Hello, all, and welcome. My name is Fawzi Kawash, and I'm an Associate at JP Morgan. It's my pleasure to introduce Mario, Co-founder and CEO of Oscar Health. With that, I'll hand it over to you, Mario.
Thank you. It's great to be here, it's great to see so many friendly faces. That's real commitment to show up at this time of the day to do a presentation, thank you. Thanks to those listening on the webcast as well. I want to take you through where we are in the company. You can read this yourself. Disclaimer is here. I'm sure they're on the website as well. Cornelia can read them out to you afterwards. We started just about 10 years ago at this point, the company started really in anticipation of three broad trends we think rippling through the U.S. healthcare system. Shift towards consumerization, shift towards digitization, shift towards value.
Against that backdrop, it's been our strong belief that you need a digitally native payer to really take advantage of these kind of trends. Today, from where we sit, we're convinced that these really are the trends, that the system, the U.S. healthcare system, is on an unstoppable path towards, and that we, as Oscar, can thrive uniquely well in such a system because of the investments we've made into our technology stack and member engagements that makes us quite unique. On the flip side, we're quite aware that we have not yet demonstrated that we can do this as a profitable business. One of the things I wanna make sure I bring to you today is that we are delivering on this very crucial profitability milestone for the company. 'Cause we're now a scaled health insurer.
We now have higher member engagements than we think most others, and we have built all of this on our own technology stack, and those are three very unique pieces that others can't bring together. That lets us affirm a couple of things. Number one, we landed a membership for 2023 right against our goals, where we wanted them, we wanted that number to be. Number two, we believe, and we expect our insurance business to be profitable in 2023. Number three is that we believe a lot of the actions we've already taken, and I'll take you through this later, that really are already baked into the P&L, have not really been baked into the street's estimates. Number four, that we've remained firmly on the path to total company profitability for 2024.
Through presentation today, I hope you will see we have a clear actual path towards all this with some of the building blocks already clearly in place. I will start with the track record and where we are as of now. We're now a company with over 1 million members over the third quarter last year. We're driving approximately $7 billion of Direct and Assumed Policy Premiums in 2022, and that's a 75% compound annual growth rates over the past five years. It's actually six years now. Even with this, I'd call it a momentous, tremendous top-line growth, we've been able to drive more than 10 points of MLR improvement over the same time periods.
That, I think, we internally tie directly to the fact that we have industry-leading member engagements and that we have built this all on our own technology stack. That's really shown up in all kinds of ways. One tiny example, about 66% of Oscar members with an account utilize our tools to find doctors. In fact, I should say this right now, half of my presentation will be a couple slides. The other half will be a demo. I thought of either doing an expressive dance or a demo to, you know, entertain people at this time of the conference, but I'll stick with the demo here for now. The members love the experience. We are at a 45 point Net Promoter Score as of the third quarter. Industry average still stuck around three.
For those members, the technology and the engagement is lowering costs as well. Members who go to a physician that we recommend, that we route them to, generate about 11% cost savings versus not following our advice. The track that we now have, that I think you see on the slide here, is one of strong growth with improved profitability, right? Really improving at the same time MLR admin costs and then, of course, continuing to grow. I wanna take a closer look at 2022 and how it sits on the pathway towards InsurCo and then Total Co profitability.
At the start of 2022, we set out to deliver five points of insurance company combined ratio improvements, taking us to, for last year, 104%-106% combined ratio for the insurance companies. Again, that's against a backdrop of going into 2022, 80% year-over-year membership growth and 100% premium growth, top line growth. It was really very much down to our tech and our systems that we were able to effectively and efficiently onboard and serve these 1 million members last year, that we were able to also manage medical costs along the way. We therefore, we put out the 8-K a couple days ago, can affirm and confirm that we're gonna be at the midpoint of the 84%-86% medical loss ratio for 2022.
That's about a 400 basis point year-over-year improvements between 2021 and 2022. Despite that very significant growth going into last year, we at the same time have been executing on the expense reduction plan we've had, and we expect that our Adjusted Admin Expense Ratio is also coming down by about 400 basis points year-over-year into 2022. That, of course, all ladders up to a meaningful adjusted EBITDA loss margin improvements with about 700 basis points of adjusted EBITDA margin improvements as % of premiums in 2022 as well. That's 2022, and that's obviously now in the rear view mirror. Of course, in insurance land, that's a very important jumping off points for our goals in 2023.
