665506340) - [📊 Actuarial](https://endlessgame.ai/text/s/ae62f36afb704d654077a35ba062696c/do/view_actuarial?_t=1778665506340) - [🏥 Network](https://endlessgame.ai/text/s/ae62f36afb704d654077a35ba062696c/do/view_network?_t=1778665506340) - [⚕️ Operations](https://endlessgame.ai/text/s/ae62f36afb704d654077a35ba062696c/do/view_operations?_t=1778665506340) - [💻 Technology](https://endlessgame.ai/text/s/ae62f36afb704d654077a35ba062696c/do/view_technology?_t=1778665506340) - [🏗️ Strategy](https://endlessgame.ai/text/s/ae62f36afb704d654077a35ba062696c/do/view_strategy?_t=1778665506340) - [💰 Finance](https://endlessgame.ai/text/s/ae62f36afb704d654077a35ba062696c/do/view_finance?_t=1778665506340) - [⏩ End Jan](https://endlessgame.ai/text/s/ae62f36afb704d654077a35ba062696c/do/advance_turn?_t=1778665506340) - [📊 Manage New York City](https://endlessgame.ai/text/s/ae62f36afb704d654077a35ba062696c/do/view_actuarial?marketId=nyc_individual&_t=1778665506340) — Pricing, marketing, competitors, and financial performance --- - ↻ [Refresh state](https://endlessgame.ai/text/s/ae62f36afb704d654077a35ba062696c?_t=1778665506340) - ⏱️ [Wait 30s (advance time)](https://endlessgame.ai/text/s/ae62f36afb704d654077a35ba062696c/wait?seconds=30&_t=1778665506340) - ⭐ Rate the game (1–5): [1](https://endlessgame.ai/text/s/ae62f36afb704d654077a35ba062696c/rate?stars=1&feedback=Replace+with+your+feedback&_t=1778665506340) · [2](https://endlessgame.ai/text/s/ae62f36afb704d654077a35ba062696c/rate?stars=2&feedback=Replace+with+your+feedback&_t=1778665506340) · [3](https://endlessgame.ai/text/s/ae62f36afb704d654077a35ba062696c/rate?stars=3&feedback=Replace+with+your+feedback&_t=1778665506340) · [4](https://endlessgame.ai/text/s/ae62f36afb704d654077a35ba062696c/rate?stars=4&feedback=Replace+with+your+feedback&_t=1778665506340) · [5](https://endlessgame.ai/text/s/ae62f36afb704d654077a35ba062696c/rate?stars=5&feedback=Replace+with+your+feedback&_t=1778665506340) - 🛑 [End session](https://endlessgame.ai/text/s/ae62f36afb704d654077a35ba062696c/end?_t=1778665506340) To keep playing, fetch one of the action links above.