Getting us back, always glad to be here. Clover Health, as you said, we are in the Medicare Advantage space, and Medicare is what serves all our seniors in the company, in the country, people over 65, as well as the disabled. We are entirely focused on Medicare. There are multiple ways we serve that Medicare market. However, we are different in that we are completely focused on Medicare. The reason we do that is, as you said, we actually are very clinically oriented as an insurer, and we develop our own software, Clover Assistant, which is an AI data platform. We provide that software actually to physicians, mainly primary care physicians, but others as well, who look after the seniors and the disabled folks on Medicare.
By doing that, our focus is absolutely to bend the cost curve, lower costs, improve outcomes for the senior population, because we can deliver insights straight to those primary care physicians using a large amount of data that we're aggregating as an insurance platform, synthesizing and then generating these assistive insights. That's why it's called Clover Assistant, right to the primary care doctor, enhancing their ability to identify disease earlier, manage it earlier. We unfortunately all will get old, and unfortunately, as people get older, they do get sicker. The reason we're focused on Medicare is because we are so clinically oriented, we want to go to where there is a lot of disease burden, actually.
That's where our clinical platform can actually bend that cost curve, manage that disease, identify chronic kidney disease earlier, help manage diabetes, all the diseases of aging, and that helps us succeed in our mission to help as many people as possible on Medicare. It helps us succeed as a business economically as well.
Great. Thank you. Like I said, last night, EBITDA losses to positive EBITDA. Maybe you can just walk us through some of the dynamics, on, on the second quarter, and then, you know, really, how sustainable is it from-?
Yeah
... reporting positive Adjusted EBITDA?
Absolutely. Thank you. Yeah, we're very proud of the, of the results we delivered last night, for Q2. I think that where I would start is, you know, we were known for our growth. We're very, very growth on, and our products are very popular because we compete in the wide network PPO space, whereas most of what Medicare Advantage is known for is the HMO. We were growing very aggressively, growing a lot. We're taking a lot of share, and we love to do that. We think bringing our model to as many people as possible is part of who we are. A couple of years ago what we switched to as well, and we talked about this, like, starting last year, as I came into the CEO chair, was to optimize our core function.
We took the foot off the accelerator a bit on growth and then switched to. Well, we've been so focused on growth. There's a tremendous amount of room to take our technology asset, which we've always invested in, and then add to it a lot more optimization, polishing of core operations, revenue operations, medical management operations, really focusing on our home care practice, which we, we've had for a while and really has blossomed in the last year. Taking all of these things together, you know, not looking at expansion and growth quite as much, optimizing our core population.
I think what you'll see is that in our Q2 results is the fruits of all of that optimization coming to bear and the strength of our actual economic strength of our model coming out, that when you take Clover Assistant, you have a more stable cohort population year-over-year. You add all of our capabilities as Clover to that, you see a tremendous economic outcome. Really do think it's sustainable, 'cause by definition, we're focused on the sustainable profitability of the cohort. Once we're done optimizing that, well, we'll never be done, but once we have a good yards on that, we're excited to take that and then go back to growth with that as our core.
Great. You know, you're operating in a very competitive marketplace. There's giants that you're competing against.
Definitely
... Uniteds and Aetnas and, and whatnot. You know, I'm just curious how you guys decided to jump into this business, knowing that, you know, there's these behemoths out there, and really what differentiates the company versus, you know, those other players?
Yeah, absolutely. I think that the key aspect here is that, first of all, the Medicare space is one that's competed with, with a lot of different companies. There are, there are smaller companies that... known for United being very strong in that space. Humana is very strong in that space as well. One thing, though, I think that when you look at those companies, is technology is really not at their core and certainly not clinical technology, if you look at what they're doing. In that Medicare space, it was pretty obvious that having technology that assists doctors in looking after seniors is a massive vacuum. Start with saying: What do doctors need to look after seniors? They need technology. They need a way to access large amounts of data.
AI is, is the way that that's gonna happen in the future, and, and, and it's happening now with Clover Assistant. Doctors need that to look after seniors. That's evident. You say, okay, well, if that's the pathway to success within Medicare, 'cause doctors clearly need the, the, this, they need access to data, how do you attach a business model to that that makes sense? Our view is, rather than charging doctors for that software, a far superior business model is to actually help those doctors take Medicare risk, and then by taking on that risk, you can generate savings and you share savings and value-based care, generate margin off of the savings we generate for society and then w e now are able to have a situation where we're partnering with doctors, not charging them. We help them move towards value-based care.
