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2024 Leerink Partners Healthcare Crossroads Conference

May 29, 2024

Whit Mayo
Analyst, Leerink Partners

All right. We'll go ahead and get started here. Good afternoon, everyone. I'm Whit Mayo, Healthcare Services Analyst at Leerink Partners. Excited about the final presentation this afternoon, Clover Health. Andrew Toy is here. I think we're gonna go over some slides. We've got an exciting announcement this morning that I think's been in the works for some time. So, Andrew, I'll just turn it over to you.

Andrew Toy
CEO, Clover Health

Thanks very much, Whit. And I have Peter Kuipers, our CFO, here with me as well. So I'll go over a little bit about what we do at Clover, and as well, the new announcement we made this morning about our new subsidiary, which is Counterpart Health. So, forward-looking statements, we'll make those here. So to start off, Clover has been known for our MA plans for quite some time. We're known to be a MA payer. We are mainly in the New Jersey market and the Georgia markets. And but what we've always been is very clinically technology-focused. So while other plans focus on managing their populations via narrowing networks, through contracting, we are very focused on wide networks. We are very focused on. We don't focus on having anchor health systems.

We actually don't delegate much of our premium at all. In fact, we hold almost all our premium. I want to say all, all our premium. So we hold the risk on that premium, and then the way we manage that has always been through our platform, our technology platform known as Clover Assistant. So we built that, launched that in 2018, had rapid adoption within the PCP community. It's built for primary care. It's built to help primary care physicians deliver better care by identifying chronic diseases earlier, managing them earlier. So when, for example, we have some white papers that we put out there where chronic kidney disease is being identified earlier when someone is using Clover Assistant, and I'll talk more about that in a second.

Now, all of that benefit is flowing into our MA plans right now, and we're very proud of the margin improvements we've had in the last couple of years. We're proud that we are targeting Adjusted EBITDA profitability this year, and that is all driven by this very specific care model, which is physicians using Clover Assistant, primary care physicians using Clover Assistant, and in some cases, some specialties using Clover Assistant as well. And that is what you can see here on this slide is on the left-hand side. That is what we traditionally have been known for, is a Medicare Advantage Plan, focus on the wide PPO with a care model that can actually manage care on that wide network powered by PCPs using Clover Assistant. What we announced today was we are taking the next logical step.

We are making our assistant technology and platform available to PCPs who are managing MA risk for MA Medicare eligibles who are with other payers. So under this scenario, we are branding that Counterpart Assistant. While our parent company is Clover, our Clover brand is synonymous with our MA plans, so we have a different brand that we will be bringing the assistant to market with, which is Counterpart Health. It is the same technology platform, though. For a given primary care physician using the assistant, they would not know the difference between these two things. In fact, you can think of Clover Assistant as actually a white label of Counterpart Assistant for the purposes of the Clover MA plans. So hopefully that makes sense to people.

Counterpart Assistant is the core technology, and we are now making that available to risk MA risk-bearing providers, to provider-sponsored plans, to plans who are looking for help improving their MA performance, and Counterpart is now, we announced today, generally available for that scenario. It's the same proven technology platform. We've been building this since 2018. We've proven it within our MA plan. We've talked a number of times about the performance improvements we see with PCPs when they move to Clover Assistant, now Counterpart Assistant. And so we feel very confident that the technology is built, that it's the same technology that will be used in all scenarios. For a PCP, they're getting data-driven care, they're identifying those chronic diseases earlier, managing them earlier.

Doesn't matter whether it's the Clover MA plans, upstream of them or some other MA plans go upstream of them. So we feel very confident that this business enables us to generate, value and generate benefit for those in risk-bearing arrangements in other markets where our MA plans are not present. So for the value proposition, this is a cloud-based AI-powered technology. We have already built data integration, so we can come with our own data in a lot of scenarios, and we basically have very little integration we have to do. We know it works 'cause it's been proofed within our own MA plan. We know that it is something that clinicians are excited to use, and that when they do use them...

And again, please, if you haven't seen our white papers, please look at our white papers that show better outcomes on medication adherence, on earlier diagnosis of disease. These are really important dynamics that give better outcomes for the patient and also directly translate into superior loss ratios for an insurance company or a risk-bearing entity when those things happen. So we think that there's a lot of value that we've already proven out through early diagnosis. It lowers medical costs through early management, and of course, just generalized quality improvement, HEDIS gap measures, things like that for stars. For Clover Health, the parent co, in this case, this gives us a way to deploy an existing technology asset, something we've already invested a lot of resources into building, and gives us another revenue stream to actually bring this to market.

