All right. Great. Good morning, everyone, and welcome to day one of the Citi Healthcare Conference. I'm Jason Cassorla. I cover healthcare services here at Citi. We're happy to have Clover Health here today. Joining us from the company is CEO, Andrew Toy. Thanks for being here. We've asked Andrew to kick us off with an overview of Clover Health, the strategy, and we'll jump into Q&A.
Sure. Yeah. Thanks for having me here today. Clover, we are a Medicare dedicated company, so we are focused on the Medicare population and providing coverage for Medicare eligibles. We have this kind of business mainly around Medicare Advantage, which is what we're most known for, the private form of Medicare. We also wanna cover every possible Medicare eligible.
We offer participants in original Medicare, known as fee-for-service, via our ACO. We also have a home care practice that we're doing much more with, where we look after actual seniors and disabled in their home, when they become sufficiently sick that they require that kind of care. We're very focused on Medicare.
What really changes our approach towards that, I think, is that we tend to work with doctors in a very wide network. We don't do narrow HMOs, which is what Medicare Advantage is often known for. We blend the idea of a wide network, which many people get in original Medicare with narrower networks with HMO and say, "Well, neither of those models are perfect. Let's have a Medicare Advantage plan that has a very, very wide network."
What we do is we give out our software platform, Clover Assistant, which provides data-driven insights to physicians, mainly primary care physicians right now. What they do is use the platform so that they can diagnose and manage diseases earlier. What we're very focused on is Medicare and then diagnosing diseases earlier, managing them earlier.
As we all get older, we will all get chronic diseases. It's unfortunate, but it's just the way it is. Unlike younger folks who might be using the ACA, where it's more reactive care or where you're much sicker quite young, as people age in, the diseases of aging, we believe those are all about manage them as early as possible, and that's what our software platform does.
Got it. Okay. Thanks. Appreciate that. You know, let's just get into it. You guys reported, fourth quarter earnings yesterday. Maybe just give us the high levels, your thoughts on the quarter, how it played out relative to your expectations, and anything else along those lines?
Yeah. We closed out Q4. We're pleased with the quarter. We closed out the year obviously as well. Closed out 2022. I think that what you saw there is that we have material growth in our top line revenue, which we're very happy about across the board as well as in the insurance division. MCRs were significantly approved year-over-year, which we're very pleased about as well.
That continues a trend quarter-over-quarter and for the full year, significantly better than the year before, which was heavily impacted by COVID. I think things started to normalize last year, continue to hopefully normalize this year, and that trend is we enjoyed last quarter. Very much, happy with that.
We announced in the calendar year last year that we would be getting 3.5 stars again on our PPO plan, we would also get 3.5 stars on our HMO plan. That was something that we were proud of achieving and that it will also help us as we go into next year. What we discussed is that we are very focused on growing that home care practice that I mentioned just now. I think you'll see us talk more and more about that in the future as a key part that we're managing medical costs for the sickest portion of the population.
Got it. Okay, thanks. Maybe let's just start on your Medicare Advantage business.
Yeah.
You know, I think with Clover, you guys have shifted from a growth outlook to more of generating profitability much more in this near term. You're starting the year with around 84,000 members, basically effectively flat from where you started in 2022. You know, was that in line with your expectations, the way you kinda priced your plans? Are you seeing any incremental competition, benefit design changes or anything along those lines that could have impacted where you thought enrollment kinda shook out to start the year?
I think that we ended up where we thought that we would be. The way I would change the framing slightly is that we've been very focused on looking at our insurance line revenue. As we optimize for profitability, the revenue number obviously is a little bit easier to look at versus just the population and the number of members that we have.
While you're absolutely right that the year-on-year growth is about flat, I would note that we have material growth in our actual revenue with the expectations we put out for 2023. That's the number we're managing because that helps us with our path to profitability. That is attributable to obviously a PMPM revenue increase. Stars is in there. Pricing our plans against the benchmark for profitability is in there. There's a number of factors that drive that PMPM increase.
Yeah.
That's the number we've been matching towards.
Then maybe to that point around driving that revenue, I think you're up 9% year-over-year. Maybe is there a way you can help bifurcate the differences between the pure rate and, maybe just anything on the benefit from the stars, just so we have an understanding just on what's kind of more, in those numbers as opposed to specifically your benchmark, kinda the way you approach benchmarks?
