Clover Health building better health insurance

May 17, 2017

PUBLISHED BY Antoinette Siu

SOURCE San Francisco Business Times

In 2014, entrepreneurs Vivek Garipalli and Kris Gale started Clover Health to build a health insurance plan that would help people keep costs down.

They used sophisticated data analytics and custom software to coordinate care and build a clearer model of their customers’ health and risk factors. Its software works with Medicare seniors to manage their health care services. Medicare pays Clover a monthly fee for every Medicare member it serves.

The San Francisco-based company’s software tracks 46 different clinical and social data points to help low-income and senior patients avoid hospital visits, which are one of the most expensive parts of health care.

Clover’s clinical staff employs the data and conducts home visits to coordinate care, whether it’s helping a member with a prescription refill or arranging a ride to a medical appointment.

“What we’re trying to do is use data and technology to improve health outcomes and ultimately to save on costs and avoid hospitalization,” said Gale, co-founder and chief technology officer at Clover.

“What’s really unique is we’re able to assemble a complete picture of our members. We’re in a position to actually do something when we see a gap in people’s care.”

Clover sees a huge opportunity when it comes to impacting seniors’ health outcomes. Younger, healthier people on average use the health system once a year, whereas seniors engage nearly 30 times a year, Gale said.

The startup has enrolled some 25,000 Medicare Advantage members in nine counties in New Jersey, where it has been easy to expand in a market that does not have a lot of existing coordinated care. Some patients 65 and older and eligible for Medicare have Medicare Advantage, insurance managed by private companies covering extra wellness services beyond medical.

Clover has created its own technology, and its executives argue that its competitors lack this type of customized software.

“Health care management companies end up with a bunch of out-of-box, fragmented solutions,” Gale added.

With almost $300 million in venture capital funding, the startup is among a handful of high-flying health care disruptors determined to pull a lagging industry into modern technology and business practices.

Read the full article on San Francisco Business Times here.