We'll kick things off here now and keep the door open 'cause I think investors are gonna flow through.
Okay.
So, thanks, everyone, for attending. My name is Scott Schoenhaus. I'm the healthcare tech analyst here at KeyBanc. Pleasure to have Peter Kuipers, the new CFO of Clover Health. Peter, why don't we just... You know, this is a tech forum.
Yeah.
We have all tech investors. So why don't we, high level, break down what Clover Health does, and, and what is their tech stack, and what is the offering here.
Yeah
... in the healthcare setting?
Yeah. Well, first off, great to be here, Scott. Thanks for hosting and having us here. Yeah, so Clover Health has really a differentiated business model, and we do have a technology stack. So, we are an insurance plan focused on Medicare Advantage, using mostly a PPO structure or chassis. However, our approach is differentiated from other plans. We use technology, AI-powered proven technology, large language models that have been trained for many years. We started in 2018. So what our technology actually does, it helps the PCP or the general practitioner, at the point of care, make better-informed decisions about care management for a patient.
And how we do that, we connect our technology, called Clover Assistant, AI-powered, cloud-based, connects over 100 different data sources via the cloud and recommends care paths, if you will, for a physician to look at, right? So think about connected information from other EHR systems, pharmacies, labs, et cetera, right? So it's very insightful, specifically in a world where interoperability is a big challenge, right? So visibility for a general practitioner is really difficult, so our solution actually helps that. We have a couple of white papers that you can see on our website as well, really showing that we really help general practitioners recognize and diagnose chronic diseases earlier.
For example, as a white paper, you can see that, our technology enables, physicians using our software platform to diagnose, chronic kidney disease about 18 months earlier. And what that actually then means is that, of course, treatment can start earlier, right? It might have more med ex in the front, front-loaded in the front end, if you will, but total cost of care over lifetime is gonna be lower, right? So... And then, of course, for the patient, of course, there's better health outcomes as well. So, if you look at our team, right, our CEO came from Google. We've got a lot of scientists, if you will. CTO came from Yahoo as well. I have a technology background also from Yahoo and from Omnicell, so, impressed with the technology stack. So we actually are differentiated that way.
The beauty of the technology stack also, if you just look at if you talk about proven technology, so we have proven this technology operating an insurance plan at full risk. So we are at full risk for the medical cost for our Clover Health Medicare Advantage members, and we've demonstrated in published results that we are able to, what is called the medical cost ratio, to lower that medical cost ratio over time, right? So demonstrated ability. So we have now also made the same technology available for other Medicare Advantage plans.
So you're pulling a bunch of data. You're helping the provider, the clinician, the physician, make better decisions earlier on for treatment-
Mm-hmm
... ultimately for lowering cost and providing better treatment for the patient. It's a tool used for doctors.
Yeah.
Can you maybe drill in more? So it's specifically on Medicare Advantage.
Yes.
So for tech investors who really don't know, these are older, population sets, 65 and older, commercial plans. Can you talk about your current customer demographic in terms of, like, where you're positioned, geographically in the US?
Yeah.
Where you are trying to grow, where you're targeting growth in that network of providers?
Yeah.
Yeah, let's start there.
Yeah. Yeah, so most of our member base are also called Clover cardholders, if you will. It's a way to think about it. The majority are in New Jersey. But we're also in Georgia, Texas, and some other states as well. And we do have, of course, also a density in these states where general practitioners are using the Clover software. So that's where you have this overlap, if you will, of both members and the use of the software. That really leads to powerful outcomes, right? So, we have growth opportunities in these states, specifically, of course, also in New Jersey. We have a, you know, around a 10% market share. We believe we can, we can organically grow there.
And then, of course, we can expand otherwise as well, also via what we call the Counterpart-
Yes
... software offering.
That's right.
You can, we can talk about that a little bit as well.
Yeah.
Yeah.
So you know, you recently announced this, Counterpart Health. It's a subsidiary of Clover Health-
Yeah
... and it's a software platform that's available for, you know, external payers and providers. You know, let's talk about more about this software platform and the opportunity set this brings to your company.
Yeah. Yeah, so maybe let's first talk about kinda just the technology solution itself.
Yeah.
Right? The technology, it's the same technology solution that we use in our plan that has demonstrated significant results over time.
Yep.
So that same technology we make now available for other plans and also for at-risk providers. There are many plans out there that have significantly higher medical cost ratios, right? They're struggling with the economics, if you will, and we can help there, right? So the software can be implemented in one day. Essentially, physicians can be trained in one hour, right? So, and then the flywheel can start working, right, to bring down the medical cost ratio and then also, of course, improve the profitability of these plans or at-risk providers, if you will. And we have a separate presentation of that, I think, on our website as well.
On Counterpart Health, you can see there that we're confident that we're able, over time, to help these plans or providers to lower their medical cost ratio by 1000 basis points. So that's 10%.
Over what period of time can you do that?
Over multiple years.
Mm-hmm.
Yeah. And then the revenue model is both, PMPM or SaaS-based, so a monthly fee per member that's covered by this technology, per month, right? Plus then also a share gain.