Sure. Sure. I think we'll have much more to talk about that as we have actual experience emerge into 2023. It's a little early to talk about it right now, and we'll talk about it more in our first quarter 2023 earnings. I can reiterate that we shared that we believe that Stars will have an effect between 300 basis points - 500 basis points this year. We'll, you know, we'll check into that and talk more about that, but we've said that in the past. I would also say that there's a great blend in terms of how we geographically looked at our plans and made adjustments. To your point, like, last year's season was a season whereby a lot of larger plans, I would say that, you know, for example, Humana.
Humana came very strongly in the growth season and priced their plans very aggressively is what I would say. That's common knowledge. I think, you know, Bruce has talked about that. That was a good strategy for them, and they pushed really hard. I think that will then flow through in the opposite way to their plans. We were sort of on the other side of it and very focused on looking at the core benefits that people really wanted, pricing around those and maintaining those, pulling back maybe from some of the richer ones that weren't being valued as much by the member, being smart about that.
That's flowing through into those revenue numbers and also helping with retention, which is our main focus. That higher retention capability, which then goes into this year, also contributes to that revenue line.
Okay, got it. Maybe just to your point around retention, and using the Clover Assistant, all those lines. What is your retention number? How has that trended, you know, compared to last year, you know, now that your enrollment's basically flat, just to give an idea of the sense of the retention for you?
Yeah. We're not, we're not sharing the pure retention number. What I can say qualitatively is that we're absolutely focused on it because not only is it systemic to MA in general that retention drives better MCRs, because returning members generally have better MCRs, but also those returning members have Clover Assistant visits. We spend a lot of effort getting them to a Clover Assistant doctor, or maybe they are engaged with our home care program. Retention is absolutely a core focus for us and a driver of the business.
Excellent. Got it. Okay. Maybe, you know, you highlighted this a little bit on your stars, right? Your PPO plan got bumped up to 3.5 in 2023. Maintained that in 2024. Your HMO plan got a saw a 0.5 point bump in 2024. Can you just walk through some of the changes you've been making to kind of bolster those star ratings, how you feel about the sustainability of those ratings, and if you see a timeline or process in which maybe your star scores could get or improve to perhaps 4 stars and above. If there's anything, you know, functionally that needs to be added within Clover Assistant to.
Sure. Yeah, lots of different things to touch on, I think, in the stars. Let me go. You can ask more questions around it. I think stars overall, important part of being successful in the Medicare Advantage. We're definitely looking at ways to stay at three and a half stars and go to four stars. Like you said, that's how you look at these things. With Clover Assistant, I think that something I would flag that's very differentiated about us is not only are we intending to be successful on a PPO harness, which is different than most, the common wisdom, which is to go to an HMO, but we also recognize that on the PPO harness, when you're looking to serve a wide set of folks, there's a lot of benefits of that.
We've demonstrated that we can grow very quickly because our intention is to serve people who are just broader than just living right around a given health system, for example. We've done it. It gives a more diverse population, gives us access to a wider total addressable market. It does give somewhat of a headwind to stars, though.
That's something that's noted by CMS, that plans which are offering wider networks, which means offering more physician choice, more physicians to go to, and who are more ethnically or socioeconomically diverse, both have a headwind to stars. Now, we've been managing under that headwind for quite some time, and we've had improvement, and we think we will continue to improve. I feel good about that.
The nice news is that CMS is officially acknowledging those dimensions and putting out rules where in future years they are gonna adjust against those so that there's our tailwinds to plans that have more diversity, which tends to correlate with PPOs as well. We're not counting on those in order to get star improvement or maintain stars. It's just something that we're very excited to see CMS really focus on and actually deliver via their rulemaking, that they expect plans to actually perform on a broader set of the population and not just select to a population that delivers necessarily higher star ratings. Like I said, we're not counting on that.
I think the benefits of our approach outweigh one of the headwinds to stars, where we have access to a much broader population, and we've shown we can manage stars in that environment through our upgrades, getting to three and a half stars and then getting to four. I just wanted to say that I think that CMS is doing a good job with that for me.
