Clover Health (Nasdaq: CLOV) announced Wednesday that it plans to scale its in-home primary care program, “Clover Home Care,” through the new direct-contracting model from the U.S. Centers for Medicare & Medicaid Services (CMS). The announcement came as Reddit’s investor community also targeted the health care company as its most recent cause.
Headquartered in Nashville, Tennessee, Clover Health is a technology-enabled Medicare Advantage (MA) insurer, with its own in-house clinical capabilities. Launched in 2013, the company went public through a merger with a special purpose acquisition company (SPAC) in 2020.
Currently, Clover Health counts 65,000 lives under its direct-contracting program. Home-based health care organizations Spiras Health and Upward Health will be its first two partners as part of the in-home primary care expansion.
Spiras Health is a clinical provider of care management and other health-related services to individuals with complex and chronic needs. It signed a five-year agreement with Clover Health on Wednesday.
“Spiras Health and Clover Health share a commitment to addressing the needs of patients with complex chronic conditions with a unique and specialized home-based approach focused on improving the patient’s health and quality of life while reducing costs,” Scott A. Bowers, CEO of Spiras Health, said in a statement. “We are excited to work with Clover Health’s technology platform and provider network to bring a value-based approach to their most vulnerable patients right in their own homes.”
Clover Health operates in Arizona, Georgia, Kansas, Mississippi and at least seven other states.
Providing home-based primary care in as many of its markets as possible is one of the main drivers of the company’s scaling efforts, Dr. Kumar Dharmarajan, associate chief medical officer of Clover Health, told Home Health Care News.
“We know that many of our members are frail, they’re sick, they don’t leave their home, or they leave their home with great difficulty,” Dharmarajan said. “Getting in the home to directly engage with the patient in his or her environment is critical to learning about the patient, building trust and really improving their health outcomes. It is really important for us to bring home-based care models to all of our direct-contracting beneficiaries, wherever they are in the United States.”
In addition to his role as associate CMO of Clover Health, Dharmarajan also serves as chief clinician of the company’s direct contracting entity, “Clover Health Partners.”
Clover Health’s scaling efforts are also inspired by the company’s experience with Clover Home Care on the Medicare Advantage side. The company has been running the program since 2017.
From the start of the program until the onset of the COVID-19 emergency, the program has reduced hospitalizations by 17% and medical expenses by $325 per member per month, on average, compared with Clover Health members with similar health profiles.
Last year in its MA business, more than 70% of the patients Clover Health deemed appropriate for home-based primary care ultimately enrolled. This is significantly higher than the industry average, according to Dharmarajan.
Broady, direct-contracting entities like Clover Health are tasked with improving quality and lowering medical expenses for patients participating in the model. Clover Health is participating in the “Global” direct-contracting option.
In order to scale Clover Home Care on the direct-contracting side, Clover Health plans to use a combination of its internal teams, meaning clinicians and specialized home-based primary care providers that are employed by the company, as well as external partners.
The company’s technology and data platform will also play an integral role.
“Whether it’s our teams or external partners, a key linchpin here is our underlying technology and data platform that we’ll be [using] in all of these different markets around the country, whether it’s New York, New Jersey, Kansas or anywhere else,” Dharmarajan said.
Specifically, Clover Health’s platform will help the company identify the right patients for Clover Home Care. The company’s in-home care model utilizes technology, including data analytics and machine learning, to identify its highest-risk members.
It then finds solutions to lower their risk of adverse health events.
Not every patient is a good fit for Clover Home Care. Typically, the program takes on patients with multiple chronic conditions who are frequently hospitalized, as well as frail or homebound patients.
Patients who suffer from advanced illness are also usually good candidates for home-based primary care with the company, according to Dharmarajan.
“For example, they don’t just have lung disease, but they have lung disease that’s bad enough that they need oxygen 24/7,” he said.
Dharmarajan believes Clover Health’s technology platform helps the providers by providing key information that will improve care transitions.
“Doctors often don’t know when their patients are in the hospital, when they were admitted, why they were admitted, when they were discharged or if they’re in a nursing home,” he said. “You really need to know that in order to help patients manage the transition from discharge back to home, which is fraught with a lot of risk for the patient. This is why there’s so much focus on 30-day readmissions.”
Aside from the direct-contracting news, Clover Health is in the spotlight after receiving attention from the same retail traders from Reddit who made headlines earlier this year for the impact they had on GameStop Corp. (NYSE: GME) and AMC Entertainment Holdings. (NYSE: AMC).
Clover Health was trading at $20.39 per share shortly before 10:30 a.m. ET, an 8% decrease from its previous close. The stock had jumped as high as $28.85 per share, according to CNBC.