Hello everyone, and welcome Clover Health to the 42nd annual JP Morgan Healthcare Conference. I'm Cameron Wang with the Healthcare Investment Banking Group at JP Morgan, and I will be helping moderate Q&A after the presentation today. A few forward-looking statements that the company would like to go over before the presentation. The company would like to caution you that it may make forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995 during today's presentation that are subject to risks and uncertainties, including remarks about management's future expectations, beliefs, estimates, plans, and prospects. Such statements are subject to a variety of risks, uncertainties, and other factors that could cause actual results to differ materially from those indicated or implied by such statements, certain of which risks are outlined in our most recent annual report on Form 10-K and subsequent SEC filings.
The company does not undertake any duty to update such forward-looking statements. So without further ado, it's my pleasure to introduce to you today the CEO of Clover Health, Andrew Toy.
All right, fantastic. Thanks for joining us today, and I look forward to reminding you and taking you all through the Clover story so far. So just as a reminder, our vision at Clover, we are a managed care company with a deep focus on research and development in clinical technology for physicians. And what we want is to empower physicians to identify and manage chronic diseases earlier. And it's key to do both of those things, right? Because we are a Medicare company, I'll talk more about that in a second, but when you have a population who is aging by definition or disabled, like we do in the Medicare population, all of us are going to one day get sick. We are all going to get older.
It's just going to happen to us, which means that I hope not many of you in the audience have chronic diseases, but if you do have those, these will become a bigger and bigger part of all of our lives as we get older. And people are living older, further and further along and getting older and older before they eventually pass away, which means that they're living longer with that chronic disease burden. So within our population, what we're laser focused on is: how do we manage those chronic diseases? And what we definitely see is that the earlier you identify these chronic diseases, the better you can manage them. There's a lot of focus on the management parts and therapeutics, especially at this conference, like J.P. Morgan.
But those therapeutics are amazing, but the earlier you find those diseases, and we are getting better and better at finding those diseases earlier, the earlier you can manage them, the better the outcomes. But let's talk about Clover itself and where we've come in the last year. A year ago, I was showing something similar to this, but this was more aspirational. We were talking about how we had become public, and we were very focused on top-line growth, but then we were now focused, in the year of 2023, on Adjusted EBITDA profitability. We were no longer as focused on top-line revenue growth, and that we intended to get to Adjusted EBITDA profitability without the need for additional capital.
And if you look at what we've achieved in the past year, and I'm incredibly proud about this, we have made a step function improvement, definitely improved how we perform in our core business, which is the Medicare Advantage insurance business, generating significantly more, gross profit within that insurance business and, reducing our Adjusted EBITDA losses significantly, such that we are now have a very strong line of sight, and we recently announced that we, continue to intend to target that 2024 Adjusted EBITDA profitability that we've always talked about. We have line of sight towards it.
We made tremendous strides, beating our guidance, continuing to raise our targets, pushing ourselves further as a management team to deliver those results in 2023, such that we think that we have a very strong view now on how to achieve that goal, and it is very reasonable for us. Of course, it's still aspirational for that 2024 goal, and we have not yet issued our full guidance, but at a top level, you should expect us to aim for that adjusted EBITDA profitability. How are we gonna get there? A couple of different things. First of all, this has been achieved through a core transformation in the margin profile of our business. When we identify diseases earlier, when we manage them earlier with our technology platform, Clover Assistant, what we're doing is making the insurance business innately better, right?
We're using our technology to help physicians do something that's great for the patient, which is identify and manage those disease loads. When we do that, we bend the cost curve and in insurance terms, we get better margin profiles that we can then invest back into R&D and invest into better care. And that's what you're seeing here, is that as we slow down on growth, I think you're seeing the core benefits of our care model emerge, and that's what's driving the margin improvement. We also have made adjustments to our cost basis, and our SG&A has become more efficient, and our SG&A has gone down.