The way I like to think about this is that there's all the MA risk that's out there that needs to be managed. We want to manage that with Clover Assistant, Counterpart Assistant. One way to do that is to bring on that medical risk through our own MA plans. Another way to do that is to go into partnerships with other risk-bearing entities and scale that way. So one is a B2C motion, one is a B2B motion. It's something that we learned from our experiences with ACO REACH, where this is something where we know we can scale using that B2B motion, except now we're not doing it with original Medicare risk, we're doing it with MA risk, which is something we are specialists at.

So the business model here that we're delivering is, on when we're doing this with Clover plans, we obviously are holding full capitated risk in that case, and that's the business model. When we're doing this for other entities on their Counterpart, what we're gonna be doing is having a PMPM component, a recurring revenue platform fee, which we think will generate, that recurring revenue, and which we think that will be priced well, given that the amount of value we're generating. We will also have tech-enabled services revenue, which is basically the value-based care component, where we will participate in shared savings. We are looking to launch into upside arrangements here to start, meaning upside risk-only deals. We could eventually move to full capitation or downside risk, but we're not doing that to start.

To start, what we're doing is upside gain share, combined with SaaS-like recurring PMPM revenues. That gives us two different kinds of revenues, which we think will be very exciting. Right now, we've brought this to market, we've shown it to a number of people. We feel very good about the product-market fit. And so what we are doing is starting to launch into deployments, and we're focused on closing those deals, getting those deployments this year. Revenue will not probably land, start landing this year. Some will land, but it won't be that much. But we'll be closing those deals and then ramping into those deals for revenue generation in future years.

So across the board, just as a reminder, and this is something that we show, this is a short summary of what we are actually demonstrating to people when we go out there to sell and to partner using Counterpart Assistant. Our CA technology is driving all three of these columns, right? It's driving proven clinical outcome improvement, earlier diagnosis and treatment of diabetes, early diagnosis and improved disease trajectories for CKD, med adherence. These are just the white papers we've written and published. We'll be publishing more of these white papers, but these are the three that we've done so far. Great evidence of improved care there. We think we're one of the only payers really able to prove this and then to show this.

That 1,000 basis points of MCR differential, returning members who see a Clover Assistant PCP have over 1,000 basis points on the loss ratio, superior than those who do not. We've talked about that for a long time, and that's very significant, obviously, when we go to partners who want to look at improving their performance. And quality measures, and you can see those on the right-hand side here, improvement on various quality measures around colorectal cancer screenings, breast cancer screenings, osteoporosis, et cetera. These are the key things that we were discussing earlier at the keynote around Star Ratings, et cetera, driven by primary care, driven by improvements where people have that data available at their fingertips, provided by Clover Assistant.

Ultimately, I think that if you want to think about what is the key thing that we bring with our assistant technology, it is we are able to drive differences in PCP behavior without the PCP feeling that their arm is being twisted. We aren't giving them artificial carrots, confusing benchmarks. We aren't giving them sticks, where we're saying, "You're gonna be punished if you don't do this." We are arming them with information. We are in a clinically intuitive way. When we demonstrate it to them, we're like: "Hey, look, you're gonna see this information. It's gonna help you make decisions. You make the decision you want to make," right? That's how doctors want to practice medicine. We aren't compelling them to do anything. It is integrated into EHRs. They can choose to use the EHR integrated version, they can choose to use the standalone cloud version.

Either way, we typically launch this with just an hour or so of training for every PCP, and then new versions deploy from the cloud automatically, and we don't have to do retraining for PCPs when we do that. It's all a cloud-based tool that's designed to be elegant and easy to use. So ultimately, what I think we have demonstrated with our capabilities is we can take data, we can generate insights using rule sets, research, AI, and then we are able to deploy those to PCPs in an intuitive way that allows them to change their behavior and improve care and improve outcomes. And that's been proven within our plan. That's what we're now bringing and making available to any entity via Counterpart.

Speaker 4

All right. Yeah, a lot to unpack there.

Andrew Toy
CEO, Clover Health

Thanks.

Speaker 4

First, let's talk about kind of the work that you did leading up to this announcement. You mentioned that there's been some productive conversations.