There we are really very proud and happy to reaffirm that we expect insurance company profitability in 2023, meaning combined ratio medical costs plus admin ratio under 100%. I said this at the beginning, and I wanna reiterate this here with a bit more, more details. It is easy to miss that in health insurance, a lot of the cake gets baked before the year even starts. This slide here is supposed to really bring that, bring that, bring that across. We've already taken steps for margin expansion for 2023. We've already driven down admin costs by $120 million year-over-year, and we've already been able to slow the growth of our medical costs at the same time. I'll take you through the specifics here of these four different areas that we've been focused on here.
Starting with the pricing there, we took a high single-digit rate increase between 2022 and 2023, on average across the insurance book. That was above loss cost trends in the broad region in the marketplace. Despite that, really, we are about to wrap up another successful open enrollment periods, where the results are right in line with our goals. We expect 2023 membership to be roughly flat year-over-year at approximately 1 million members. Really repeating what we did last year there in terms of overall membership base. We did, before open enrollment started, engage proactively some of our regulators, and we asked for a membership cap in Florida. That is our most capital-intensive state. We are not a so-called seasoned insurance company. We're in year four.
In year five, that should flip over, have to therefore hold more capital like others, and did not want to potentially get too many members of players exiting the markets there. Irrespective of the actions of others in the marketplace, that cap ensured that we would land a membership number where we wanted it to really land. Second point here, market and product actions and optimization. We think those will drive improved performance in MLR and admin ratio in 2023. Here, for example, we exited underperforming ACA states, Colorado and Arkansas in particular, and we left the Oscar organic MA business in New York, in the Bronx, and in Houston, Texas as well.
We're also always optimizing our plan design portfolio to create more balance towards profitable plan designs and products that we think really work for members and for us on the MLR side as well. Both of these are baked, right? Pricing is in place. Open enrollment is virtually over. Products are optimized, states are left, that one we can put to 100% of the work that had to be done. On admin, we're about three-quarters of the way there, I would say, in terms of the work we have to do this year. We've got line of sights into delivering $120 million in year-over-year total company admin expense improvements. The majority of that is gonna flow to the insurance companies. That, for example, was driven by reducing our member acquisition costs.
We reduced commissions by quite a bit across the markets we are in. We managed our fixed costs very tightly by looking very carefully at headcount throughout the year. We did have a limited reduction force in the fourth quarter as well in 2022. Heading into 2023 now, we think our runway costs that we want, that we need, are tracking right to plan. One benefit we're certainly seeing here is the benefit of scale. We're a scale insurance player now. We're, I think, don't quote me on this one, the second-biggest ACA player still in the market now, somewhere along those lines. That gives us, you know, quite a bit of sway in renegotiating, for example, vendor contracts and bringing down unit costs there. An example would be chart retrieval costs.
That happens often through vendors who go into the practice and take, you know, pictures, photocopies or whatever, if we don't have an EHR integration, which we also have in many cases. Those are the kind of vendors we were able to press down on the costs, and that flows to, of course, the admin ratio and the overall profitability. Finally, total cost of care savings, a whole number of things there. A big one is we're bidding out our PBM contract again. I think we're one of the biggest players again there as well that's coming to market with a large book of business. This is one of the outcomes of the newfound scale we have, that we expect improvements there as well. Reducing medical costs takes the shape of managing our net prom costs more intelligently.
We've been working with our provider partners to reduce one-day inpatient stays where medically appropriate and other things like that. There's one thing we haven't talked as much about, which is investment income. We do have $3 billion of cash and short-term investments, you know, used to have 0% year or most, now that's not the case anymore. In fact, in the fourth quarter already, we've seen quite a bit of increase there in investment income, that, of course, will continue as we think throughout this year as well.