And we also announced in 2023 that in 2024, we would go live, and we have on, on January first, with our partnership with UST HealthProof, which would enable us to send core platform operations of the insurance business to a trusted partner, and that we would enjoy significant SG&A benefits in the 2024 year from that transformation on our core operations. And we look forward to sharing more on the progress there, but we expect that that will be a big part of closing that additional gap towards adjusted EBITDA, breakeven, and then profitability. So really, really strong improvement in our MCR, right? I think that people haven't really looked at this, and in managed care, it's very rare that you see these kinds of improvements.
When we were really growth on our MCRs and our insurance segment, we're sitting north of 100, which meant that we were obviously not happy with where that was. We really pushed ourselves to improve on that and into 2022, you can see that coming down into the low 90s, and then we have now entered the sort of low 80s in terms of our 2023 outlook on our insurance MCR, which is, you know, the inverse of gross margin effectively. So this margin improvement is being driven by the core performance of our care management platform. This is the differentiator that we have. This is what makes Clover, Clover, is that this medical performance is not being driven by optimization of networking. We are around an 80,000 person plan, so it is not driven by massive economies of scale.
This performance is being driven on a wide network of physicians, which is traditionally harder to manage in managed care. It's being driven, still subscale, what anyone would say for insurance. But because we have Clover Assistant, our core technology asset, the 80,000 people we're looking after, we are encouraging to see Clover Assistant physicians. A good number of them are seeing Clover Assistant physicians multiple times a year, and they are receiving that data-driven primary care, where Clover Assistant is helping their physicians access data, access AI-driven insights, on a daily basis to care for our membership, and that is what drives Clover's performance. It is not the usual things that drive performance within managed care, but it is what we're seeing emerge right now within our financial performance, and I think that really highlights the benefits of our approach and our care model.
And not only does it work very well, as you can see in the margin performance here, but because we are software-driven, we are able to deploy our capabilities, we think, to almost any primary care physician, eventually, perhaps every physician. We just ask them. Our onboarding to Clover Assistant just takes about an hour, and after that initial hour, there's no really more training that we have to give those physicians because it's designed to be a simple way to access that data, access those insights, help them deliver better care. So it really is a lightweight from a deployment perspective. We don't need to go in and deliver full practice transformation. That's not our business, but we see the value-based outcomes of practice transformation through the deployment of a software platform.
We also have our home care asset, and what in here, any Clover member can call in and say, "I would like—I have a regular doctor, and I see them, but I would like someone to come to my home and see me there." And we are able to deploy a clinician. It could be an MA sometimes, it could be a nurse practitioner, an RN, it could be an MD, but we're able to send them to the home.
And in particular, for the sickest population, we take over the primary care of our sickest population when they're multiply comorbid, entering end of life through potentially palliative and hospice, optimize that final part of their sort of healthcare journey, and make it as comfortable for them as possible, give them as good care as possible, to help them see a physician that they trust in the comfort of their own home. So if you want to think about what's driving the performance on the left-hand side, think about it simply this way: We can manage almost any population by saying, "Keep seeing the doctor you're seeing right now." Other managed care platform companies say, "Well, you know, you should change doctors.
Come see our doctor." We don't say that, for we say, "Keep seeing the doctor you're seeing now, and we're going to give that doctor software to help them look after you better." And they do, and we'll talk more about that in a second. And then the vast majority of people get looked after by their doctor, hopefully powered by Clover Assistant. And on the right-hand side, when people get sicker, more comorbid, leave the home less, near enter perhaps that those final stages of their healthcare journey, we tend to take over their care through Clover Home Care, and we see tremendous benefits of doing that. So as a high-level summary, before we talk more about our care model, what are we really doing? It's a continuation from 2023. Last year, I said we were targeting Adjusted EBITDA profitability.