Andrew Toy
CEO, Clover Health

Mm-hmm.

Speaker 4

I would presume, across risk-based positions-

Andrew Toy
CEO, Clover Health

Yes.

Speaker 4

MA plans, and, I'm sure someone else, other providers.

Andrew Toy
CEO, Clover Health

Yes.

Speaker 4

What do you see of those three buckets as perhaps the more immediate addressable market to begin to grow?

Andrew Toy
CEO, Clover Health

Yeah, great question. The way I think about, I think all of that is there, as you said. The quickest pathway we see right now is going through the providers, because you can actually do two things. You can go straight to a provider and say, "Hey, launch with us," right? And they are generally already have, the people we're talking to already have risk-bearing arrangements. If they're on fee-for-service at a later phase, where we'll help them go to risk. Right now, we're going to providers, groups who already have risk arrangements with upstream payers.

Speaker 4

Okay.

Andrew Toy
CEO, Clover Health

And then, so they're like: "Okay, great, I want to just improve my performance, therefore." We do the demonstrations, we show the clinical benefits, they get excited, and then what we say to them is, "The great thing about this is, there's no full transformation of the practice. They can just roll this out PCP by PCP-

Speaker 4

Mm-hmm.

Andrew Toy
CEO, Clover Health

and just do 5, 5 PCPs, 10 PCPs, 20 PCPs, 50 PCPs, just like we do in our own MA plan.

Speaker 4

Right.

Andrew Toy
CEO, Clover Health

Then that scales up quickly. So we find that that is a very good way to actually come to market.

Speaker 4

Okay. Many risk-bearing groups already have a form of technology, not Clover Assistant, but can you integrate with their existing systems? Do they have to operate, you know, on a standalone basis?

Andrew Toy
CEO, Clover Health

Great. Yeah, yeah. So normally, what we see is, when we come in here, we say we're doing something different, right? And they're like: "Okay, what are you doing?" And we show them the demonstration, we show them the clinical, and we have a very good hit rate of saying, "Okay, this is different. This is not the same. This is not the same as other things we're doing." So we see that we are additive to anything they're doing and that they've already deployed. We've had a lot of conversations. We feel very good about that product differentiation. So what we say is, if you're already using pop health tools, this is not a pop health tool, right? If you have, like, a general analysis system, and you wanna just generate dashboards, you wanna generate, sort of like lists-

Speaker 4

Yeah

Andrew Toy
CEO, Clover Health

And things like that, that's not this. This is a personalized care system. So you can just keep using your pop health tool, and you can add this right on top. This is not like a replacement for the EHR, right? This adds on top of that as well. You can keep whatever you have turned on there. It's additive as well. So we tend to be able to prove that this is additive to what they're already doing, and also, therefore, additive in terms of value generated.

Speaker 4

Okay. And this is all gonna be on a subscription basis, a price per member per month?

Andrew Toy
CEO, Clover Health

Yes. So we are gonna have the platform license fee, which is gonna be a recurring revenue, format-

Speaker 4

Right.

Andrew Toy
CEO, Clover Health

So a PMPM. And then, we are not-- We think this is really its own product. It's born in a plan. It's really built for managing risk. So we're not bidding this as like an HCIT solution. It could fit into that category, but it's not something where we will respond to RFPs and things. It's really its own pitch, is what we say. So we'll have that PMPM, where we're like, "That's what we do for the platform," and then we always wanna participate also in that upside as well. 'Cause we have such conviction we can help. We have such conviction that we can add a lot of value. We want our partners to also have that conviction. That's part of the sales, sales pitch. And when we see that they believe that, then we believe there's plenty of economics for us to share in.

Speaker 4

Okay. Unpack the upside. You're, you wanna participate in the upside over time, so-

Andrew Toy
CEO, Clover Health

Correct.

Peter Kuipers
CFO, Clover Health

Mm-hmm.

Speaker 4

To the extent that they are showing improvement in MLR, you get a piece of it?

Andrew Toy
CEO, Clover Health

Correct.

Peter Kuipers
CFO, Clover Health

Correct.

Andrew Toy
CEO, Clover Health

That, that's right.

Speaker 4

Alignment of interest, that's always a good thing to, to see. What type of investments do you think you need to make between now and launch date to begin the commercialization of this in the sales force? And I'm sure not all of that is in the plan that you have for this year. Maybe it is, but...

