I don't have a ton of first-hand knowledge, but I know that being licensed to provide health insurance in NY specifically is no joke. Todd Park (former US CTO,

I don't have a ton of first-hand knowledge, but I know that being licensed to provide health insurance in NY specifically is no joke. Todd Park (former US CTO, AthenaHealth founder) once told me that he didn't pay much attention to Oscar early on until he found out they had gained an NY license, at which point he dove into it. More broadly, many hospitals and hospital are getting involved in the ACO (accountable care org), which gets at some of these goals, but it's not 100% clear that an ACO model can be successful (financially or for patients), and it doesn't cut out all the relevant middle-men.