We continue to do so. We've demonstrated tremendous momentum in terms of reaching that goal, and we think we're gonna get there, and so that is our goal as management, is to hit that Adjusted EBITDA profit line. We are gonna improve our insurance fundamentals, and so we did exit our ACO REACH presence, so we are no longer focused on Original Medicare. There may be a time we return to that, but it's not right now. We are absolutely focused on reaching that profitability on the basis of our insurance segment, which is our Medicare Advantage plan. We're gonna continue to manage our liquidity position. We've always said that we believe that we would be able to reach Adjusted EBITDA profitability without needing additional capital, and we continue to aim for that goal.
We will look towards setting the groundwork for a return to growth eventually. Growth is not our top-line goal right now. When I talk to the team, I say, "Growth is fantastic. If we can slide that in, let's do that." But growing the Adjusted EBITDA KPI is what we want to do so that we hit profitability, and then we will return to top-line growth at some point. Let's talk about the fundamentals of the care model. What makes us different? I really want to land this point with everybody because I think that we can do a better job talking about what the fundamental difference about Clover Health.
First of all, we focus entirely on Medicare. There are others in the managed care space who have a blend of portfolios. There are people who are in commercial, people who focus on the ACA.
We don't focus on those areas. We are only in Medicare. We do have duals in our population, but we don't really focus on standalone Medicaid either. We focus on Medicare, and that is what we do.. And so I think it's one thing that tends to make us different. Not, not unique, but different. The thing about the Medicare population is that they have a high chronic disease burden, and because they have that higher chronic disease burden, we think there's a lot of room where if we look after that chronic disease burden better, we will just perform better versus our competitors in that space. Because managing those conditions is very different from sort of actuarially just doing calculations, doing network management, et cetera. We are all about managing those conditions. How do we do that? We do that with our technology platform.
Once again, we are not in the practice transformation business. We are in the business of helping physicians do give better care through accessing in data-driven insights using our software tools, backed by data, backed by AI. The easier we can make that, the better job those physicians are gonna do. We had that home-based, officeless, officeless clinical practice that I talked about just now. This is a very asset-light way to deliver care is into the home. We have no brick-and-mortar practices. We have a lot of clinicians, but no brick-and-mortar, sort of, offices for people to go to because we're looking at the sickest people in the comfort of their own home. Once again, driven by Clover Assistant data, but the site of care is different.
We think that this gives us the ability to really go into almost any market, deliver our care model, and improve Medicare Advantage performance in that market. So between all of these things, I don't think that you'll see any other company approaching their performance in MA the way that we do. Overall, we're very excited to be in there. Sometimes people ask me, like, "Are you looking at commercial? Are you looking at ACA?" And I think that our care model actually will work anywhere there is a high chronic disease burden. We're not in the business of trying to collect as many healthy people as possible so that we can have the healthy people just wash out the cost of the sicker people. That's really the business of healthcare in a lot of other markets.
Well, do the best you can with the sick people, have a lot of healthy people to make get your profit." What we're saying is, we are gonna be really good, and we are good at managing the sickness burden of the chronically ill, and that is why I'm excited to be in the Medicare market. That is where, as we all get older, we will have those conditions. That is why our platform has disproportionate effect within Medicare, and I think there's plenty of room in that market for us to grow. It's far from saturated. It's a good place for us to be. So once again, re-emphasizing, these are the two assets that we have. This is how we see the world, is we have a significant investment in research and development of Clover Assistant.
This is not an IT function of an insurer; this is a product development team. I consider it to be IP generating, intellectual property generating. We file patents on our, on our software. It is a standalone product. It is capable of being. It is cloud native. It is capable of being deployed into any number of clouds. We can separate data, so we can service any number of different entities. It is built as a Clover software product that helps manage chronic disease burdens, and it is focused right now at our own plan. I'll talk about later about our thoughts about perhaps expanding to other plans, but right now, its main customer is our own health insurance entity. But it is built technology-wise as a standalone software product. Clover Home Care, standalone clinical practice.