Got it. Okay. sounds good. Maybe just, you know, jumping to the proposed 2024 MA rates. You know, on the fourth quarter call, you discussed that Clover is perhaps somewhat insulated, I guess, compared to others on the risk coding changes CMS is proposing. Maybe just unpack those thoughts a bit, you know, and if the proposed rule is finalized as is, you know, would it impact your go-to-market strategy in 2024? Just any of your general thoughts on 2024 proposed.
Yeah. I think that this is going this calendar year's AEP, which will be the 2024 AEP. Speaking just as an MA plan in general, like, you know, we have not finalized our bids. Almost no plan at this point would have finalized their bids. The advanced notice is not even finalized yet. RADV mostly is, but the new changes to the risk scoring algorithms and HCCs, et cetera, have not been finalized. I think a couple things make this upcoming, sort of 2024 season, interesting.
Number one, just going back to the stars point you just said, while we maintained our 3.5 star rating, got a 3.5 star rating upgrade for our HMO, I do think that a number of managed care organizations had star challenges in previous years, which will emerge next year basically as well. Those are known knowns that were coming into this season that has a bit of disruption to the environment. Second of all, on the risk adjustment side, these new changes are relatively recent, and some of them are surprising to the industry. We've always said, myself and Clover, that we really support the efforts of CMS to do revenue integrity.
What that means is that in Medicare Advantage, unlike most other MA managed care programs, what happens is that you actually have a different premium per person. That tends to not be the case in commercial, for example, even risk-bearing commercial that might not have that dynamic. Well, that's useful.
What I think was emerging in the environment is that there was a lot of coding that was happening that was often correlated with having a lot of downstream risk bearing providers, where when the risk adjustment incentive was passed to providers were coding maybe fairly and maybe accurately, but there was a much higher prevalence of certain codes in the environment than would be seen elsewhere. That higher prevalence of codes was not necessarily correlated to a higher cost basis in the environment either.
That's what CMS is now adjusting. Any plan that has exposure to that, we have actually quite minimal exposure to that. We have very few downstream risk-bearing agreements, so we don't pass that down to providers. Providers who are Clover Assistant aren't taking risk when they're using Clover Assistant, just say a technology tool.
We feel, while we are impacted, everyone is impacted because the rules are changing, the most impacted would be those who have exposure via those downstream risk-bearing providers, because those are the people, those are the doctors who are doing the diagnoses. They'll either be directly impacted or they'll be impacted via those risk-bearing contracts at some point.
What I think we'll see, quite possibly, I'm no guarantee yet, is that there will be a pullback in benefits if all these rules go through because the revenue drop can be quite significant. I think in some of the reports I saw, this is not from our data, the reports I saw, some risk-bearing providers are anticipating a 10%-20% reduction in their total MA revenue.
That's a lot of reduction. That's far higher than the 2%-3% CMS is indicating in its advanced notice. That's gonna disrupt that environment. That will flow up to the payers who are taking those risk-bearing agreements. I think that some pullback in benefits might happen. When those pullbacks happen, I think we will be well equipped to perhaps compete in those markets going forward.
Got it. Okay. Excellent. Maybe let's just shift to the cost side of the equation, you know, and MCR trends, right? There's a bit of prior period development benefit in the numbers, but, you know, would you say that the original 93%-94% guidance you gave out for 2022, kind of a fair way to depict where you ended up for 2022 on a normalized basis? Just for a-
Yeah. Yeah, I think that's a very fair way to put it. I think that looking at the year, the 93, 94, which is what we had said, is a fair way to look at that year. While we don't quantify PPD, we did have PPD in most of our quarters last year, and that did affect the overall GAAP results coming into Q4. I think that 93, 94 is the way that we basically look at that.
Okay, perfect. Off of guidance, you know, you're basically guiding to 400 basis points to your point of, MCR improvement on a year-over-year basis.
Right.
We've talked about some of the stars, benefit the favorable rates. You know, just on the underlying medical cost trend, you know, what are you seeing there? Maybe what is Clover Assistant coming to play to help manage those costs?
Yeah. two dimensions. Well, firstly, let me caveat to say it's still early for us to look at real medics trends because the claims experience has not fully emerged yet, right? We still have a lot of IBNR, et cetera, in the claims experience.