In MA, we're doing that. In our non-insurance segment, we're doing that. We now have an engine that has an amazing business model attached to amazing technology. Really, when we look at the Humanas and the Uniteds, yes, we're competing in terms of lives, in terms of MA, but in terms of mind share of the doctors and what software are these companies providing for that mind share to the doctors, we're, I think, in a league of our own.
I'm gonna throw in a question here with respect to the doctors using the platform. You know, we've heard a ton about physician burnout, you know, documentation, and electronic health record and all that.
Absolutely.
Clover Assistant is just another, you know, tech platform.
Yes.
Maybe talk about, you know, why it's efficient for the physicians to use Clover Assistant and it, you know, maybe why it's not a hassle for them.
Yes. It's absolutely agonizing for doctors in the field right now. That's just me wearing my overall healthcare hat, not even my Clover hat. Really, really tough time where they have to use so many different systems. There's so many different payment options. They just wanna treat patients, as you know, but they have all this documentation burden. You know, that documentation is extraordinarily helpful, and it generates data, but it's a lot of effort for them. I think that what we think about it at Clover and with Clover Assistant is a couple of different things. Number one, the more of their Medicare panel we can cover, the better off we are because... They're better off as well, 'cause they can just use Clover Assistant and just say, "Medicare, Clover Assistant," right? We're not all the way there right now.
On the MA side, we're one of many MA companies, but that's a big part of why we have our non-insurance segment, is to cover the fee-for-service side of things, and eventually, potentially, we've said, cover even other insurers on the Clover Assistant as well. The, and the more of that Medicare panel we can cover, the easier it is, we definitely see, for doctors to think about Clover Assistant and use Clover Assistant. We also have our next wave of EHR integrations that are, that are launched and are coming. That helps a lot as well.
The last thing I'll say is, really, we find that when physicians feel like the tools are helping them deliver care versus like, you know, a tax on them to document their care, there is documentation in Clover Assistant, don't get me wrong, we need that data, but there's a lot of insights we provide where doctors are saying, "Oh..." You know, we put these quotes out there. "Oh, you know, I would never have ordered this test if it wasn't flagged for me in Clover Assistant." Those magic moments, I think, really help us build up credibility with the doctors.
You know, in part, driving the positive Adjusted EBITDA, the first in the company's history yesterday, the MA or the insurance MCR, medical cost ratio, was, I believe, 77%.
Yeah.
Significant improvement there year-over-year and, and even from the first quarter. You know, there's been a lot of noise about MLR.
Sure
loss ratio. You guys use MCR.
Yep.
You know, how did you buck the trend, I guess?
Yeah, absolutely. I think a couple different things, notes on that. Number one, we really look at our first half performance. Like, I think our Q2 performance, we're very proud of, but the right way to look at us, we think, is to say, "Okay, Q1, Q2, there is noise within this Prior Period Development," things like that.
Mm.
The, with the first half MCR, which is coming in in the low 80s, is a good way to look at our business so far this year. That's the number I tend to anchor on a little bit more. The second thing I think in terms of bucking the trend is that we are very agile with Clover Assistant, right? We're able to build in new rules from CMS. We're able to adjust the profile of our, our, of our population. The way we think about it is, we manage the widest set of our members with Clover Assistant, with you giving Clover Assistant to their PCPs.
For the sickest folks, we have our home care practice, where we're seeing a lower, for example, inpatient admission rate when we add them to our home care practice and take them all the way through their end-of-life journey with palliative and hospice services as well. For the, for the sickest few, it's Clover Assistant plus in-home care. For Clover Assistant on the wider network, we're managing care that way. We think that as a lot of folks like United and Humana, et cetera, have come-
Mm
to PPO, 'cause that's where all the growth and popularity is, honestly, my opinion is they lack the tools to manage care on the PPO. They know how to do it on the HMO. They're, they're very good on the HMO, they've had to come to PPO 'cause that's where the demand is. We are experts on that PPO between home care and CA. That's always been our, our play. I think that perhaps some of that inflation and in the trend is because in the last growth cycle, the last couple of growth cycles, they've been moving more and more onto PPO. They lack as many tools for management there, you're seeing that flow into perhaps the generalized MCR trend.
One of the things that I think is impressive about the numbers you posted year to date on MCR is the population that you're dealing with. You're three and half s tars.
Mm-hmm.
You know, some of those other companies I mentioned are four s tars.
Sure.
or whatnot higher. Can you talk a little bit about the population you're serving and how it's different from maybe the cherry picking that goes on?