All of that, including in 2023 being very focused on further optimization along these four lines, admin, total cost of care, and so on, we think positions us very well to, even on the EBITDA for the total company, produce a dramatically lower EBITDA loss in 2023 than what we had or guiding towards in 2022. Of course, then also puts us on the pathway towards in 2024 having the total company break even. We'll take you through the full 2023 guidance in the earnings call on February ninth. We just announced that in the press release, hopefully you're gonna be able to listen in there as well. That's clear now as an insurance company here, and I think the profitability, a profitable insurance business with all the upsides of that, is coming into full view now.
We're also very confident that we're doing this position very well among the larger market trends. I said at the beginning, right, we wanted the company to do well in an environment that is more consumerized, that is more digital, and that is more shifted towards value. That's exactly what we're seeing in the system in all kinds of ways. That means for us two things. One is, I think it values, it validates our strategy. I think we've been, you know, positioning ourselves well there. We also think the more the market flips in these directions, it's a first-move advantage of sorts for us to be able to do that well. I'll take you briefly what we're seeing there, both externally and internally. First, of course, clear focus on the consumer. It's always been the DNA of Oscar.
In an environment where the consumer has greater choice, greater visibility, I think that's a great environment. That's one we can thrive in. I don't have to tell you this, CMS said this morning, ACA, I think, is now about $60 million in sign-ups for this year. I think we're heading to $20 million there before long. Medicaid redeterminations will start, another at least three years of growth just from coming from that. That makes this market, you know, pushing up against Medicare Advantage. How short was that, right? Eight years, we's almost at the level of MA, after that market's 25 years or so at this point. Again, I think that will continue.
I think a very interesting shift to watch, and I hear that in the rhetoric from other insurers now as well, is the shift of employers towards individual, potentially. There's now a regulatory tool called Individual Coverage HRAs, where employers could just give you stipends pre-tax, and you buy your own plans. We're starting to hear that from brokers in certain marketplaces. I think that's a powerful move. Contributions, defined contribution-style health insurance, right, belong among the talking heads discussion. Now it could be a real thing. Anything that makes the ACA grow one of the largest carriers there will obviously be a good thing for Oscar. The second thing, digitization. Again, obvious the market's become more digital, right? Pandemic has further pushed us forwards. We see a real value in that.
The fact that we can very easily rejigger our systems is driving about $20 million in increased savings on the admin sides, going into 2023. The example here is we have Virtual Primary Care plan designs in now five states. About a half mil members have access to these. When members of Oscar attribute themselves to an Oscar Virtual Primary Care physician, there's about a 5% total cost of care reduction that comes from that, so in these plan designs. I think overall, you know, the industry's really woken up to power of digital and everything else.
Whereas others have to either start from scratch there or stitch together a lot of different solutions, we really have built this with a very long-term architecture in mind and can connect the dots there nicely in the full stack platform we have. Finally, value, of course. We have now 48% of members of Oscar attributed in some form of value-based care deal. A bunch of these are upside only or some additional rewards and so on, but we have a good chunk now also in really fully capitated, global, risk upside downside deals, and really think are pushing the envelope there. Are constantly working with provider partners, provider groups, health systems to push members further into that. Better outcomes, lower costs, nothing to complain about there.
In fact, that is what I wanna do my demo about as well. We can, I think in a nice way now, use our technology stack to enable provider partners in risk de-deals, that's a whole another growth story I think we have ahead of us. The more individual, the more digital, the more value-driven this market gets, I think the more well-positioned we are, for both members and for providers as well at the same time. One last slide before I pop into the demo. You know, we talked a lot about technology, I sprinkled in a couple of examples for how the tech stack has really been able to help us. And again, I just really wanna state this again, right?
We doubled into last year, onboarded or re-onboarded 1 million members and still were able to get Admin savings and MLR savings. I think that's not an easy feat. If we didn't have that tech stack in-house, that just wouldn't have happened. I mean, thinking of having to go to vendors to ask for charts and risk codes and so on, I think would've been a nightmare there. Some key differentiator, therefore, technology stack. We chunk this up into three different categories, what we've built. There is the engagement and growth platform we have. There is a payer Admin and some automation platform, and there's everything we're doing on clinical engagements and analytics as well. Engagement growth includes obviously member experience. It includes the broker experience actually as well. We've got a very nice broker web application.
