CMS Upgrades Clover Health’s PPO Plan to 3.5 Stars
October 08 2021 - 11:35AM
Today, Clover Health (Nasdaq: CLOV) (“Clover”) announced that the
Centers for Medicare and Medicaid Services (CMS) has upgraded
Clover’s PPO plan to 3.5 stars on the Medicare Star Ratings for its
Medicare Advantage (MA) plans for the 2020 measurement year.
Currently, over 90% of Clover’s Medicare Advantage membership is
served through its PPO plan.
“The improved star rating for our PPO plan demonstrates our
ability to improve access to great, affordable care and
meaningfully impact the lives of our members. We have high
conviction that our open network approach is fundamental to
promoting health equity, and we remain laser-focused on addressing
our members’ needs,” said Andrew Toy, President of Clover.
Recently, Clover announced that CMS approved Clover’s 2022
expansion plans, which will nearly double the geographic footprint
of Clover’s Medicare Advantage plans and make its PPO plan
accessible to Medicare eligibles in 209 counties across nine
states.
Clover believes that providing affordable plans with great
benefits on an open network is essential to bringing high-quality
care to those who have historically lacked access. Notably,
approximately 50 percent of Clover’s Medicare Advantage members are
people of color, compared to the industry average of 34 percent.
Additionally, the National Committee for Quality Assurance (NCQA),
which is conducting a study on behalf of CMS’s Office of Minority
Health on strategies to drive the equitable delivery of care, has
informed Clover that Clover has been identified as a plan with
strong performance on a prototype of the Medicare Advantage Health
Equity Summary Score (HESS). Clover is proud of this achievement
because of its commitment to ensuring high-quality care for those
most in need.
According to a recent study from JAMA, Medicare Advantage plans
with a higher percentage of Black and Hispanic members consistently
receive lower star ratings, demonstrating how the current formula
for star ratings does not address headwinds for plans serving more
diverse populations. Clover believes potential future changes to
address this critical systemic issue, such as including a measure
of health equity in the calculation of star ratings, could be a
significant tailwind to the company while creating a more fair and
equitable healthcare system. Regardless of the ratings, Clover is
committed to serving everyone eligible for Medicare, and the
improved star rating shows the company’s ability to do so.
About Clover Health: Clover Health (Nasdaq:
CLOV) is a next-generation risk-bearing organization aiming to
achieve 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 is designed to aggregate patient data from across the health
ecosystem to support clinical decision-making by presenting
physicians and other providers 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 have the freedom to choose their
doctors. We offer two models of care: affordable Medicare Advantage
plans with extensive benefits; and care coordination for Original
Medicare beneficiaries through Direct Contracting. For both
programs, we provide primary care physicians with the Clover
Assistant and also make comprehensive home-based care available via
the Clover Home Care program.
With its corporate headquarters in Nashville, Clover’s workforce
is distributed around the U.S. and also includes a team of
world-class technologists based in Hong Kong.
Press Contact: Andrew
Still-Baxterpress@cloverhealth.com
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