Clover Health to Scale In-home Primary Care Program Through Direct Contracting
Today, Clover Health (Nasdaq: CLOV) (“Clover”), an innovative
technology company committed to improving health equity for
America’s underserved seniors, announces plans to scale its in-home
primary care program, Clover Home Care, through the U.S. Centers
for Medicare and Medicaid Services’ (CMS) new Direct Contracting
model. The goal of Direct Contracting is to make the Medicare
program more financially sustainable for taxpayers while improving
health outcomes for beneficiaries, which aligns with the work of
Clover Home Care.
Clover Home Care is led by Dr. Kumar Dharmarajan, Associate
Chief Medical Officer of Clover and Chief Clinician of Clover’s
Direct Contracting Entity, Clover Health Partners. Launched in
2017, Clover Home Care was designed to better identify and care for
the company’s most medically complex members, with a focus on
health outcomes improvement and medical expense reduction rather
than risk adjustment. From inception of the program until the
outbreak of COVID-19, the program reduced hospitalizations by 17%
and medical expenses by $325 per member per month, on average,
versus a control group of Clover Health members with similar health
Home care for high-risk individuals is more scalable than
fixed-site-based care, and permits technology deployment to enhance
care and outcomes directly where patients live. Home-based primary
care provides access to care for the frailest and most medically
complex older adults, particularly those who are homebound. It also
gives greater insight into social determinants of health and
medication concerns through direct review of the home environment,
prescription bottles, and more.
Clover Home Care is differentiated from brick-and-mortar models
and many other home-based care programs in a number of important
Focus on clinical-value. Clover Home Care provides
direct, 24/7 access to physicians, same day urgent visits, and
collaborative care with in-network primary care physicians.
Clover’s model and technology enable provider visits to focus on
major drivers of hospitalization risk, patients’ most important
clinical concerns, and advance care planning needs.
Values pre-existing primary care relationships.
Program participants are encouraged to continue seeing their
pre-existing primary care providers in addition to the Clover Home
Care team. Many patients have longstanding and productive
relationships that Clover works to maintain if the patient wishes.
This approach contrasts with many models in which patients are
actively reassigned by payors to new primary care providers who
disintermediate patients from their pre-existing doctors. In
contrast, since the inception of the program a majority of patients
continued to see their pre-existing primary care provider after
enrolling in Clover Home Care.
Technology-driven. For patients enrolled in Clover
Home Care, clinical teams use Clover’s technology platform, the
Clover Assistant, to identify key medical conditions requiring
further management, medication improvement opportunities, and
additional gaps in care. In 2020, providers using the Clover
Assistant had a gap closure rate on HEDIS quality measures that was
approximately 10% higher than providers not using the Clover
Assistant. The platform also flags recent hospital stays to
clinicians using automated data feeds from hospitals and skilled
nursing facilities to promote timely visits after discharge to home
that lower hospital readmissions. The program continues to
integrate and build toward technologies to facilitate patient
engagement and monitor patients remotely to identify early evidence
of deterioration in health.
Sophisticated patient identification. Clover uses
in-house proprietary machine learning algorithms to identify
patients expected to have high future costs due to adverse health
outcomes. Patients targeted for the program have a hospitalization
rate that is approximately four times the rate of the average
Clover member. The algorithms have been designed based on clinical
concepts supported by the medical literature rather than
business-only considerations and do not index solely on patients
who have a high historical cost. As a result, patients targeted for
Clover Home Care include those with rising medical risk with little
to no regression to the mean in medical costs in the year after
identification. Competitors’ models often focus on historical costs
only, as it allows easier negotiations with their payor
Unique patient insights. Engagement in the home
leads to a deeper understanding of environmental factors impacting
health, including dangerous living situations, lack of healthy
food, and disorganization around medications. Medications are the
most common cause of adverse health events in older adults, and
patients entering our program have regularly been prescribed more
than 15 unique medications in the year prior to enrollment. House
calls also permit meaningful interactions with family members and
other caregivers who are critical to helping oversee care plans for
many older adults. Moreover, establishing remote patient monitoring
programs within the home as a center of care can be used to more
efficiently target disease exacerbations and utilize telehealth
strategies in seniors.