What we do see more qualitatively, the one thing that we just know outside, most people have talked about this is while COVID is certainly, you know, luckily, less of a factor right now, this is a more intense flu season than I think in regular years. I guess the whole tripledemic situation. I'm not calling any red flags there. I think it's accord, same for everybody. Flu is a little bit more intense this season. That's a more qualitative statement.
To our CA, I think that what we're looking at is that all of our approaches on our wide network PPO, but as well as our home care practice, is powered by Clover Assistant, which allows us to have a central view of care being delivered over that wide network or into the home. You'll see us talk a lot more about the effects of that, in those two different dimensions as we go into 2023.
Got it. Perfect. Maybe just, you know, let's talk about your home care business, right? I think that kind of goes under the radar for many. I think it's been part of the Clover, you know, model for some time. You know, just maybe discuss, you know, give us a little bit more detail in the home care business, the economics, how you sell into that model, the growth outlook there, and then, you know, how much of a bigger portion of the business could it be? I think you said 4,000 members for 2023 year.
Yeah.
You're targeting, but where could that go? Just give us a flavor of that home care.
We're targeting the 4,000 members. We are looking at around $150 million of Medex. The way to think about it is, Medex under management is the way we think about it. That business, just to be clear, is actually doctors going into the home and delivering home care. you could call it like home visits from a doctor if you wanted to. It's very different from home visits from just a, say, home health assistant. We're not talking about that kind of business. We're talking about actual primary care being delivered in the home.
The way that we think about it is at some point it makes sense for us to approach a member's PCP and say, "Look, you've been seeing this person for a while. We still want you to be engaged, and you can still see what's going on via Clover Assistant, right, if you would like to.
We would like to be part of the primary care journey for this member at this point because they've become sufficiently ill or comorbid." I'm not talking about palliative or hospice yet, even though those are available under the program, but just sort of like enough comorbid that it makes sense that they get more frequent visits, and they're not gonna come into a brick-and-mortar setting at that frequency. Visiting them sometimes even, like, twice a month, you know.
Like, that can happen once a week for some members. We figure out what the level of frequency makes sense based upon the morbidity. We talk to the primary care doctor, existing one, if there is one, to coordinate and make sure that's okay. We see those members now in the home, and we take over really a primary care relationship, using Clover Assistant say, "What can we do to manage those conditions in the home?"
Because these members tend to be amongst the sicker ones, there's a lot of medics, anticipated medics, certainly per member. We are able to manage those conditions. We are able to do drug reconciliations. If they end up in the hospital, hopefully less, we can do post-acute management.
All of those things in that home setting. I think there's been a lot of discussion in the industry that home is gonna be the future, but I think that home-based primary care is really powerful, and I think that pairs really well with telemedicine-based primary care, which emerged during longitudinal primary care, which emerged during the pandemic. These are two really big aspects which flow out of our home care practice. It has both of those dimensions available to our members.
Got it. Does, you know, is it the doctor panels and they have, you know, half of Clover, you know, comes in, and it's maybe half the other needs to, you need to be more in the home or, you know, just give us a flavor? Is this incremental membership that, you know, you're highlighting or you're taking share of, or just give us a little flavor of how you kinda grow that member base?
Yeah.
How you're managing that.
Yeah. Right now, it is entirely Clover members. What happens is, you can think of it almost as a practice which client is the MA plan or the ACO. It can go either way. What's happening is they're enrolling membership that is sticker from the plan. It's optional, of course.
Yeah.
We don't make anybody do this.
Right.
It's a very highly regarded program.
Yeah.
It's got a very high NPS. We're proud to do it because it's a great, it's a great mission to have. We grew to 3,000 members, 4,000, about $150 million, all from just our own plan. There's nothing that keeps us from offering the service elsewhere.
We haven't done that yet. However, it's focused on Clover membership right now and making sure that that Medex, you know, the benefit to the plan is that Medex then gets funded. What we're doing to expand that is we're actually identifying additional cohorts that could benefit from home-based care beyond just the comorbid. There might be specific conditions-
Mm-hmm.
where it makes sense to enroll somebody into the home. It might make sense to have a hybrid, and we're looking at this, which we're really excited about, the hybrid between that tele PCP and home-based care. I'm making it up, but like maybe a once a week visit. We say, "You know what? Let's move two of those visits a month to a tele PCP session with the same doctor.