Also our CRM that we've built to engage members and providers alike. These tools help drive retention. We're seeing about six points higher retention of members who are digitally engaged versus those who are not year-over-year. That's obviously deconfounding for all kinds of other influences like age and geography and things like that. There's a real impact there. On the payer admin side, that's where that $20 million in savings comes in between last year and this year, in just automating more, getting more engagements. You know, we can do a lot more just through even just online nowadays, right?
One of my friends sent me this chat stream with another unnamed insurance company where they asked for a cost estimate, and they said they can generate it in three days, which is interesting, you know? That's enough to fax probably something to the claim system, run it through. Of course, we can do that in real time. Finally, clinical enablement analytics platform. You know, these are actually the tools that we use in our provider risk-based deals, I'll take you through this. We think there's a lot more MLR points and growth we can get in just that part here on the right side. +Oscar is our attempt to monetize this technology in different ways beyond our own insurance business.
As you watch through the demo here, you can keep that in the back of your minds. The Campaign Builder tool I will show is a tool that right now we're selling as a module to provider partners and health systems and so on. Okay, let's go into a demo here actually, and then we can take some questions afterwards as well. You know, it's always the best way to bring the technology to life and the experience to life. I think when we thought about what should we do here in the demo, you think about the three trends again. I think there's good evidence we've got great member engagement, so I don't have to tell you that again. There's good evidence that we've got, you know, good digital tools. Don't have to show you that again.
How do we use the tech stack in the value-based deals? That's a really interesting one we haven't talked that much about. That is a really important part of our strategy, to push more towards value-based deals there for, of course, the MLR side, but actually also the growth sides. In the ACA in particular, narrow networks still rule the day, and the more you can incentivize the provider partners there to, you know, use their own brands, to advertise the kind of plan that they're in, with you, the better that is really for the overall book of business there. Obviously within the realm of what's regulatorily possible there. I will show what we are doing in that space. I wanna take three different perspectives.
First is the perspective of the provider partner. What we let them look at from a data and insights perspective, that's sort of where we generate the insights. The second part is how we then use those insights and take action, and run campaigns, do outreach to providers and members, and so on, and really just run that over and over again. The third one is then how does that look through the eyes of the member? 'Cause the member, of course, needs to be convinced in the end to take action on their own healthcare, and we can really help with that. We're starting with this year. This is a actual but blinded dashboard. That's we get that little demo thing there at the left.
There's no-- It's real data, but it's not-- but it's blinded basically, that we use in conversations with provider partners. I'll show you a couple of things here. This in particular is a dashboard we look at, we use with provider partners to look at how successful are we in step one, driving members into attribution with primary care physicians, and then step two, getting members to actually engage with the physician, right? Attribution is one step. Second step is you gotta get them in for the annual wellness visits, follow-ups, and things like that. We have a lot of control over that. Some, you know, I saw a tweet the other day that's another insurer. That's a different one than the other one I mentioned before.
Sent a member, attributed to them to, I think, a pathology clinic as a risk-bearing PCP. That does not bode well, I think, for the outcomes there. Maybe it's a coded message. Starting at the top here with how do we attribute members. This is what we show the providers of the panel that we are giving to them. How many members are coming through just claims-based assignments, right? Who do we see just from claims? Who's going to which PCP? How many members do we assign demographically, where they live, who they are, things like that. How many members do we actually get into provider practice because they go through the Oscar onboarding tools, and they select PCPs through us. I'll show you that later on as well.
you know, that 28% of members who comes through our tools, we sort of have good evidence there that they might not have otherwise attributed themselves to that particular PCP, maybe not at all, or maybe just our network somewhere or to a different PCP altogether. We have just good control over driving more and more assignments there. We scroll down here, the providers can pull this up and look at this, right, where membership is, where how successful we are in different parts of, in this case, Florida on attribution. Look at this chart down here. You see a particular provider groups doctor-level performance over here on the right side, and they can go and dig into that with us.
