Clover Health’s Medicare Model Uses Technology to Improve Member Health
Healthcare startup Clover Health believes that traditional insurers in the Medicare space don’t do enough to leverage their data (as reported by Fierce HealthPayer), and it plans to compete for Medicare business via a technology-heavy model it says can save money and improve clinical outcomes.
It may be working. As reported by Fortune, “In the first half of the year, Clover said its members had nearly 50% fewer hospital admissions and 34% fewer hospital readmissions than the average group of Medicare patients in the New Jersey areas it serves. [This fall], the company has doubled its number of customers to 15,000 senior citizens in New Jersey.” Fortune also reports that the company has raised over $135 million in venture funding.
In addition, Clover is making some bold claims. In a press release about its venture funding, the company says it is “reinventing the health insurance model by integrating technology into every aspect of its members’ healthcare,” and it describes itself as “the first and only health insurance company successfully using technology to improve health outcomes.”
Among its efforts aimed at achieving this, Clover
- creates personal health profiles for each member with data collected from many available sources including claims, customer service interactions, lab results, pharmacies and home visits;
- addresses high-risk or disease-prone patients first, with hopes to prevent long-term hospital stays or expensive surgeries;
- emphasizes customer service (it has a large team of customer service representatives to schedule appointments and answer billing questions); and
- employs nurse practitioners, social workers and other care teams who either work with members’ doctors or conduct at-home visits and interventions (like routine check-ups after a patient has undergone any procedure to facilitate recovery).
Kris Gale is co-founder and chief technology officer of Clover Health. In an interview with Becker’s Hospital Review, Gale told reporter Max Green that the company continues to fine-tune this model. He says, “By having better data integration, better proactive care interventions and improved clinical outcomes, we’re able to provide more affordable health insurance.” Michael Dixon, whose company Sequoia Capitals has invested $35 million in Clover, believes “using technology to reduce costs and save lives will result in a fundamentally better health insurance product for consumers” (SOURCE: TechCrunch).
And so Clover has the attention not only of trade and business publications but of its competitors. A business model that uses data (an existing resource) to optimize effectiveness, drive down costs and improve member health? That’s an attractive proposition. If it succeeds, we have a feeling other insurers will want to – and perhaps need to – acquire similar capabilities.