Prioritization of patient engagement. A high
proportion of targeted patients must be engaged to maximize
outcomes improvement and cost reduction at a population level.
Through multi-faceted engagement of both patients and their
physicians, the program ended last year with 72% of its target list
enrolled, which Clover believes is significantly above the industry
Anchored on clinical value, not risk adjustment.
The majority of value generation for many legacy brick and mortar
and home-based care models has come through additional
documentation of member health conditions rather than true clinical
outcomes improvement. In contrast, Clover indexes on improved
member health outcomes including hospitalization reduction,
improved performance on quality measures, and better care at the
end of life. More than 75% of Clover’s historic financial return
from Clover Home Care has occurred via outcomes improvement and
cost reduction rather than risk adjustment.
Removing legacy barriers to care. Direct
Contracting beneficiaries joining Clover who are identified as
eligible participants will have access to Clover Home Care. Much of
this cohort falls within socio-economic groups that largely have
not received this level of attended care. For example, enrolled
patients are almost twice as likely to be signed up for state
pharmaceutical assistance programs that help reduce out of pocket
costs for medications. Clover currently plans to build and share
data-sets around improvements in health that are attainable for
complex older adults through its model.
Clover is excited to scale its home-based primary care program
within the new Direct Contracting program from CMS. While the
Clover Assistant will be used to properly identify eligible
participants, achieve high rates of program enrollment through
direct collaboration with primary care providers, and facilitate
high value care coordination, Clover has partnered with trusted
entities to keep pace with the growth of Direct Contracting.
Leveraging the asset-light power of the Clover Assistant in
collaboration with trusted clinical organizations allows Clover to
be able to scale at the speed of software.
Bringing this high level of complex care management to the fee
for service Medicare population is another step forward in Clover’s
drive to health equity. By providing home-based care to this new
cohort of beneficiaries, Clover aims to simultaneously support
improving health outcomes while reducing costs for the government
and helping the sustainability of the Medicare program.
Clover’s first two partners, Spiras Health and Upward Health,
were chosen because of their record of exceptional care delivery in
the home via a multidisciplinary model, which is core to Clover’s
strategy for complex care management.
About Clover HealthClover Health (Nasdaq: CLOV)
is a next-generation insurance company dedicated to achieving
health equity for all Americans. While our mission is to improve
every life, we particularly focus on seniors who have historically
lacked access to affordable high quality healthcare.
We aim to provide great care, in a sustainable way, by having a
business model built around improving medical outcomes while
lowering avoidable costs. We do this while taking a holistic
approach to understanding the health needs and social risk factors
of those under our care. This strategy is underpinned by the
company’s proprietary software platform, the Clover Assistant,
which aggregates patient data from across the health ecosystem to
support clinical decision-making by providing physicians with
real-time, personalized recommendations at the point of care.
Making care more accessible is at the heart of our business, and
we believe patients should always have the freedom to choose their
doctors. To support this belief, we offer two models of care:
affordable Medicare Advantage plans with extensive benefits; and
care coordination for Original Medicare beneficiaries through
Direct Contracting. In both cases, we provide primary care
physicians with the Clover Assistant and also make comprehensive
home-based care available via the Clover Home Care program.
With corporate headquarters in Nashville, Clover’s workforce is
distributed around the U.S. with a team of world-class
technologists based in Hong Kong. The company manages care for
Medicare beneficiaries in eleven states, including Arizona,
Georgia, Kansas, Mississippi, New Jersey, New York, Pennsylvania,
South Carolina, Tennessee, Texas and Vermont.
Investor Relations:Derrick Nuemaninvestors@cloverhealth.com
Press Contact:Andrew Still-Baxterpress@cloverhealth.com
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