Got it.
So a tech-enabled services fee, where we then share in the, in the savings-
Yeah
... by lowering the MCR. The first slice, if you will, think about officially, the first slice, we give to the, to the customer, in this case-
Yes
... the other plan or, the risk-bearing provider, right? So, it's actually really a beautiful model 'cause you don't really need to argue or discuss-
Right.
the savings, because it's a simple calculation, right?
Yeah.
That's beautiful. Then in the upside from there, after that first slice, we share in it proportionately, right? In with a different percentage.
Now, if you're executing beyond expectations, do you... Is there an opportunity to renegotiate those terms year to year? Or, I mean, are we not there yet because the product is so new that,
Yeah, we're starting. I would say we've commented publicly that we have very good momentum in the pipeline as well. We see a lot of interest, right? So, yeah, of course, these deals are mostly multi-year.
Yep.
With a renewal option, of course, as well, and an expansion option. Yeah.
So the Counterpart application, the platform, how does it sit on the payer and the health system? Like, how do doctors use it?
Yeah.
Just kind of describe the technology-
Yeah
... and the platform.
Yeah, the implementation is very straightforward. It's cloud-based, can be installed in an hour, essentially, right?
Wow.
On our website, you can actually see the user interface. I came from a technology background for many years. I do care about user interface, and it's a really elegant user interface. It's an Apple-like, elegant design, where some of the EHR systems and some rev cycle systems are maybe a little bit more difficult to navigate. This is a beautiful system that, as a user, you will want to use. So it actually generates suggestions to give care, if you will, and from a human perspective, you will want to look at it. And we have proven results, if you will, that we actually have a.. You can really call it yield or conversion, actually, in general physicians choosing the right care path, if you will, a recommended care path.
How big is this Counterpart Health opportunity, Peter, in your opinion, both in the near and longer term? Do you think it's a bigger opportunity than, you know, just your current what I wanna call install base, but it's not really your install base, but is your current customer set opportunities, with the-
Yeah
... MA members that you're working with? How do you think about this?
Yeah. Maybe we can talk about the shorter term and kind of medium term-
Yeah
... and longer term and delineate there. Shorter term, what we've said is we have a rich pipeline that's progressing, and deals are getting signed, if you will, and deals are getting implemented, right? And then, of course, we talked a little bit earlier about the revenue model, right? So the PMPM SaaS revenue will start to show up over time, and it will build as members grow, as well as recurring revenue. The share gain largely recognized after a year is completed.
Yep.
We can calculate it. It's pretty straightforward, but still, that's gonna be after the PMPM, if you will. Of course, we have sized the opportunity, and we're, of course, refining the go-to-market approach as well. It's a little bit too early to size it, but I would say it's definitely meaningful. Gross margin profiles are similar to other SaaS companies, right? So the beauty here is that we already have a proven technology. We're not pre-revenue, right?
Right.
So, there's more to come, right?
So you're saying your gross margin profile is that of a typical software business, 90%, 80% gross margin profile?
I wouldn't go that high.
Okay.
Yeah. Yeah, it's, it's more... It's lower than that, obviously.
Okay.
Yeah.
Yeah.
But above the gross profit profile of the plan side today.
Yeah, of course.
Yeah.
Yeah, yeah.
Yeah. Meaningfully.
So really large, high-margin growth opportunities by offering this, this, this capability?
Yes. Yeah.
And you can offer it nationally, right? There's no hindrance in going to different states.
Correct.
Okay.
Yeah. Yeah.
You know, maybe let's switch topics here. Bigger picture, why should investors put Clover now in the same category as other tech companies or AI-focused companies rather than a healthcare services? I know you're trying to sort of shift this business model in that direction.
Yeah.
How, how do we, how do we bridge that?
Yeah, well, that's why we're here today as well, of course. I would say we're probably one of the only companies or really small group of companies in healthcare where we have applied AI, a large language model, machine learning, in real life, with real-world results, both for patients and also financially. So that is different. We chose, when the company was started, actually, to prove it out in a plan-
Yeah.
and get real-life results. So the other choice would have been just develop maybe a technology solution and see where you can implement it. So we chose the first option.
And, Peter, maybe give some back. You know, you're relatively new to Clover, and the CFO, as the CFO. What attracted you to this company?
Yeah.
And I'm sure you had other opportunities, but why-
Yeah.
Why, why did you choose Clover?
Yeah. Yeah, great, great question. You know, what I'd like to do is, what I've done, of course, over my career, is, scale platforms, scale technology, if you will. There's a beautiful opportunity, both on the plan side to use the technology, but also on the Counterpart Health side, right? So there's very favorable unit economics that we see. We should also mention that kinda the power underneath also of the performance is really also really cohort management, right? So the software tool really enables cohort management upfront, at the point of care, real-time, and not, you know, after claims have been processed a couple of months later, if you will. Also, you know, it's not only the technology, we have a lot of talent in the company. A lot, lots of talent.
So I would say there's a lot more to come, right? And then maybe the health of the business, so we had results, 2Q earnings we reported-
Yes.
yesterday. Uh-
Why don't we dive into that?
really strong business fundamentals and, and momentum as well. So those, those three things, right?