Here on the left side is interesting charts where each dot is a provider in that particular group, and we can look at physicians who are in this bottom right quadrant here. These are doctors who have a lot of members, their percentage of members assigned to them, but they're not driving the annual preventative visits, right? They have members assigned to them, but members are just not coming into the office. That's clear just, you know, healthcare outcomes and money left on the table because you don't get the risk score, you can't put care plans in place and things like that.
There's a real example now, what I'm gonna show now, the campaigns we run for these providers are campaigns where we say, "Let's attribute first, and then let's get members into in for annual wellness visits." How do we do that? That's where this Campaign Builder tool of Oscar comes in. Again, that is a tool that we actually can sell and use commercially, not just for our own book of business, but for provider groups and health systems, other insurers' book of business as well. It's an internal tool that lets us take any input data and derive really any outputs action. For example, we use this for bill payment reminders, and for attribution, obviously, and for, you know, HEDIS gap closure and for other things like that. Appointment reminders as well.
If you look at just this chart over here, right now there's about 182 active campaigns running against the overall Oscar membership. This is actually just looking at our own book of business now in January 23, right? Look how that came up throughout the just last year as well. Even a year ago, we were only running 86 campaigns. We just have a lot more stuff running through the systems. You can see there's a relatively recent development here as well. Some members have high engagements. If you go kind of further down here, which I won't do now, you see a lot of members click through to the messaging we send and things like that. I'll show this with the example of the campaign we're gonna now look at.
This is now one of these campaigns, and this is again a real campaign that we ran with certain provider groups across the country. The idea of this campaign was drive annual preventative visits. Again, this is a copy and paste of that campaign, so I can mess with it a little bit without any danger here of messing anything up. This campaign idea is members who haven't been to the doctor in one given year, get messaging, go to the doctor, and you know why they should go, and things like that. Right here from the get-go, right, you can see I can move this around here, obviously. We distinguish between chronically ill members and healthy members. That is part of our insights.
That's chronically ill folks tend to respond better to messaging around their relationship with a provider, long-term relationship. Whereas healthy people respond more towards messages around convenience. You really wanna squeeze out every bit of response metric from the member you can by tailoring the messaging in this way. In this case, we branch by geographic region for these different segments. Just all these are all Florida rating regions or counties. When we branch further, we said, "Some people should get an email, others should get a secure message," and obviously, we can, you know, do other things like that. You know, here's a fun one. We can send a fax if we want to, you know. Not recommended, it is in there as well, or a letter.
Just gonna leave that to the other insurers. You know, it's very easy for the providers to customize this with us, right? Here you can see. This sort of very tailored messaging. Have you booked your visit with doctor? Fill in the blanks yet, and the systems can fill this in automatically because, again, we know the member's attributed doctor. And by the way, if you go to a different doctor, we see that in the claims, and we can reattribute you automatically. You see the messaging around provider of care for $0, right? Things like that. That's running this campaign. Once we click go here, which I shouldn't do now, down here, review and launch, this thing will just run.
It'll pick up on members who in the claims haven't seen a physician, and it'll start pushing out messaging and follow up and things like that. Now I wanna flip over to the members view. Of course, I got logged out. Sorry for that. Let's see if I can still log in here. Oh, nope. I gotta briefly flip over. Sorry. That's the issue with the demo, you know, but you can see it's all real, at least. Get into this member account here. This is a member account from a member who... It's not a real member in this case, of course, but depending on members exactly like this going through onboarding really right this moment, I think this is a member we placed into Florida in this case.
I wanna show you two things real quick on how this looks to the member, starting with how it looks to choose your PCP. Right? Again, this is sort of where you can let us stray very, very quickly. You come into. This is the member's website. You come in here, obviously same in the mobile app. It says, "Choose your primary care provider." Required in this case, so we can do that differently. We can either you search for provider, of course, if you already know where you wanna go, or we say we have providers near you, and we take you into the Oscar Care Router. That's a long-standing piece of technology we've built over the years.
This Care Router ranks these physicians on the left here, based on quality of outcomes, based on member experience, based on cost of care efficiency, based on availability and stuff like that. You see, you know, Dr. Robles here, for example, gets a badge for being great at preventative screening. I can click through here now and see that, I think we're in the Orlando area here in this case. Right then and there, you see how easy it was for me to, as a member, to get attributes and go through this onboarding process. Now, again, as I mentioned before, attribution is only part of the battle here. The annual checkup becomes to be the second important step. This, in this case, is one of these campaigns that we've been running there.
