Clover Health — similar to many other Medicare Advantage (MA) players — has its sights firmly set on the home.
But unlike its larger and older MA peers, the relatively smaller and newer Clover isn’t held back by certain structural constraints. That ability to build a home-focused model from the ground up is a big part of Clover’s future, Chief Scientific Officer Kumar Dharmarajan told Home Health Care News.
And the technology-enabled Clover’s future is bright: Founded in 2013, San Francisco-based Clover has raised about $925 million since launching. Among its backers: Google parent company Alphabet Inc. (Nasdaq: GOOGL).
HHCN recently caught up with Clover’s Dharmarajan to learn all about its in-home care ambitions, its approach to partnerships and evolution into a payer-provider hybrid.
Highlights from that conversation are below, edited for length and clarity.
HHCN: We’re talking at the beginning of October, when a bunch of MA plans are starting to reveal what their 2020 offerings will look like. What is Clover doing?
Dharmarajan: If you’re asking about specific bids and plan offerings, those vary by location. Clover doesn’t just have one U.S. plan, in other words.
More broadly then, could you talk a little bit about what Clover is doing in terms of home care?
We have a number of different offerings where we engage with members in the home. One of those is our in-home care program, where we provide in-home primary care services for some of our most vulnerable members, people with multiple chronic conditions, frailty and advanced illness.
Many of these folks are frequently hospitalized and have limited life expectancies. For those members, we wanted to provide a technology-enabled house calls experience. House calls have been shown by CMS and some of its demos to be really important to those who have trouble accessing care, including those who are homebound.
Many of the Clover members in this program do have difficulty leaving the home.
We give them access to physicians, nurses, social workers — people who will see them monthly if needed. They’ll spend an hour or so at a time with our members. Contrast that to getting 10 minutes with your doctor in the office.
We focus on very comprehensive, holistic care that’s aligned with members’ values, preferences and prognosis. We provide a number of interventions that are on the cutting-edge side.
We do pharmacogenomics testings. We want to make sure members’ medication regimens are best-aligned with how their bodies metabolize drugs. A lot of folks are on 10, 15 medications.
In some of these cases, it’s like a witch’s brew, right? We want to make sure the regimen our members are on promotes their health — and doesn’t cause side effects.
For some of our members, we also give them access to what we call “the Clover button,” which is an ability for them to contact their provider directly. They don’t have to remember a phone number. They just press a button, then they could talk through that and speak with their medical team.
And we do a bunch of other things where we really integrate payer and provider. Clover is a technology-enabled health insurance company, but this in-home care practice, this house calls practice is wholly owned by Clover.
Clover the health plan has access to a lot of different streams of medical information that we provide to Clover the practice.
For example, we often know when a member of ours is hospitalized or heads to the ER. We can get real-time data feeds a lot of times from those institutions. We then feed that info to the medical practice so they know exactly when a person leaves. In turn, we can engage with those individuals in the home as soon as they’re discharged.
We’re really excited about that partnership between plan and provider.
Do you provide any home health services as well?
At this point, Clover does not provide skilled home health services and things that fall into that bucket. We do have social workers who see our members and help with financial challenges. We have nurses who are part of our team, experts who are well-trained in, for example, wound management.
We’re not trying to be a home health agency, but we do have some of those skillsets naturally within the team. And we do partner with home health agencies to really advance the care of our members.
In general, home health is probably underutilized for a lot of frail elders. We look to use home health care wherever it could benefit a member.
It sounds like — if you’re having social workers go into the home to help with bills and financial planning — that you’re also focused on social determinants of health.
Unfortunately, it’s not a coincidence that some of the sickest, most vulnerable patients are also the most vulnerable from a social perspective, whether that’s in regard to finances, housing, food or language barriers. For us, addressing social determinants is just part and parcel of the practice.
It’s not something that we see as a unique strategy or something new that we need to suddenly start doing.
It’s certainly en vogue now to talk about addressing social determinants of health. We just think it’s always been very core to the model of, you know, improving care for homebound older adults.
A lot of MA players are leaning further into home care because of CMS’s efforts to expand supplemental benefits. Is Clover?
Regardless of that, committing to a home-based strategy is something that Clover has been interested in doing and has been investing in for some time. Home-based care is very scalable compared to brick and mortar.
It’s also clear to us that home-based care allows you to pick up on and address issues that you would never see in an office setting. You go into the home of an older adult, you see six different bottles of insulin, all of which are different. This literally just happened with one of our members, who was actually blind. She didn’t know which [insulin] to take.
When you go into the home, you see that. You can see what’s in the refrigerator. You can engage with family members. There’s an incredible amount of data.
Can you share any outcomes data tied to your home-based care program?
With our in-home care program, we’ve seen reductions in [hospital] admission rates, reductions in ER visitation rates. We’ve seen reduced medical expenses overall. And we’ve heard from a lot of members who are just positive and grateful for the program.
Many people have never had house calls before.
You said you do partner with home-based care providers. What do you look for in those partnerships? What should our readers know?
I don’t think I can tell you our specific partners at this point. But generally, I think there are a few things that are very important to us.
One is responsiveness. If you have a home health need, being able to quickly make the referral and have a team get in there ASAP is so critical.
Also having bi-directional communication is important. Once the home health provider is in there working with our member, we want to hear from that provider if they see something they’re concerned with. Even if it’s just, “The member doesn’t look at good today.”
Provider groups need to be collaborators and, in a sense, sensors. Home health providers might be in the home more frequently than we are, depending on a member’s needs.
Do you have any personal care partnerships?
We have spoken with some and have embarked on some pilots. We do recognize that non-skilled services are an important part of the overall picture.