Here’s How Clover Health Is Taking on the Biggest Players in Medicare Insurance
It’s fair to say that the health insurance game is dominated by a handful of large providers who are able to scoop up the lion’s share of business by dint of their brand recognition power alone.
This landscape can make it difficult for smaller providers to penetrate the market and encourage customers to give them a shot. There are plenty of advantages to allowing a smaller brand to become your health insurance provider, but it can be challenging to break through the idea that these larger companies offer a more secure service.
However, there are a handful of smaller health insurance providers out there who have the chops to take on these whales of the industry and they’re achieving it through a host of innovative ideas.
Clover Health
Since its relatively recent founding in 2014, Tennessee based Clover Health has been providing its customers with Medicare Advantage insurance plans and operating as a direct contracting entity with the US government. Despite its size, Clover Health believes it has the right stuff needed to swim in the same seas as its larger competitors.
Clover Health sees the current health insurance landscape like a fortress. For a small army to penetrate a massive and well defended position like that, it needs to look for weaknesses and take advantage of them.
For Clover Health, this weakness is the cynicism which revolves around traditional healthcare regarding the ability to drive down costs while maintaining or improving clinical outcomes.
"I would say the cynicism within traditional healthcare is massive," said Clover Health Cofounder and CEO, Vivek Garipalli. "If you talk to individuals who have spent many years at the big incumbent health insurers or consultants who work with them, or whomever, they don't actually believe that you can lower total cost of care and improve outcomes. I don't think it's a lack of caring. If large incumbents had a very clear and scalable way to drive down total cost of care and improve outcomes, I think we'd be hearing about it 24-7 on commercials, advertisements, and so forth."
Clover Health thinks the biggest problem therefore with larger providers is that they are too focused on metrics such as their internal KPIs and not putting the patient from and center when they are creating value-based propositions. This leads to the patient essentially getting left behind, while the providers chase stats like a retail business.
Expense Optimization
Clover Health understands that it cannot beat the larger providers at their own game – much in the same way a small store can’t take on Walmart or Amazon when it comes to driving down prices – but needs to find other ways to offer its customers better value.
To achieve this Clover Health is looking at the largest part of its cost structure – medical and drug expenses – and trying to optimize spending in this area, while maintaining the level of service customers would expect from a larger health insurance provider.
Clover Health achieves this with Clover Assistant – a digital tool designed to support physicians with making risk-based decisions and allow them to provide a superior level of care while optimizing spend. Clover Health understands this tool is what can help it compete with the larger providers and pours a great deal of its time and energy into improving it.
"What we're simply saying is we have a lot of data," said President and Chief Technology Officer, Andrew Toy. "Let's make it actionable for you. So, we're putting very actionable pieces of information in front of the physician. It's completely their call. Their hands are on the steering wheel all the time in terms of what they want to engage with. They just think about it. If they decide to follow our recommendation or not or confirm a diagnosis or not, then they are providing us feedback as well."
And Clover Health has recently further strengthened its Clover Assistant by integrating it with network-enabled, purposeful software and services company, athenahealth – a brand which shares Clover’s mission to build a thriving ecosystem that delivers accessible, high-quality, and sustainable healthcare for all.
"Operating on a wide, open network requires us to constantly search for ways to support all different types of providers, from big hospital systems to single practice physicians serving rural communities, as they each grapple with their own unique needs and workflow," said Toy in a press release. "Developing a deeper integration with leading EHRs helps to eliminate redundant documentation while expediting bi-directional data sharing to ensure the Clover Assistant is surfacing the most valuable clinical insights for providers."
Final Thoughts
Taking on the largest provides in the healthcare game is no mean feat. However, Clover Health is approaching the mission with the right attitude – put the patient first, engage with physicians, and find innovative ways to drive down costs while boosting outcomes.
You can hear Clover Health Chief Product Officer Andrew Chock speak at Digital Insurance Summit 2022, taking place in May at the Renaissance Chicago, IL.
Download the agenda today for more information and insights.