This is yet another communication channel. This is not an email, not a secure message. This is a banner in the app. It is all driven by the same Campaign Builder logic. Look what happens when I click on here now, Book your visit now. It opens this thing here. It's an applet actually. What that means is that it'll open anywhere, meaning if you get this link in a, let's say, WhatsApp message, very popular, obviously in Southwell in particular, it'll still open in the same way, meaning you don't have to log in. This is totally customizable. I think I asked the team earlier. It takes us 15 minutes to put this together. If we wanna slap somebody else's logo on it or whatever or something else, very easy to do.
Here, same message as you saw before, right? Even better, go and schedule now here. I get this, you know, appointment slots recommendation. Then I don't know why it needs to do some thinking here, but I should be able to then complete the appointments. Once I do that, then I get a little animation that rewards me for that. Maybe it's not available here. Okay, this demo stuff here. Anyhow, this actually does work in person. It worked for me earlier as well. You know, that's how we're getting this engagement here. It doesn't work. Yeah, there we go. See? Okay, great. There's the animation and all this stuff, right? Again, this is all nothing up here. Demo URL. It's a demo campaign, but it's really running at all points in time.
Member experience, very easily doable there, and we can use this for any kind of other campaign design as well. Of course, we sit down with the provider partners, and we look at the results on a regular basis. We have typically monthly joint operating committees with these providers. We can really take them through, you know, how the campaign's working. This is now again, one of these real campaigns, where there were about 2,900 members that we sent this communication to. I think the rest here had already seen a PCP. That's why we didn't send it to them. Fifty-one percent actually opened the email or opened the message and went in there and read it. Seventeen percent, actually, we then saw within a month them go into the physician we recommended.
That from all we can tell is an incremental, we test this against control groups, and we just drive incremental attribution and wellness visits there as well. Provider partners love this because, you know, they just typically don't have the infrastructure to do this themselves. We can just make this part of the, of the, of the risk deal there. This is of course, also a good proof point for then eventually going and saying, "Do you want this for the rest of your book of business as well?" One more thing before we go to questions here, that I also wanna briefly show. You know, here's another dashboards. Again, same kind of thing. We use this in exactly the shape and form for provider partners as well. This one looks at care gaps. In this case, again, you got NPIs here blinded.
That's why it's the demo part here. You see cervical cancer screening rates for these members. The neat thing here is that you can compare low-engaged members of Oscar with medium to high-engaged members. This is an engagement level that we ingest based on how are they using the app, the website? Are they talking to us on the phone? To us in this case. You actually nicely see that it drives up these care gap closures, you know, in a very nice way. This raises the question of what do we do if we wanna drive, let's say, colorectal cancer screenings? I wanna briefly go back to the member up here again. I should have blown this up a little more so you can see this better.
Of course, we designed a campaign there that drives colorectal cancer screening, and that message came from the concierge team here in this case. Right down there, this is the messaging app with a customer service concierge team. You get this kind of a message here that says, "May colonoscopies aren't so scary, pretty quick, and they're good for you. You can do a colon test for free at home for $0. Get yourself checked." You can just respond to this message, we will send you these tests. Very powerful as well. I think in this case it was also about, if you take a look here is this campaign here.
You know, about 68% actually engaged with this communication. In this case, we had a control group, and the target group had 34% higher utilization of these at-home colorectal cancer screening tests than the control group. So really big lift in just closing those care gaps. By the way, I do wanna click on this link as well real quick, back in the member app here, right? That's where we then say, "All right. If you wanna see a gastroenterologist in your area, click here." The app goes in, and we'll just, in the meantime, as this thing is spinning here, generate a cost estimate. This is not something that's sort of pre-stored and pre-computed or whatever. It actually calculates the cost estimate by going through the claim system.
