Program has driven reductions in hospital stays and medical expenses
Inks new partnerships with leading home-based care providers, Spiras Health and Upward Health
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 profiles.
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 ways:
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 Health
Clover 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.