Yes. We definitely look to serve as wide a population as possible. We wanna serve everybody. One, I, I always use the health equity terms for it. I think it's the right thing to do. Our mission says it's the right thing to do, but let me flip away from the mission for a second. I think it also makes good business sense, right? Like, in a business, only insurance really has a business where you try to not have the biggest TAM as possible. You try to, to your point, select down to a smaller TAM, and I'd like to have as big a total addressable market as possible. That's why we're focused on the wide network. That's why we're focused on serving in our population.
We have a much wider range of socioeconomic sort of profiles within our, our population. We don't offer a dual SNP, you know, for dual eligibles for Medicaid. We have a general plan, for a general plan, a much higher rate of folks who are also eligible for Medicaid. We also have a much wider sort of ethnic diversity within our plan as possible, not as possible, compared to others. I think you'll see that from our geography, right? The geographies we're in tend to be much more diverse. They tend to be a little bit more on the urban side, we're not someone who goes and says... I'm always asked, "Why don't you go down to Florida? That's where all the MA is." I'm like: Well, that is-- that's where everyone else is, right?
They, they, they're just going there because they think that's where that cherry-picking type market is available. We thrive, and our model thrives in all the other areas. Why wouldn't we go there where it's much more difficult for people to compete? Because we have Clover Assistant, we can what manage on the wide network, we can manage a diverse population. I think that does affect our stars a little bit, and currently, we've talked about that in the past. That CMS is fixing that in the future, and we're happy for that. I think that it does mean that there's a higher disease burden in our population. As I already said, we thrive where there's a higher disease burden as well. I'm proud on a mission standpoint to do that, I'm proud on a business standpoint to do that.
I'm just jumping back to Clover Assistant. You've talked about, the MCRs, like, $1,000, I think yesterday you said.
Absolutely, yeah.
well more than 1,000 basis points different for members that are managed by physicians using Clover Assistant versus not.
Yeah.
With the, the MCR that you posted yesterday, reported yesterday, you know, does that insinuate, like, we're at an inflection point? I know I always want you to give, like, penetration-
You do, yeah.
-of members, but just how do we think about, you know, that the 80% some odd for the year to date, or 77% yesterday, in terms of where that can go as Clover Assistant adoption increases?
Yeah. I think that we don't share that number of where the penetration is, as you know. But what I can say is, is that we're simultaneously proud of the number that we're achieving. I'm happy, and we still have room to go up into the right on the coverage as well. There's two different dimensions that are around that. Number one, not everyone is just naturally gonna get a visit. It's very hard to get not even 100% of people have a primary care physician.
Mm-hmm.
Right? Part of what we're focused on is making sure everybody has a primary care physician, 'cause that's, on Medicare, you really should, and then have as many of those physicians as possible be using Clover Assistant, and then covering additional folks with our home care practice layered on top of that as well. With our home care practice providing additional support for the needs of that last, the last mile needs of that sicker population. I think there's room for us to go, even on the coverage front. Where I'm especially proud also, is that we're constantly improving Clover Assistant, even for the population that is already covered. It's not just a static platform, we're constantly pushing code, updating the, the AI models, updating the datasets we're training on.
For all of those improvements, you'll see that flowing into our result as well. We're focused on coverage. There's room to go, and there's certainly constantly plenty of room for us to optimize and deploy new features on CA itself.
Okay. Maybe headwinds, tailwinds, discussion in terms of the regulatory environment. I mean, obviously, there's been some changes, I guess, on the headwinds side, you know, there's been in the media, something needs to be done about Medicare Advantage in terms of risk adjustment and, things along those lines. You mentioned health equity. Obviously, there's a push by the federal government to improve health equity, and, and so there's some changes, coming along on that front. Can you just talk about headwinds, tailwinds, how you think about reimbursement rates, risk adjustment, and then health equity?
Yeah. Great question. The way I think about it, I, if you allow me to be a little bit glib to open up on that, there are certainly headwinds and tailwinds, and I'll get to those in a second. I really do believe, and the way we think about it at Clover, is that all changes to the program endure to our benefit. Because remember, our core ability is to manage our care model in our network of CA physicians on a much more dynamic basis, right? We don't have to recontract, we don't have to... We can just sort of make code adjustments and push it out to the network.
We see it as the changes coming from CMS, we can make adjustments, react, like, and generally, we support everything that CMS is doing 'cause health equity is good, all these changes are good. Our agility is a huge advantage in that regard. I think that what you'll also see is that health equity, strong tailwind on Stars, there's even talk about it flowing into sort of risk adjustment profiles, because risk adjustment is not controlled by health equity, adjusted for health equity right now. Lots of tailwinds in that front. The headwinds in the industry are just rates, general revenue rates, you know, like all those kinds of things.
