Dive Brief:
-
Clover Health, a technology-based payer that offers Medicare Advantage plans, is expanding into six new markets next year: Camden, New Jersey; Charleston, South Carolina; El Paso, Texas; Nashville, Tennessee; Philadelphia, Pennsylvania; and Tucson, Arizona.
-
Clover currently offers MA plans to more than 30,000 seniors in four states, which it hopes to double through its new market entrances.
-
The San Francisco-based payer also announced it is working with Taiwan-based Cathay Life Insurance to use artificial intelligence products that can predict elements like what patients will need hospitalization and when.
Dive Insight:
Clover said it selected those six cities based on "a receptive customer base" and the company's ability to deliver Medicare Advantage plans in those areas.
Vivek Garipalli, CEO of Clover, said the MA expansion and AI platform growth are "both core to Clover's mission" of improving health through technology and personalized medical care.
Clover also said last week its technology has an 85% accuracy rate in identifying patients who are at risk of being admitted to a hospital in the next 28 days. The payer said having that data allows healthcare professionals to "proactively administer the appropriate medical care" and prevent hospitalizations. Cutting down hospitalizations can improve both patient quality of life and reduce costs.
Clover, which received funding from Alphabet, enjoyed improved finances in 2017. In May, the company said it was starting an in-home primary care program that features genomic testing integration, which it said will help medical therapy management. The company rolled out the effort in New Jersey. It includes regularly scheduled personal check-ins, monitoring and home-based lab and radiology testing.
Clover isn't the only payer expanding its business. Oscar Health is looking to move into MA in 2020 and Centene, which increased its ACA footprint to 16 states this year, expects to grow further in those states and possibly into additional states next year.
Payers reported a strong overall quarter recently, which saw them finding success in Medicare, Medicaid and even the Affordable Care Act exchanges. Health insurers have made the transition from large commercial business to more reliance in government plans. Some major insurers, including Humana and Aetna, have seen their commercial membership drop this year, but they've been able to absorb those losses through more members in government plans.