Andrew Toy
CEO, Clover Health

We think that we are already well on the way to have the first few customers signed up, and we'll have more to talk about that as those roll out. We already have a number of folks who are actually deploying, as we speak right now, with commercial arrangements in place. That's not a scaled deployment, that's more of-

Speaker 4

Pilot.

Andrew Toy
CEO, Clover Health

I wouldn't say they're pilots, it's just that we're not-

Speaker 4

Sure

Andrew Toy
CEO, Clover Health

sort of, like, jamming the funnel right now

Speaker 4

Got it.

Andrew Toy
CEO, Clover Health

and flooding the funnel. They're not pilot, they're production deployments.

Speaker 4

Yeah.

Andrew Toy
CEO, Clover Health

We're beyond pilots right now.

Speaker 4

Mm-hmm.

Andrew Toy
CEO, Clover Health

So we're deploying there. They will be revenue-generating, so the business model is, you know, always can be customized, but it's pretty well-tuned. We're not looking to just sort of go massive scale. We learned from the ACO REACH that we don't wanna overly scale too quickly.

Speaker 4

Right.

Andrew Toy
CEO, Clover Health

We wanna make sure we get our sea legs under us, even though I have very good conviction around this particular business. And so, yes, there's some sales team investment, where we've already made a number of those. We believe that the support model will be very similar to what we already do within the MA plan, right? So we're very familiar with what it takes to support a provider from the Clover MA plans. We're gonna prove that out, just make sure that deployments proceed and are clean, that the support model bears out, but we feel pretty good about that as well. And from a technology perspective, the investments are pretty much already made, and so it's gonna be a generally high-margin business.

Peter Kuipers
CFO, Clover Health

Yeah. Yeah, the gross margins we estimate will be significantly higher than the current margins on the MA plan.

Andrew Toy
CEO, Clover Health

Sure.

Peter Kuipers
CFO, Clover Health

Yeah.

Speaker 4

What level of customization can the users make in terms of the care gap intervention and how the workflow works?

Andrew Toy
CEO, Clover Health

Right, that's actually a really good question. Right now, we do not allow for very much customization at all. The way that we think about, and we're not, we're open to it, but generally, we've not had to do any customization.

Speaker 4

Yeah.

Andrew Toy
CEO, Clover Health

Let's put it that way. The reason is that the way we talk about this is, it is, once again, it's additive to the existing workflows, and it is something whereby we kind of like to think about it as GPS or turn-by-turn directions, right? Like, this is something where we're gonna make suggestions. The suggestions are optional. The PCP can practice medicine as they see fit, and then they can go through a list of suggestions that we have, insights that we produce, and they can just react to those and respond to those. Because of that, we haven't actually had to do a lot of customization. It tends to be fairly intuitive. What we do have is sometimes they want to see that inside their EHR versus on a separate pane of glass.

The pane of glass issue does come up, but not sort of a workflow or data stream customization.

Speaker 4

So the medical groups that are currently using, it's not called Clover Assistant anymore, it's called, what's it called? Counterpart.

Peter Kuipers
CFO, Clover Health

Counterpart.

Speaker 4

Counterpart.

Andrew Toy
CEO, Clover Health

Yes.

Speaker 4

Counterpart. Are they currently paying you a PMPM right now?

Andrew Toy
CEO, Clover Health

The ones who are launched under the Counterpart model? Yes.

Speaker 4

Okay.

Andrew Toy
CEO, Clover Health

Like, they are.

Speaker 4

Yeah. Okay.

Andrew Toy
CEO, Clover Health

Yes.

Speaker 4

Um-

Andrew Toy
CEO, Clover Health

That's why we're announcing the general availability. So another way to put it is, the pilot phases, we believe, are. If you do a new, like, sale, of course, you might always do a pilot because that's a prelude to a sale, if that makes sense.

Speaker 4

Yeah.

Andrew Toy
CEO, Clover Health

But the phase where we're sort of testing the business model, testing those kinds of things, I feel like that phase is now concluding, and we're ready for general availability, which is what we announced today.

Speaker 4

How easy is it to integrate with a lot of the legacy health plan systems today so that they can deploy it to their doctors, or is it not, that they work on a license with you, where they're like: "We're gonna pay you a PMPM for your services, and we're going to allow our downstream medical groups to use it?" How does that work?