It could potentially service any number of seniors, but once again, for now, it is focused on our own health insurance plan, our own MA plan, and that is where we deliver care into the home. I consider both of those assets differentiated. I think that it is rare for any managed care company to have one of those assets, and we have both. Together, they form the basis of our differentiation, and I think now that with 2023 is almost done, we haven't closed our books fully yet, I think you're seeing the effect of that care model deliver outstanding performance within our own plan. And here's some evidence of that performance.
We've consistently shared, and we continue to see that 1,000 basis point MCR loss ratio differential for returning MA members whose PCPs are using Clover Assistant as opposed to those who do not. We see correlations to the changes in the timeline of care, which is critical, and I'll talk more about that in a second for Clover Assistant. Thousands of clinicians are using CA to manage our patient population within our managed care, within our own insurance plan. Same thing on the home care, deployed, in active use, showing real results. Here, I'm gonna focus on those high-risk members. Like I said, any member can have a home visit, which I'm super incredibly proud of. But most importantly, the most sick, high-risk members, about 3,500 of them, we look after in a primary care model in the home.
We're seeing an actuarially significant impact. We're sharing it there, about $500 per engaged member per month of savings, driven by lower inpatient admissions, readmissions, et cetera, for that sicker population who is being managed by home care. We do measure our Net Promoter Score for these areas, and we're delighted to say that people are happy with this care. I think that makes sense, right? If you have a trusted physician seeing you in your home, that's a good experience for people, especially when you're struggling with a chronic disease or multiple chronic diseases. So I want to talk a little bit more about the evidence we're seeing from CA in terms of changing that timeline of care that I mentioned just now.
The way I think about Clover Assistant is that we are creating the software-powered physician. Software-powered. We're not aiming to replace physicians. We're aiming to use data and make it very easy for physicians to perform better, practice medicine the way they need to practice medicine, but armed with more information, more insights, more timely insights. That's why we say software-powered.. We've shared what we call mini white papers on each of these topics, and I encourage you all, they're on our website if you would like to see more detail, read the papers. But I wanna highlight how critical I think this is that we're able to deliver this.
All of this is tied, remember, because we have the business model of insurance and health insurance, that when these things happen, we are looking after people better, and we are therefore seeing better results within our medical loss ratios. This is a chronic kidney disease example. If you look at this, doctors who start using Clover Assistant, so the same doctor who goes from not using CA to using CA, will start diagnosing chronic kidney disease stage III. We use stage III as the anchor point because that's when CKD tends to be start to become symptomatic and, and you need to really look after it. Diagnosing it earlier, managing it earlier, and when you manage it earlier, you can see there that GFR, which is the kidney function, measurement, the filtration rate, stays higher during that period.
So we're seeing evidence of that earlier diagnosis, that earlier management, and the retention of higher kidney function simply through PCPs starting to use our software tool. Remember, there's no practice transformation here. There's no going in and, like, doing side work. This is just we're giving PCPs a software tool. We're accessing that data. We're applying AI, MLs, and rules to all of that information and surfacing those insights to the physicians. They respond to that, and we're seeing that critical earlier diagnosis, earlier management, better retention of kidney function. Here's a diabetes example. Here, what you can see is that with before and after or with or without Clover Assistant, you're seeing that the initiation of diabetes medication correlated to a Clover Assistant visit.
What we're seeing is that when people are going in and seeing their PCP, if that PCP is using Clover Assistant, there is a higher correlation to the deployment of diabetes medication with that visit. What does that mean? That physician didn't see diabetes before. There was no diabetes medication being taken by this patient before. They have a Clover Assistant visit, and now they've initiated diabetes medication. We see that initiation rate be higher with the CA doctors, which we believe means early identification of diabetes, early initiation of management of diabetes. And here you can see other biomarker improvement from here, right? You can see A1c being superior, lower is better, right? Here, when you're on meds earlier, you're gonna have better blood sugar control. That makes sense, right?