Mm-hmm.
Two of them maintained in the home. Right? I think that we in healthcare, we're seeing this very split. Like is it telemedicine? Is it brick-and-mortar? Is it the home? I think the right answer is a hybrid of that according to the circumstances of the patient. That gives very high satisfaction, that gives high engagement. When you see high engagement with a doctor, then you can do a lot to actually help manage the patient.
Like a lot of the, you know, ED frequent flying, like, you know, like showing up and going and getting admitted a lot, these are all signs that someone does not just have a strong relationship with a given physician, we believe. Our home-based practice really helps with that.
Got it. Is there any way so far, I mean, you've had 3,000 or so members today, just, you know, you've talked about the ability to get in there to help save, right, the high-flying EDs and the like, any way to kinda just give us a baseline or understanding just, you know, I think conceptually it makes sense, but just is there anything quantifiable at this point or do you need a bigger base to kind of rectify or anything like this?
We definitely look at the statistics internally and examine.
Yeah.
We haven't shared anything publicly yet.
Okay.
I think at some point we might do that.
Sure.
What we're seeing is that there's definitely a significant benefit to actually managing these patients. It could be just blunting, meaning there might be no medic savings, but we believe that we're not having the trend increase.
Yes.
Right? In some cases, it definitely, it decreases.
Right.
Like the Medicare expectation. There's a lot of different versions of how this delivers a benefit.
Sure.
What we even see when I look at this is that members who really like it affiliate often with their doctor more than their plan. Our membership even sometimes affiliates with the care they're receiving in the home.
Yeah.
They know it's coming from Clover, but they think of it as a doctor service, not as a plan service, almost.
Yeah.
It's all coming from the plan.
Right.
We like that when we see, when we see that happen.
Okay. Got it. Perfect. Yeah. We'll look out for that some more to come there. Maybe just switching gears to your non-insurance side of the business. You know, you've taken a bit of a step back for 23.
Mm-hmm.
You got 55,000 lives down from 165 or so at the end of 2022, as you focus on your profitability. You're now targeting a margin of business that's over 400 basis points better than last year, 98%-100% range. Maybe just how to characterize the step back, you know, how that profitability is being generated, what gives you confidence making that target for 2023?
Absolutely. Our focus here as we shifted from that growth, heavy growth, global cost kind of mindset into the path to profitability, it made sense for us to look at every one of our businesses, look at MA, look at the ACO, and then to some a logic sense, look at the practice as well, and say, what we want is positive margin contribution from these areas, like the dollars.
Yes.
The ACO, I think I'm very proud of what we did. We launched quickly into a CMI program. We proved that when we say to doctors, "We want to work with you on your full Medicare panel, and we want to work with you to help you get into Medicare value-based programs when you've not been able to do that before," there's a large set of doctors who want to do that.
We were adding doctors every year very quickly. That led to a lot of volatility in the program. There's a wide range of performance within that. That we expect that. We expected that before. We intended to use our tools, Clover Assistant, et cetera, to help, like, normalize that.
We want to now generate our a positive contribution in a much shorter timeframe than we originally anticipated, which caused us to make an adjustment to the number of participating providers, as you said, in the program, which also reduced the number of actual patients in the program.
From that, and once again, we don't have 2023 results to share, but we anticipate from our data significantly less volatility in that program, and hence the guidance that we've put out. It will be hopefully a superior MCR on a smaller base versus an MCR which was north of 100, which we were not happy with on a very wide base, which caused losses in our obviously in our financials.
Got it. Maybe just piggybacking off that notion, you know, what is it or what about those, you know, doctors you've kind of targeted, right? The 55,000 members, you know, what are they doing, I think, or how are you seeing them from a financial perspective, that's differentiating these providers? Is it greater adherence with the Clover Assistant or anything that maybe just help? Do you kind of notice this wide range of outcomes right here in your first year, you know, the 55,000 members and the providers there? You know, how big of a difference does that swing factor in helping you kind of in thinking about the-
Yeah. Yeah. The way I would think about it is let's step back for a second and not even think about like, Clover, but let's think about the readiness of a given physician or a physician group or a health system, you know, you scale it out, to go to value-based care. There's a number of things that you have to do. You have to get out of that fee-for-service mindset.