Andrew Toy
CEO, Clover Health

So every deal is a little bit different. So I'll speak in generalities here. Generally, it is what you just sort of said, where we are generally contracting with a higher-up entity. So I'll make up an example. Let's say there is an academic medical center, and they might have a CIN, right, associated with it, which has got a bunch of physicians, community, their own docs, and things like that within the clinically integrated network. Then they will be paying us a PMPM for that CIN, basically, and then they will be moving chunks of folks into launch. So they won't just say, day one, we're going to pay you a PMPM on everybody, but what they'll select is on a launch plan, these are the group of folks will go first. We'll get them going, then they'll start paying on those.

Then the next wave will go, we'll start paying on those. It is basically based on launching doctors, so they'll identify physicians who are going live, and then the attributed population will go live at the same time, and then the PMPM will be paid on that population.

Speaker 4

Okay. What would be a manageable or reasonable level of growth in any one year as you launch this?

Andrew Toy
CEO, Clover Health

It's somewhere between, like, you know, one practice and the number of ACO practices we launched, which was a lot-

Speaker 4

Yeah

Andrew Toy
CEO, Clover Health

... like in one go. But I think what we saw is that we have the capability. What Reach taught us, while that was ultimately not the right program in original Medicare, what it did teach us was that we were able to pull a lot of risk in very quickly through this B2B methodology and sign a lot of contracts very quickly.

Speaker 4

Mm-hmm.

Andrew Toy
CEO, Clover Health

I think tuning this to be like MA is, on MA, makes it a lot more, a lot, a lot safer, let's be honest, right? Because it's upside-only risk. We're much more familiar with the MA program. CMS could make changes, like, you know, MA is less vulnerable to that by statute. So I would say that we are being judicious and disciplined in how we roll it out, but I would hope that this would scale like a software business when it's fully rolling.

Speaker 4

What have I not asked about this?

Andrew Toy
CEO, Clover Health

I think that the thing to think about here is: why are we fundamentally different than value-based other value-based schemes? And why are we fundamentally different from other technology schemes?

Speaker 4

Mm-hmm.

Andrew Toy
CEO, Clover Health

I think that the answer is, whenever I think about this, is that we sit as Clover in a very unique intersection between the two things, right? Very few full risk-bearing entities, like the MA plan, are completely reliant on technology to generate their... We, you and I have talked about this a lot, right? Like, just no one takes that approach, right?

Speaker 4

Right.

Andrew Toy
CEO, Clover Health

And so we have that experience. When we compare ourselves to software companies, we can command, we believe, a significantly higher margin and price premium over regular software companies for a PMPM and upside basis, simply because we can point to the results within our MA plan and say: "Look, look at how much value we can generate. This is worth it." And that's something that's very difficult for my software compatriots to be able to do. And so when you go to the value-based guys, they totally understand the value side. They don't have a software tool. They have all these other practice transformation, they have all these other ways they do it, but it's not software-based.

When you go to software folks, they totally get that, but they're completely on ARR, they're completely on, I think, diminishing somewhat like fee structures as they compete with each other. And what we're hoping to do here is bring those together, and when they come together in that intersection, have a unique offering for the space.

Speaker 4

Okay. Anything else, Peter? Peter's very excited.

Peter Kuipers
CFO, Clover Health

Yeah, I'm excited. Yeah, I would just point out maybe also the, just the additional, the incremental cost for deployment is really low-

Andrew Toy
CEO, Clover Health

Yeah

Peter Kuipers
CFO, Clover Health

... right? Because the technology is already built, platform is there, proven results.

Speaker 4

All right, last one-

Peter Kuipers
CFO, Clover Health

Yeah.

Speaker 4

I want to shift to some less fun stuff. What was the work leading up into the overall launch? Like, how long has this been in the works? How many years and months and-

Andrew Toy
CEO, Clover Health

So, the technology is the same technology.

Speaker 4

Yeah.

Andrew Toy
CEO, Clover Health

So I think the key thing here is, like, we've been investing, and we've been talking about this for a long time, right? So the tech is there, tech is there, tech is there. Then I would say there's a bunch of learnings that we got from the Reach program, right, that is factoring into how we think about this now, because, well, once again, different, value-based program, but similar B2B motion, contracting, all those kinds of things. And so we've been working on this version of it, probably really, really in earnest for about a year, about a year now, and really taking it to market, probably really focused this year.