If you begin meds earlier and you have better blood sugar control, you see lower initiation of insulins. Insulin's quite expensive, expensive to the member, expensive to the plan, not a good lifestyle to be on. If you can stay on meds longer, better lifestyle, better control, better costs, and lower instances of hypoglycemia. Why do we look at hypoglycemia? Well, if you go on insulins as well, you tend to go up and down on your blood sugar. If you are on the meds, you stay more stable. Once you go on insulins, you risk hypo, too low blood sugar, not just hyperglycemia. Also, a correlation to improved medication adherence. We released this mini paper this week. Here, what we're seeing is that doctors are using Clover Assistant. We're flagging to them when medications are not being picked up.
They're having those conversations with their patients about staying on their meds. It's not easy to keep people on their meds, but the person had the best equipped to have that conversation is the PCP, not the health plan, the PCP. We flag that data to the doctor. They have conversations. We see better adherence. Once again, critical for the management of disease in general, certainly the cost-effective management of disease. And so these are the things that we look at. These are the things that we do research on. These are the things where we say the most trusted interface to the patient is their doctor. We are not delivering these insights directly to the patient.
We are delivering them to the doctor because the doctor is the one trained to have these conversations, to do this management, and they want to practice management, but practice medicine better and better, but PCPs are under a lot of pressure these days. Very little time per PCP visit, so much data to look at, so much time just spent doing documentation in the EHR. How do we make it easier for them to deliver this better care? And once again, because we are in the health insurance business, if they deliver better care, patients are gonna get better care, which I love, and we are also gonna see that economic benefit flow through to our insurance business. So these are the software-driven aspects of our care model. We're incredibly proud of them. We'll keep on producing these mini papers.
Please take a look at that. And I think that this is really key, is that to say: How do we get this software out so that most people we have are managed by Clover Assistant? How do we then get it so that most people on Medicare are one day managed by Clover Assistant? So looking forward, right before we take some questions, the goals that we've established, I'll go over again. This is really, you know, it was a 2-year plan between 2023 and 2024 to get to that Adjusted EBITDA profitability is what we're seeing, and this is the second half of that plan. We're continuing to target it. We intend to get to that positively, for full year 2024.
We have significant SG&A savings arriving in 2024 that were not in at all in 2023, so we should expect. When we issue full guidance, you'll see some of that. You'll see that in there. Continued improvements within the core of the platform, and I think that the ceiling is incredibly high with Clover Assistant. We've not maxed out what Clover Assistant can do, right? And all the care we delivered in 2023 to our membership, that returns in 2024, we'll see the effects of that member-better member management. If you stayed more consistent on your diabetes meds in 2023, you're gonna have a lower cost to us, we think, in 2024.
So you're gonna see this compounding effect, that as we deliver better and better care and have our membership return to us, that our margins continually improve because of the nature of how healthcare works. We spoke about this at our earnings. We did get a 3-Star rating. We were very close for 2025, and we received a disappointing 3-Star rating for the 2025 service year. So we are aiming to make that a 1-year event. We have a number of different Star initiatives that were deployed through 2023 and into 2024. We aim to get back to that 3.5-Star rating, and then have a pathway to eventual 4-Star ratings. So Stars are important to us. We were disappointed by that 3-Star rating.
We think we will be fine economically, and we will manage through because we have so many places to continually drive momentum. Stars will be a headwind in 2025. We aim to make it a one-year thing, and then, be firing on all cylinders after that. I look forward to returning to profitable growth. So I doubt we will return to a growth-at-all-costs mentality. We were, to some extent, like that earlier in our journey, but profitable growth is key. So once we cross the line over into positive Adjusted EBITDA, we will stay there, but we will have strategies whereby we are growing the top line while maintaining that positive Adjusted EBITDA, growing that positive Adjusted EBITDA.