You have to make sure that you have tooling like EHRs and data reporting and all those kinds of things. You have to train your physicians, you have to do all those things. We launched our ACO because we feel well equipped to have a very technology-centric way of doing those things, but it still takes some time.
I think that the way I think about it is we had a very wide funnel of folks, and let me just use a metaphor for a second.
Mm-hmm.
Let's say that you're using a college. We were taking on the progression. The seniors are ready to for full upside downside risk and value-based care. They need better tooling, and we can give that to them with Clover Assistant. That's the last gap that they need. And we can give them that technology tooling. Otherwise, from a culture perspective and thinking and how they're working with and their philosophies, they're ready and they're successful.
We hope that we can select and look at for those folks, and we're working with those folks this coming year. Originally, we were also taking sort of juniors, sophomores, freshmen that year, and every year they'll progress up that funnel. We were seeing that people would progress.
The only thing we've made an adjustment now to say is we believe that ACO REACH really is best because it's upside downside risk to take maybe the seniors, maybe really talented juniors, and that's what we're gonna focus on.
We've discussed, we haven't formally announced the like, what we're doing, but we've discussed the fact that we intend to go into something like MSSP, where because it offers things like upside only and no downside, those programs are probably better to put the interest we're receiving from those freshmen and sophomores. It's still a good interest. We wanna just put them in a program that better fits where they are in their journey. They'll mature and then eventually progress into the upside downside programs.
Got it. Okay. Just maybe to that point around that, you noted this MSSP possibility. You know, how is it working with it? I mean, are they receptive to that argument? Are you working with them today? You know, just on this continuum of moving up on risk and getting to a more of an upside downside of the ACO REACH. You know, how is that kind of playing out for you and how is Clover Assistant kinda helping in that kind of regard too, in thinking about that?
Yeah, absolutely. I think that a lightweight approach and services light approach is very popular, right? I'll emphasize that the services light part of it, because we are very much reliant on the, I would say other approaches to value-based care right now. I'm not deriding these approaches.
I think they can be very successful. When your service is heavy, an analogy I would give would be like we're trying to give, you know, GPS and a tool to like, you know, in an Uber, so that anyone can be successful, like in that business. Whereas there's another business where, you know, you just get a full chauffeur and you get driven around like, and that's the way. When your service is heavy, I think that's one way to transform a practice. We're just gonna come in and do stuff for you.
Mm-hmm.
Embed with you. Can be very successful, but it's a very finite number of practices you can work with because of the level of lift that it takes. Our approach is wider, broader, able to accept many more physicians. I think we absolutely demonstrated that through the interest we received on our ACO. I think that it's, you have a lot of people who need to go to value-based care. They see that need. They don't want full, like, embedded services from a partner or a vendor, and our model fits very well with that.
Yeah. Okay. Yeah. We'll be on the lookout for that too.
Yeah.
Excellent. That sounds good. Maybe let's just take a step back and everything as you're kind of, you know, from a strategy perspective, you know, you haven't given guidance on the out years, obviously the model's continuously changing. If we were to put the pieces together and you achieve a level of reasonable profitability over the coming years, you know, how do you see that trade-off between growth and profitability over the long term, you know, both for your MA book, both in your non-insurance business, and then maybe, you know, maybe just said in another way too, you know, what gives you confidence that you can achieve profit growth over the long term, as well?
Yeah. Absolutely. Our focus right now, just to be clear, is to go towards the world that you're just stating, where we have profitable... I like the word sustainable, right? Sustainable growth that makes sense. I think that there's two dimensions to it. One is we have not retreated to what makes our product different at its core, right? Well, at its core, what we're offering is physician choice, right?
That which members really like, and that you can offer to them via their co-pay stuff, like the wide network of the PPO, no referrals in the HMO, geographic broadness, ethnic, and socioeconomic diversity within the population, all great things. We've not retreated from that at all.
We've made just some adjustments to some sort of the other benefits, like I said, that perhaps were not being valued as much. The core value proposition compared to the core value proposition of other MA plans is still there, right? You're like, "Oh, you, do you want an HMO around one narrow health system? If you do, join that HMO." That's great. That's not our general population we're targeting anyway. We're targeting folks who don't want a narrow, health system HMO.