Speaker 4

Okay. All right. We're gonna have to do some follow-up calls about this. This is exciting.

Andrew Toy
CEO, Clover Health

Yeah, should be good.

Speaker 4

All right. Are your bids in yet?

Andrew Toy
CEO, Clover Health

Uh,

Speaker 4

I'm kidding.

Andrew Toy
CEO, Clover Health

... They should be. They should be, but like, we have, we've had a final bit of tuning. It should be in clean this week.

Speaker 4

What do you think the biggest surprise will be in a few months from now, once we see everyone's bids?

Andrew Toy
CEO, Clover Health

So definitely, as you were talking just earlier today with John, I think the real sleeper is Part D, right? Like, it is a... And that's because there could be some massive unknown unknown, right? But there's a massive known unknown in the Part D national direct subsidy, right? Because as all this risk moves into the PD portion of the plan, you're gonna see, you're gonna see premiums and stuff all move around. You're gonna see basically, even the member the patient-facing portion of this all move around. And I think that's something that people aren't talking about enough as well, is we talk about it as an MAPD context, as of course we do, but it should also be discussed in a standalone Part D context.

I don't see a lot of people talking about the effect on standalone Part D, and I think that could have a significant effect as well, which would then affect, obviously, sub and fee-for-service, and then that affects MA, if that makes sense, right? As it cascades. That's what I think we should all be keeping an eye on.

Speaker 4

Got it. PPO, HMO, you guys have had for a long time, an orientation around open access panel. How are you sort of experimenting more with HMO going forward in any of the new markets or in New Jersey?

Andrew Toy
CEO, Clover Health

We are not looking at our HMO product. You know, obviously, at this stage of the bid, normally, we don't talk about it, none of us talk about it 'cause we don't want to have competitive information.

Speaker 4

Long-term strategically, yeah.

Andrew Toy
CEO, Clover Health

Yeah, but strategically, I think it's pretty clear that HMO is not central to our strategy, right? Like, that wouldn't surprise anyone. That's not giving away competitive information. So really, the way we think about it is, at the end of the day, everyone else really has HMO as the way they could manage costs. Even when they had a PPO, it's really trying to wrap around certain anchor health systems that help manage costs, and the more people go into true PPO wider networks, the less plans we're able to manage those costs, which I think has led to some of the effects that we're seeing in the broader market.

Speaker 4

Agreed.

Andrew Toy
CEO, Clover Health

So, Clover Assistant is a good sell for that, by the way, and so that's why I think Counterpart, it's great timing for Counterpart to come and help with some of that. So we want to help with that on the Counterpart side, and then for us, really, that PPO network, the community doctors, those kinds of things are really our sweet spot. We don't really think that HMO is the place where we would focus. We might do some innovations, we might do some experiments, but, like, it's not a place that we particularly feel like we have to go.

Speaker 4

Yeah. Every time I go back and look at my Clover model, I get surprised this year with the growth that you have in your PMPMs.

Andrew Toy
CEO, Clover Health

Mm-hmm.

Speaker 4

I know a lot of that is you haven't been growing the book as much the last two years.

Andrew Toy
CEO, Clover Health

Yeah, so it's aging.

Speaker 4

And it's aging-

Andrew Toy
CEO, Clover Health

Yeah.

Speaker 4

So you're getting better on coding and other things. But maybe just bridge me, like, how much of that improvement in PMPM is coming from cohorts and coding and whatnot, just the maturation of it?

Andrew Toy
CEO, Clover Health

Of course. So, like, there's generally, like, three dimensions that are gonna flow into that, right? One, one of it is going to be as the cohorts age, you know, one year is hopefully, like, not a lot for regular people, like, in terms of health, like, it doesn't make a difference. One year is a lot for the Medicare population, right? Like, there's significant increase in sickness burden in one year. So dimension number one is just demographic aging and the cohorts aging, so that's one part of it. And we're doing pretty well keeping a sticky membership base. They're staying with us. We're not growing a lot, and so as you said, those cohorts are aging. That, that's dimension number one. Dimension number two would be, the generalized documentation of the sickness burden and identification of the sickness burden.