The way I think about that is CMS is making appropriate changes because there's a lot of places where and we've written a paper about this, on risk adjustment, where delegated risk, capitation, value-based capitation, there's been some gaming, I think, of that, of that, from some providers, some, some plans. Making sure that that is not happening, I think frees up dollars for CMS to allocate to the trusts, to allocate to other parts of MA, where it's actually helping care. I think risk adjustment revenue is all good when it's helping care. It's when it's not helping care, that it's a challenge, and those changes are, are really targeted at that latter category.
With, like, Clover Assistant, if you're driving down the cost, you could offset any, you know, type of headwind.
That's right. Because Clover Assistant is absolutely. We are absolutely always looking for the early identification of disease and the diagnosis of disease. You can't manage a disease if you haven't diagnosed it. That doesn't.
Yeah.
You know, obviously, it goes together. Exactly as you said, because we're so obsessed with the management of conditions, that really, I think aligns us with where CMS wants to go.
Let's get into some financials, just as we close out here over the next couple minutes. You know, you talked about the cash position being at a level to support 2023, but you had some comments, you know, yesterday...
Mm-hmm.
-in terms of, that you think you're good in terms of generating profitability in 2024, and, and just, you know, thoughts on the capital position as well.
Yeah. I think our... We are absolutely aiming, and we said this in our remarks, Scott and I both said this, that we are absolutely aiming to get to our 2024 Adjusted EBITDA profitability without the need to raise new, new capital. Now, there's always reasons we might want to raise new capital, like, for example, growth capital, you know, at a group conference, those kinds of things make a lot of sense. We are not aiming to raise capital for the purposes of getting to profitability.
Mm-hmm.
We feel pretty With our latest quarter in the books, we think there's tremendous momentum towards that. Everything is arcing in the, in the right direction. I, we're gonna have a lot of momentum through the end of 2023, and then into what we think will be watershed 2024.
Okay. With respect to guidance, you know, you just posted $10, $10 million positive Adjusted EBITDA, but the guidance contemplates you swinging back to a loss in the third and fourth quarter. Can you just talk a little bit about that? Like, maybe what's baked into the second half? You know, any details there, just conservatism or how you think about that?
I think the number one phrase is, like, we want to be appropriately conservative. I think that that has been our sort of the way we've been done all of our previous quarters, right? You've, you've seen it as well, that we wanna be appropriately conservative. As we said, we said that we intended to be profitable on an Adjusted EBITDA basis in 2024. We did not say in, in 2023, right? Like, I think that lines up with what we've always been saying strategically, and we do have that appropriate conservatism baked into the second half of this year, just to make sure that we're looking for, looking around all corners.
Even the way I think about it, still, in a positive way, is even with that appropriate conservatism, that allows us to have that line of sight to that profitability mark with no reasonable need for capital. We think that if we beat that and do better than that, that just accrues to additional profitability, and that's a good thing.
Okay, great. Since we have a couple minutes left, what we haven't hit on is the non-insurance business, the ACO REACH program. You right-sized that over the last year. The MCR on that in the, you know, initial year was pretty negative.
Yeah.
now you're essentially break even, in the first quarter was 96%, I think.
Yeah
... MCR. Yeah, thoughts on the ACO REACH program and, like, where can you get MCR on that? You might not have as much density as you do on the MA front.
Yeah.
I'm just curious what the trends are for that.
I would say, just, just to answer your question first, is, the ACO REACH program in terms of MCRs, we haven't given any guidance as to where we think the, the, the margins can eventually be. I would broaden the way to think about our non-insurance segment to this. The reason we went into ACO REACH was not because we wanted to be in REACH, it's because we wanted to be in fee-for-service, right? Clover Assistant is able to manage care, it's very clinical, and we can back it with any value-based capability, a value-based fee-for-service capability, a value-based MA capability. We wanna bring Clover Assistant to as wide a range of patients as possible, and then cover as much of that doctor panel as possible.
You'll see us that with REACH, we want that to be a profit-- certainly not a loss-generating business for us, but a profit-generating business. You will see us broaden our non-insurance thinking to cover any place we can actually bring Clover Assistant in a value-based care way, to cover as many patients within a doctor's panel as possible, which includes, potentially, other MA plans, right, as well. That's the way I think about that segment. Fee-for-service is a big part of that thinking, and REACH is part of the fee-for-service thinking, not even all of the fee-for-service thinking. You know, MSSP, et cetera, can cover parts of that as well.
Great.
That's the way I think about it.
Well, we're right on time.
zero seconds.
Andrew, thank you so much, and congratulations...
Thank you.
... on a strong quarter.
Thanks so much. Thank you.