Dive Brief:
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Medicare Advantage (MA) payer Clover Health is starting an in-home primary care program that includes genomic testing integration to help with medication therapy management.
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YouScript will provide a clinical decision support tool to help Clover’s most vulnerable members while reducing emergency department (ED) visits and hospitalizations.
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About 500 Clover Health members in New Jersey have joined the program.
Dive Insight:
Clover said the voluntary program is being offered at no cost. It includes a physician-led team with primary care physicians, nurses, social workers, medical assistants and care coordinators. The program identifies and addresses “all outstanding and incipient patient concerns, including those related to medication management.”
Five percent of Medicare fee-for-service beneficiaries in 2013 drove 42% of annual Medicare FFS spending.
Care team members interact with Clover's technology platform, which uses pharmacogenomic testing to help personalize drug regimens.
The program includes regularly scheduled personal check-ins, monitoring and home-based lab and radiology testing.
The bid is the latest example of an MA payer and healthcare organization looking to reduce hospitalizations and costs for the most vulnerable patient populations. Humana, the second largest MA payer, is buying a piece of Kindred Healthcare, a home health, hospice and community care businesses.
CMS is giving MA plans more flexibility to offer supplemental benefits to certain beneficiaries. This greater flexibility lets plans design offerings that go beyond traditional MA benefits and can include meal delivery and transportation to non-medical appointments.
Clover Health, who has received funding from Alphabet, recently reported that it lost $22 million in 2017, an improvement over the previous year. Clover also increased its revenue from $184 million to $267 million and expects revenue in the $330 million range this year.