That feels good. Other people are coming into PPO now as well, so we feel good about that because the way we look at that is while they're trying to come into PPO because it's an area of large growth within Medicare Advantage, there is no systemic way they're managing care with doctors. On that PPO. The HMO gives you that by default, right?
It's a narrow health system, so you can coordinate tightly with those doctors. We've not seen anyone who's coming to PPO have something like Clover Assistant, which lets you successfully coordinate care, diagnose diseases earlier, and manage them earlier on that wider network. People are just coming in eating margin to try and grow more on the PPO. We have a systemic advantage on the PPO. First of all, PPO is a differentiator, and we believe we have a systemic advantage on the PPO. We're not just tuning our model to make sure that we have sustainable profitability on that, and then our I feel confident will be retained.
Got it. Okay. Excellent here. Maybe we'll just shift more strategically. I mean, beyond the Clover Assistant, you've touted its capabilities and benefits for everyone involved. I guess, you know, what is the biggest barrier adoption for a physician, you know, ultimately using or leveraging Clover Assistant? Is it just critical mass of a Clover membership on a physician panel? Anything else? Maybe what are you doing to help address some of these barriers that you're seeing from an adoption perspective on Clover Assistant?
Absolutely. Simply like Clover Assistant right now is a cloud-based software platform, entirely cloud-based, like, you know, will feel very familiar to anybody who uses it. There's no installs or anything like that. I think a couple different things. One, we normally, when we have a conversation, a physician will see the benefits of Clover Assistant very quickly, like maybe one meeting, right, we'll do that. Also, in terms of training someone for Clover Assistant, probably, you know, one, tops two, you know, one hour meetings, and then they're off and running, right? We've designed it to be very self-learning, if you know what I mean, as people use it. What's the barrier in that case?
It really is that when a physician does not have enough of a Clover membership within their total panel, it's just another thing that they have to remember for one of their insurance payers. You know, they accept 12 different kinds of insurance. For one of them, they have to do something different. That's not a big deal if they have a larger panel.
Those folks are actually quite happy. If you maybe have three, four, five Clover members, it's a lot of overhead, we recognize, in order to do that. That's why we've always said that our goal. You'll see built into our strategy, the ACO is part of the strategy, is to try and cover as much of a physician's Medicare panel as possible with Clover Assistant, right?
The first big stride on that was the ACO, because we can now cover the Clover membership and all of fee-for-service. That gives us a lot of critical mass in that particular case, right? Our goal is to try to cover as much of that as possible. When that happens, we see any physician where that occurs, Clover Assistant is, you know, like we're past that hump, and it works out very well for all parties.
Got it. Okay. Maybe what leads to that point? You know, not just, you know, the Medicare Advantage, the fee-for-service, you know, mentoring into new ACO REACH or new MSSP, however you wanna frame it, much less capital light, much easier to kind of navigate through. Is that how you're going to lead the future growth, piggyback on Medicare Advantage, or how would you kind of frame that?
Great. Yeah, great way to think about it. When we look at something potentially like MSSP, right? Like when you look at that business, I think there are some businesses where you're generating significant margin from MSSP. If we can do that, and I'm not giving any guidance, giving top-level thoughts, of course, like, of course I want that.
I think we have a different way of looking at these programs that others don't, which is these are great ways to get our software integrated into physician practices, add value to the physician practice, and get the software embedded. At that point, we can work with them to move them into value-based programs in a number of different areas downstream of that. We see MSSP as potentially a good business in its own right.
Really what it is a way for us to work with as many physician groups as possible to generate that coverage of the Medicare panel. We were gonna do that originally with ACO REACH. However, the downside component, where it causes us to actually take economic losses on folks who are not quite ready yet, we fully intend to work with any doctor, right?
I love working with these doctors, but let's move them into a program where maybe, like, those losses aren't incurred so early and then move them across when they're ready while still getting the benefits of that earlier software integration.
Got it. Okay. Understood. That's helpful here. Maybe, you know, with the Clover Assistant, you know, you're continuously improving that product. Thinking ahead, are there any capabilities or clinical features you wanna highlight as the next areas of focus build out for Clover Assistant? Maybe anything on those fronts that you wanna flag for us?
