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Clover Health started the new year with a bigger membership base. The insurance startup reported 54,000 members had enrolled in its Medicare Advantage plans for 2020, up from 39,400 in 2019.

After a few bumpy years with executive changes and a recent restructuring, the San Francisco-based startup is looking to turn over a new leaf. The company currently has 400 employees, down from roughly 500 last year. The company restructured in March, affecting about 140 employees, which it said was part of an effort to shift resources away from tech talent and build more expertise in the Medicare Advantage market.

Most of Clover Health’s members are still in New Jersey, where the startup first launched its plans and now covers statewide.  Clover Health also has a presence in select markets in other states, such as Savannah, Georgia and Charleston, South Carolina. The company attributed the bulk of its growth to the Garden State, with roughly 1,200 of its new members coming from other markets.

“We’re in a number of new markets now,” said Andrew Toy, Clover’s CTO, who was named president of the company in February.

Clover Health is one of a handful of insurance startups focusing on the Medicare Advantage Market. While Clover has been around the longest, new entrants Bright Health and Devoted Health have popped up in the last five years.

Similar to its competitors, Clover touts its technology as what sets it apart from well-established Medicare Advantage plans. The company’s software isn’t just focused on claims, but it also has a clinical component, Toy said. It can share important information with physicians, such as if a patient was admitted to the ER recently, as well as information on new clinical protocols.

Toy said it was a way of fitting together New Jersey’s fragmented health care market.

“Not everyone goes to Kaiser,” Toy said. “By having the software, we’re able to bring that same approach to any doctor.”

Clover differentiates itself from Bright and other payers by opting for wide networks. The company charges the same for in-network and out-of-network providers, and has limited out-of-pocket costs. Toy said the company’s software was a means of coordinating care while letting members keep the doctors they already know.

“Why do you have to narrow the network to get those benefits?” he said.

In the long term, the company’s strategy is to bring in members that traditionally haven’t been the target for Medicare Advantage plans, and expand to markets where narrow networks are not the norm.

“We go to markets where narrow networks and value-based contracting have been difficult to do,” Toy said. “We thrive in these markets.”

The company also plans to roll out new clinical protocols for patients with diabetes, kidney disease, congestive heart failure, and other chronic conditions. The company raised $500 million last year in a round led by Greenoaks Capital, bringing its total funding just short of $1 billion. Last year, Clover had a 3-star rating from Medicare.

Source: Clover Health touts membership growth after restructuring

Healthcare Innovation & Investment

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