Of course, we're always going to be making investments, so we're not just only going to grow the profit side of things, but it will free up room for us to increase our investments everywhere as we grow the top line and maintain our margins. And finally, I will just do a little bit more here. I have talked a little bit about the fact that we want to expand our offerings. The way we think about this is, we have built an incredible tool in Clover Assistant to be able to manage value-based Medicare, right? We are able to manage those diseases earlier, identify them, and we see those results all the time. How do we get more people managed by Clover Assistant? How do we bring those benefits to more people, both from a care perspective and an economic perspective?
And what we're looking at is two dimensions. One is the growth of our own insurance business will expand the market for Clover Assistant, of course, and we will do that as per the profitable growth statement. And second of all, we are looking for ways to bring this so that a doctor can use Clover Assistant for their entire Medicare Advantage panel. I used to say the full Medicare panel, and one day I think we will bring Clover Assistant back to original Medicare, but in the short term, because we have such high conviction around the MA market, what we're looking to do is how do we let doctors use Clover Assistant for their entire Medicare Advantage panel, including other payers? So basically going to a multi-payer format for our software.
MA is the same for all payers, so there's very little product development that's necessary. We think if it works well for us, it's going to work well for a lot of people. We can help the payers improve their performance. We can help doctors improve their performance. It's a lightweight touch, so it can work with almost any doctor. We think there's a good market for this, and I look forward to sharing more with all of you about that strategy, going forward. But we've spoken about it in the past. I continue to reiterate that I think that will be an angle that we take in order to be able to return to profitable growth, on the basis of the investments we've made in our technology. And with that, I would be happy to take any questions from the floor. Yes?
Is there a mic?
Yeah. So we'll now open the floor to Q&A. If you're here with us in the audience, just raise your hand, and there will be microphones floating around. If you're joining us virtually, we can read your questions online. But I think there's a question up here, right? Yeah, up here.
There's a mic coming from the back.
Yes.
Yes, please.
I came in a little late, so I just want to clarify one thing and then ask another question.
Sure.
So the premise with the software that you're providing for the providers is really to manage or allow them to better manage the care through getting, while interacting with the whatever insurance plan they have. Is that-
I think that's right. Right now, we have our own insurance plan, so for clarity, it can work with any insurance plan, we believe, but it really right now is focused on just our insurance plan, but your, your thesis is correct. Yes.
With that being said, the software. So as a provider, if I'm seeing a patient, and I have to document in my EMR for, you know, whatever charting I have to do-
Understood. Yeah. Mm-hmm.
Is this another? Am I logging on to this other software platform to fill information into that too? And if so, have you looked into, you know, what is your thoughts or solutions on, you know, API access or interoperability between your software and in EMRs?
Yeah.
Because the biggest thing is, I'm sure there's value to this, but when you depending on the physician that you're dealing with and how well or not, you know, or-
Sure
how unorganized their practice is, they may or may not have time to really kind of maximize the use of the software. So just wondering if you have thought about that.
Yeah, excellent point. So how we have thought about, lots of nuance in what you said, so thank you for the question. Lots of interesting research that we've done. So first of all, I'll start by saying, at the baseline, the vast majority, and we have a lot of doctors using it, managing a lot of patients right now. The baseline is that it's a separate web app, separate login, completely side by side, completely independent from any EMR infrastructure. So what I mean by that is, it is independent of any EHR infrastructure and does not require any EHR in the infrastructure. So if you want to use it as a separate app, that's the baseline, if that makes sense. Then, we do have same things like SMART on FHIR capabilities.
We have things where we have you specific EHR integration, APIs, which is, you know, proprietary to the EHR. And we do have EHR integration. It's not required, but if the practice wants that integration, then we're able to do that with things like Epic and Athena, et cetera, et cetera. And we have a number of folks who are using that as well. We have a number of folks who don't do that because, you know, it's easier for them to actually use it side by side-
Right
but we give them that choice, if that makes sense.
Yeah.