Yeah, absolutely. What I'd like to point to is we put out some material recently which focused on the benefits and the data that we're seeing. It's about diabetes, and it's about chronic kidney disease, where I've mentioned several times that Clover Assistant and Clover itself is about the early detection and early management of chronic disease.
Yeah.
In CKD and diabetes, we're seeing and we're sharing some of the information we have in those conditions about doctors who are using Clover Assistant. Remember, these are not employed doctors, right? Anyone like that. These are the wide network doctors who are actually using Clover Assistant and we're seeing earlier detection of disease, and we're actually seeing a bending. We're not using the cost curves. We want to do it via clinical examination.
We're seeing like, for example, like an early detection and therefore earlier management. Then we start to see slowing, not slowing, but we actually overall slow the progression of something like chronic kidney disease, degeneration of eGFR, which is a clinical biomarker of chronic kidney disease. Because you manage it earlier. Very simple.
There's no magic here. If you catch it earlier, you probably go on the drug earlier. It might be the same drug that you would go on if you were caught a year later, but you're going on that drug a year earlier. Obviously, that slowing of the progression starts a year earlier. When you do these things together, they compound to just keep someone healthier for a longer period of time is what we believe.
Got it. Okay. Excellent. You know, maybe just, you know, we've discussed this in the past, but I kinda wanna return to the potential utility of licensing Clover Assistant, as a product be leveraged by other health plans, bolster physician adoption, you know, with that Software as a Service kind of format. You know, just, you know, you've highlighted this before, but are you still considering it at this point? You know, based on where you're at, you know, how would you kind of frame that?
Speaking as a technologist, you know, coming from, like, a enterprise software background, I'll split into two different dimensions. One is that, like, is Clover Assistant built to be a cloud offering that can be ramped up quickly based upon account logins, no heavy lift, all those kinds of things.
All the dimensions of having a cloud-based piece of enterprise software exist in Clover Assistant already. It's just built that way from the ground up. I feel really good about that. It's really then do I intend to have physicians, do I want physicians to be able to use it for their entirety of their Medicare panel, which is more than just a Clover basis by definition. Yes.
Yes, I do, because I already said that that really helps with the soaking of Clover System into the workflow of the physician. Now many more people are benefiting, patients are benefiting, which I love from a mission perspective. The only thing that we haven't discussed yet is sort of a timing or a business model around those kind of things. We're not ready to discuss that yet, but I'll say that's just the final component of this, because we've already stated that the technology is built that way, and we intend to try and cover as much of that Medicare panel as possible.
Got it. Okay. Excellent. You know, we're kinda coming up against time here. You know, give me, you know, is there anything that, you know, we haven't discussed you wanna highlight or anything that, you know, investors should be considering about as Clover on a go-forward basis or any other kind of themes that you wanna flag at this point?
I think number one, I think just a very easy way for everyone to think about it is if you're thinking about insurance or managed care, Medicare, early detection of disease and early management of disease helps with the cost basis of Medicare. It helps people stay healthier longer.
Now we've seen with the latest rules coming from CMS, it's where CMS wants to go because they don't wanna be paying for things that don't actually provide value, right? The key to this and the key to unlocking everything is to help as many physicians as possible. There aren't enough physicians in the United States as it is, so we cannot solve this problem with narrow networks. It has to be every physician we've got.
We've got to make them as good at Medicare as possible, as quickly as possible to sort of when they manage patients, they are doing all the best standards of care on the, on the biggest areas, right? COPD, CHF, CKD, diabetes, right? And managing those conditions. We believe that simply software, Clover Assistant, is the way to solve that particular problem.
That's, that's our philosophy, that's our thesis. MA, our ACO, these are all practice. These are all ways to get that philosophy to as many Medicare eligibles as possible. It's about that early detection, early management. We already have so many drugs that can manage these diseases, right? We don't have cures for a lot of them, but we will at some point.
It's missing the management opportunity or leaving the management opportunity to too late that is affecting the quality of life and affecting the cost of care for seniors in the Medicare problem. If we could solve that, a lot of problems are then solved. That is the mission that we're focused on. I think that sets us apart from almost every other insurer or MA plan.
Okay. All right. Got it. Andrew, thank you for for coming. Thank you for Clover for being here. We're gonna wrap up at this point. Thank you.
Yeah. Thanks for having me. Thank you.
Appreciate it.