The way we think about that is, one, you should always be good at documentation. If they have an actual condition, you should document it. That's just good quality documentation. Number two, remember, Clover Assistant is also, a lot of our AI points to this, identifying diseases as early as possible, right? That doesn't mean that that person wouldn't eventually get treated for a disease. It just means they're getting this, getting treated, identified and treated a year or maybe two earlier than they otherwise would. So as you see that effect cascade in, that also affects the revenue PMPM side, because if we find out you have CKD, we're gonna start treating the CKD, but you also get the diagnosis earlier, right? So that effect is definitely flowing into the cohorts now, in a very recognizable way.

I want to also just really point out that a lot of the stuff around V2 8, et cetera, I think a lot of people have challenges there, 'cause while we have always focused on chronic disease identification and management, what CMS really targeted, as John said earlier, was codes that did not have really any management. They just had revenue, and those were now just have been pulled out, and I think appropriately so. So that falls in that second category, and we feel good about where we stand on that. And then the last category is the bid, basically, right? If the more aggressively you bid, basically, the more your revenue will come down, and because we have...

We've not really pulled back aggressively, but we've stopped adding every year, and others have caught up to us a little bit, I'll admit that, and that slowed our growth. But because we're no longer adding to benefit richness as much as we were before, that's also helped on the margin side.

Speaker 4

How do you feel about some of the new states that you guys have grown into? And are you adding additional investments into new states, you feel like, or is we back to, you know, New Jersey, the core at this point?

Andrew Toy
CEO, Clover Health

New Jersey is the core for our plan. I'm not saying that we wouldn't expand the MA plan. We have thoughts about how we would do that, but we used to sort of measure ourselves on how many counties are we going into this year, and that kind of stuff. I don't think that that's the right growth strategy, for us. You don't want to just have network adequacy and licensure. It just creates a cost basis that doesn't have a return on it. So what we really look at now is all on a PBP basis, on a county basis, on a market basis, where is the profit being generated from? And focusing on how do we grow more in those particular markets, because that is how we grow sustainably and profitably.

That's gonna be concentrations around New Jersey. It's gonna have concentrations around Georgia, where we already have presence.

Speaker 4

Right.

Andrew Toy
CEO, Clover Health

What you'll see us do, again, we will expand the MA plan, we will return to growth, but it is far easier for us to, when we think of expansion, I think of where do I have Clover Assistant coverage? And it's gonna sound a little bit like the ACO, but it's with Counterpart, we now have the ability to get those deals in other parts of the country and look just like, almost like we are an MA plan in that capacity, because we're taking on that MA risk, and so that's a much better way for us to expand. We immediately, economics, we get much more scale, much more quickly.

Speaker 4

Mm-hmm.

Andrew Toy
CEO, Clover Health

It's a much lower cost of entry.

Speaker 4

I'm gonna strike out on this question, but say, five years from now, I look at the composition of earnings within the business, how much would you say is core health plan versus the-

Andrew Toy
CEO, Clover Health

If you look at my long-range plan, I don't know if it's 3, 5, 7, like a long-range plan for where we would go, right? I would say that I think it would be interesting, our business should look like we have a very significant MA plan that has been growing, that has been generating a profit. It's a high profit. It's a, sorry, it's a high revenue, lower margin, revenue line. Then, similar, when we look at something like Counterpart, that is going to be generating higher margins, so more, more operating margin, basically, on there, and a lower cost of entry, and something that can scale a lot more quickly.

So I think that you will see in the medium- to long-range plans, that the majority of our operating profit I would like to be actually coming from a growing counterpart business. But that doesn't mean that I am discounting a steady growth-

Speaker 4

I understand.

Andrew Toy
CEO, Clover Health

-within the core.

Speaker 4

Yeah.

Andrew Toy
CEO, Clover Health

Yeah, both-

Speaker 4

Foundational business plus the-

Andrew Toy
CEO, Clover Health

Yeah.

Speaker 4

Yeah. Yeah.

Andrew Toy
CEO, Clover Health

Yeah, yeah. I hate to use a, using a techie like sort of the analogy would be like, like, that's like our AWS, like, like, like equivalent. Don't draw that metaphor too far, but like, it's, it's, it's a reasonable way to look at the world, I think.

Speaker 4

Yeah. Any questions from anyone in the room? Peter, Andrew, thanks for joining us today. This was, this was good. Congrats on the announcement.

Andrew Toy
CEO, Clover Health

Fantastic.

Speaker 4

Thank you.

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