And then they can select. And the last thing I will say is, the EHR remains, we consider Clover Assistant to be part of that medical record, if you see what I'm saying. So we have a very easy way to just generate Clover Assistant, and there will be things that are in Clover Assistant that the EHR didn't prompt for. That's why we're seeing the benefit. If it was all in the EHR, then there would be no benefit, right? To the Clover Assistant. But when there is additional documentation there, we find it make it very easy to link that into the EHR, so you can add that to your clinical note, and that way it becomes one note within the within the EHR, if there was any care changes that were driven by CA.
Is there any advantage or have you thought about, you know, getting the insurance companies or some, whoever's creating CPTs, to create a CPT for the use or the integration of this? If you can show that it's benefiting, you know, the patient population, therefore, you're gonna get increased, you know, compliance from the physicians because they're now financially incentivized to, while the patient is still benefiting from the use of this, to actually make sure that they're integrating this, this software.
I love the nuance in the question, by the way. So, generation of CPT, really cool idea. So right now, they are financially incentivized, to be clear, because we are the insurer, we do financially incentivize them. We change the payment schedule when they're on Clover Assistant. I didn't talk about it here, but we do do that, so great point. And that's their incentive. What we actually say is, "Take a little extra time, and we recognize you're taking time to use this software. I'll make it as easy as possible, but it's still additional work." You know what I mean? Like, of course, it is. Hopefully good work-
Mm-hmm.
. but it's still additional work. But we're gonna compensate you for that time. We're trying to not squeeze you as much. We totally get it. This is rough as a doctor, and that's the way we think about it. We don't do it through necessarily a claim right now, because Clover Assistant actually can issue payment directly, 'cause we're the insurer. But a cool idea on the CPT. You know, it—I can share more if you wanna come and talk to me at the end. Yeah, thank you for the questions.
I think there's a question in the back there.
Yes. Sorry to move the mic around from diametric corners of the room. Hi.
Hi. Yeah, sorry for making you walk with the microphone. Again, so maybe a naive question here, but could you sort of clarify the sort of qualitative improvements necessary to move up Star Ratings, and
Sure
why, you know, yeah, where is there a sort of limit you see while you have a sort of restricted model or? Yeah.
Yeah, yeah. Let me talk about stars. It's a very nuanced topic, but let me first of all say, Star Ratings are made, are a constellation, pun I guess intended in that case, are a constellation of sub-measures that are largely not related to each other, right? So just for everyone in the room, a Star Rating could be something like, are you keeping people on drugs, I mean, their medication, all the way through, is did they wait more than 15 minutes when they go to see their doctor? It's a number of different things. And so there's not one answer to Star Ratings. What I will say is that we tend to do a little better and focus on the clinical Star Ratings.
We feel really good about that, and where our attention is really being drawn right now is how do we make sure that we do better on the non-clinical Star Ratings as well, because they all aggregate into the overall Star Rating. The other thing I will say is that. And this is not an excuse. I want my Star Ratings to come up, right? So I'm not, I'm not making this excuse available to us, but I will say that, there are two things that are generally statistically known to be headwinds to Star Ratings. One is PPOs do worse on Star Ratings than HMOs. They just do. You can look at the stats across the board, and we're very concentrated on PPO.
And the other is the more diverse your population from a socioeconomic and ethnic standpoint, the harder it is to do well on Star Ratings, and we're a very diverse plan, and we've seen those statistics go in there. CMS has acknowledged both those things and has made some changes to the Star Ratings structure, which will kick in just in a few years' time, though, so we cannot rely on those. But I just wanna say that, first of all, just acknowledge there are those headwinds, and there is some relief coming from CMS. In the meantime, we have broken apart every single part of the Star Ratings and had that assigned to the owning team, and we wanna make sure that we're amazing on those clinical Star Ratings and do even better because that's the beating heart of, like, what Clover is.