Yeah, let's dive into that.
Yeah.
What are some of the highlights from last night when you reported results? Maybe the top sort of talking points.
Top metrics.
Yeah, top metrics. Sorry.
Yeah. So organic revenue growth, double digits at 11%, year-over-year. Adjusted EBITDA, $37 million, sorry, $36 million for 2Q, $43 million for the first half of the year. Industry-leading medical cost ratio, MCR-
Yep.
That really proves the model again and again. Cash flow generation from operating activities, $46 million and positive net income. All above our own expectations and,
Consensus.
and also consensus as well.
Right.
It's very strong, and we're just getting started. Of course, we're really building value here on the medium to long term.
Right.
So...
You know, maybe the next question is, you know, AI gets a lot of buzz in healthcare, in various different ways. Maybe, Peter, we can talk about, you know, how do you see AI and technology changing the healthcare industry?
Yeah
over the next several years, and maybe specifically-
Yeah
in your end markets?
Yeah. AI is definitely, in my view, in our view, needed in healthcare.
Yeah.
The question is, where do you apply it, and how do you apply it?
Mm-hmm.
Right, there's definitely a shortage of specialized or qualified labor in many areas in healthcare.
Yes.
To talk about the U.S. specifically, right?
Yeah.
We focus on the point of care.
Yep.
Right? Where general practitioners, PCPs, might see 20 or 30 patients in a day. They're stretched for time. They can't see all the information. We bring all the information together from all these data sources with a holistic view. So A, that's a really great point, or area for AI, if you will. But I would maybe delineate between AI-type applications for kinda dashboarding, maybe pop health or kinda rev cycle that will have results, but not necessarily directly on, on care. So we care about AI applications with real-world outcomes, both better outcomes for patients and better financial results also, and lower medical cost of care-
Great
-in total.
Last question for me, and then I'll open up to the audience. Can we talk about your liquidity, your balance sheet, where you-
Yeah
currently stand after
Yeah
-2Q results?
Yeah. Yeah, very strong balance sheet, no debt, over $450 million of total cash, $201 million of that for the end of June is in what's called unregulated, so it's not related to the, to the insurance plan, if you will. Positive cash flow, again, in the, in the first half. We don't anticipate any need for external funding, if you will, to continue to grow, to grow the top line and profitability over time.
Is it building your own tech stack? Would you look for M&A to do some bolt-ons on the tech side? How are you viewing M&A?
Yeah, on the core of essentially using AI at the point of care for general practitioners and PCPs, we don't believe we need any acquisitions there 'cause we're industry leading. There might be some adjacencies on maybe on the dashboarding side here and there.
Okay.
That'll be helpful, but we could maybe also develop it internally. I'm really impressed with our technology team as well. As you can see in the prepared remarks in yesterday's earnings call, we're also now starting to provide an update on the technology and innovation roadmap.
Wow.
We'll, we'll continue to do that, as you can find that there, if you will.
Great. Well, I'll open up to the audience. I have maybe a few, a few more, but anyone have any questions for Peter on Clover?... Maybe a follow-up to your new Counterpart. You're selling both into, payers, the insurance-
Yeah
companies, but also directly into providers.
Yes.
Have you had to alter or change your sales force? How is that go-to-market strategy different, and what, in your... If you had to sit here today, what do you think is a bigger opportunity or the easier, easier conversation to have, the payers or the providers?
Yeah. Yeah, I mean, that's, that's a great question. Of course, our go-to-market strategy is evolving.
Mm-hmm.
Right? So we're talking about healthcare here, where a sales cycle, generally, as we know, is kind of up to a year, right? So a benefit we have, though, is that implementation of Counterpart Health can be a day, essentially, right? So that, that is, that's definitely a benefit. Yeah, so we have a sales/BD team. That's the right way to think about it. I mean, it's fairly early on to delineate between the two. Maybe there's other areas as well, where Counterpart can be very attractive for users. I would size them for now equal.
Okay.
Equal opportunities between the two. Yeah. Yeah.
What differentiates you versus your competitors? Is that the very usable, elegant interface, or when you win against somebody, why do you win? And conversely, when you lose, why do you lose?
Yeah. Yeah, there is no, there is really no direct competitor, right? So if you look at it, I guess, via two lenses, right? From a consumer perspective, so the, the insured member, the Clover member, really looks at freedom to choose their general physician, PCP. So the vast, vast majority of our members are on our PPO plan, so they can choose their general physician that they want, if you will. And of course, also other benefits, the OTC benefits are also important. So that's kinda delineation on the consumer side. While the general physicians are not kind of a customer, if you will, right? We, of course, talk to them to really show the benefit of the software for them to use in their practice, right? Better health outcomes, et cetera. That's the way to think about it. Yeah. Thank you.
Well, thanks, everybody, for attending. Peter-
Great.
Good to see you.
Yeah.
And all the best-
Okay
and your success with this company.
Okay.
Thanks, everybody.
Great. Thanks for having us. Thank you.