Just literally just what happened is a claim got adjudicated, it comes back with a diagnostic colonoscopy would cost this member right now $100 with Dr. Molina, who's a real doctor in Orlando, Oscar pays $443 of that, right? Down here is the adjudication and whatever. That's another really nice part of how we can tie this all together. With that said, this is kind of the arc I wanted to show, right? Generate the insights, share a lot of data with the physicians we have in risk deals, drive campaigns, and sit side by side to design those in a good way, and then look at how they perform and really drive the engagement through the member layers, interfaces we have there.
That's, I think the sort of flywheel we like to think about in Oscar terms. That leaves one thing, which is to close out the presentation overall with some closing takeaways here. Again, as I said, I think the most important aspect of the company for this year is 2023 insurance company profitability. We reaffirmed this. I hope I give you some additional data points as to why we feel so confident about this, partly because of the fact that we just did a lot of the work already coming into the year. That's the stepping stone towards Total Co profitability in 2024. The second thing is, once you have a functioning insurance business that throws off EBITDA, you know, we think that can just get better and better in inflationary times.
Probably not a bad thing there in a sense, because, you know, rates will produce investment income, premium rates in the marketplace will continue to drift up there. I think we'll just as a, as a strong player in the ACA, continue to benefit from all that. The third one is, you hopefully saw this. This is really very much driven by tech rebuilds in very concrete ways. There's opportunity of monetizing much more of this tool +Oscar in the future as well. Once we've hit the insurer profitability, I think we have even more proof points and opportunities there.
The more the markets shift towards consumerization, digitization, value-based care, I think the better positions we will be because we don't have to go to too much the outside world to ask for permission to build something. We've got this internally on our own stack and feel great about this. That's our confidence outlook on the next... on this year, next year, February ninth, earnings call, we'll do the guidance for 2023 and close out 2022. Looking forward to your questions.
Well, thanks very much, Mario. We have around just over five minutes left for Q&A. I'll start with one question, then we'll open up to the floor.
Mm-hmm.
You mentioned +Oscar in your presentation. What's the latest strategy there, and how are you thinking about monetizing the tech?
Yeah. I think what we're doing right now is we spent a lot of time in the last 18 months going through and saying, "What do we have there?" The conviction we really have is we have many components of our technology stack that have real economic value. They have tremendous value if you apply them against bigger books of business that exists, whether it's in paying claims faster or in closing care gaps and other things like that. That's really step one. Step two is now how do we bring this to markets? This year we're focused on the Campaign Builder. You saw the tool. It's a smaller PMPM play, but it is easy to deploy for us. It can get us into many more doors than otherwise with the bigger rollouts.
Scott Blackley, who was CFO until more recently when Sid came back, is now Chief Transformation Officer, is really fully focused on go to market there with partnerships, with other levers we can pull there, focus there. The bigger deals we wanna make, we continue to want to make, but we wanna make sure we have the right both enterprise sales function there and implementation as well. That'll just take us through this year to make sure that we have that in place.
Got it. Let's see if anyone on the floor has any questions. We have a microphone going around. One at the front.
How do you guys see the relationship between profitability and cost of reinsurance and how reinsurance is relevant today?
Yeah. It's a great question. We have about the same level of reinsurance from 22 into 23. It didn't turn that dial very much. Right now, I think reinsurance is a cost-effective source of capital for us, certainly better than raising equity, for example, against future growth. It is still costly. You know, it still weighs on the EBITDA as compared to if that same book was in some other insurance company's entity. I think this is a real side effect of insurance company profitability. By just having the profitability there this year, as we expect and as we target, it'll give us a lot more flexibility in what we were gonna do in the future with reinsurance.
In the meantime, we have a chance to actually, obviously, get even better deals there. I think we talked about this earlier with some folks already, but we did actually renegotiate one of our reinsurance deals, and that cost is coming down into 2023. It's another thing that's actually showing up in the, or will show up in the P&L as well. Good right now, big future opportunity for taking costs out. We have a lot of reserves sitting in many different entities in, across the country. There's a big opportunity, I think, and Sid is focused on that in rearranging that in the right way and over time, getting more reserve capital flexibility.
When we go back to stronger growth, we think in 2024, we can just grow into reserve capital that's, we think we already have in some of these states.
Well, if no further questions, thanks so much. It was a pleasure to have you at JPM.
Thank you. Thanks again for coming out.