Then we wanna make sure that despite those headwinds in the other star ratings that come from the structure of the stars, I'm not gonna wait until that relief comes from CMS. We're gonna really focus on those and make sure those are better as well. And I think that'll help us really stay at 3.5, and then have a line of sight to 4 stars. Thank you for the question.
So another question up here. There's a lot of buzz around home health. How does Clover Home Care differ from what others may offer in the space?
Yeah, so on home health, great question there. One thing that the home health is used for a lot of different products and services. One is home health aids, and that's not what we do, right? We don't send people to the home to necessarily, say, help with, like, making the bed or doing the laundry or day-to-day tasks. I think the way that we think about home health is that we are a practice, a clinical practice, a primary care practice, that has a different tiers of service available for different levels of intensity of sickness burden by our population, ranging from the very, very sick, which is our main focus, to just.
And just the general population member of Clover, and we can deploy those clinicians. We are staffed to do it, we have the logistics to do it. We can deploy those clinicians to that home to deliver whatever level of care is necessary to the member, and that's the way we think about home health. So it's really almost like a home visit from a clinician, not just home health in general.
Where would you say Clover Assistant and Clover Home Care sit in their overall evolution?
so I definitely think we are in early innings of all of the evolution of our entire company, but as well as the evolution of our products. I think that even as they stand today, I'm incredibly proud of their overall performance. You can see the emergent performance in our numbers, and I'm really delighted that that's, that that's the case. But there's so much more that we can do. Like, we have a full R&D team working on Clover Assistant. We were working, you know, we used to just talk about it as machine learning, ML, but, you know, we use the AI designation now. There's so many places where we are bringing AI into day-to-day use by clinicians to help them do their jobs better.
Again, in no way do I think that the right goal should be to replace clinical judgment with AI, but there's so many things that clinicians are doing. The questions that were asked by this gentleman here just now, there's so much stuff that clinicians are doing that, you know, are not top of license for them. The more we push them to their top of license judgment, both in our home care practice and within the general network, Clover Assistant lets them use that judgment, use those insights, delivers better care, and the key thing is, once again, we are not necessarily trying to let them do something that they didn't know how to do. This is not training a physician to know about a drug they didn't know. One day we might do that, but we're not doing that now. This increases the breadth of care.
When someone really, really has one condition, it's very easy for a clinician to become myopic around that condition, and we're talking about a multiply comorbid population. So Clover Assistant sort of opens the aperture a bit, gives them a little bit of more time to look at more conditions, so they don't have to be as myopic around that primary complaint, and when we look at that and deal with that in both the home care setting and in the wide network, and we can bring those concepts across the board, that's when you see better clinical performance, that's when you see better insurance performance. So I really think that there's an incredibly high ceiling on our approach.
Got it. So I think we have time for one more question. If there's none from the audience, I'll take it from online. What makes you most excited for the long-term potential of the company as it relates to the progress the company has been able to deliver thus far in 2023?
Yeah. So what am I most excited about? Thanks for that question. What I'll say is, remember, once we have a profitable plan, an 80,000 person plan, right? That's not a huge plan. It's, you know, it's a, it's a decent sized plan, but it's not huge by the standard of a United or a Humana or a Cigna. But we will be profitable, Adjusted EBITDA positive, and we will be on that carrying within there, this home care differentiated capability and the entire Clover Assistant research and development capability are embedded within the profitability of that particular plan, right? So it's a plan that is doing a lot of R&D, and it's doing a lot of differentiated care in the home.
And I think that I'm really excited to say, how do we then expand that and bring that model to as many people as possible on the other side of profitability? Because that's when I think we have a real virtuous cycle of capability leading to better performance, leading to more people coming under our management, leading back into more R&D capability, and which And because we have that differentiated ability to deliver our results through technology, I think that we are fairly strongly differentiated in our ability to build that virtuous cycle.
Thank you so much for your very detailed answers. That concludes our time today. Thank you so much again, and please, let's give him another round of applause.
Thank you, everyone. I can stand on the side here if anyone has any questions.