How Clover Health Is Making At-Home Care Benefits Work In Medicare Advantage

For a health plan to have success investing in home-based care, it has to have sufficient coverage.

It also has to think outside of the box for ways to support the people who need at-home care the most. That’s what Clover Health (Nasdaq: CLOV) believes, at least.

Headquartered in Nashville, Tennessee, Clover Health is a technology-enabled Medicare Advantage (MA) insurer with its own in-house clinical capabilities.


Brady Priest, the divisional home care CEO at Clover, believes that its care and support capabilities are differentiators.

“The biggest differentiator today is our coverage,” Priest said at HHCN’s FUTURE conference in August. “Another one that we’ve really focused on recently is the concept of support. The folks we manage in the primary care-like practice where we’re augmenting the care they can get — those are the folks that are using the facilities the most. We look at those high-cost patients, on the insurance side, as a form of a cry for help.”

By turning its attention to those higher cost members, Clover is proactively getting ahead of avoidable hospitalizations.


Being proactive can mean helping members gain access to the supplemental benefits that Clover offers.

“That proactive part is really the key to making some of these supplemental benefits work for the people that need them,” Priest said. “I think the folks that will proactively take advantage of these benefits, generally, don’t need as much support. So, the ability to proactively get to the folks who really need the help — that’s the point of [our] home care program. The need that we see in high medical costs is really a need for more support, and that’s how we try to deliver it.”

That proactivity has already shown dividends. When those measures are applied, Clover is seeing a 25% reduction in inpatient utilization.

“If you don’t have enough support, you’re going to show up at the ER a lot,” Priest said. “Because the ER is actually a great place to go if you have a problem. They’ll feed you, they’ll take care of you. But that’s what we see is that, when the support level is low in those beginning stages, the ER and hospitalization rates are up.”

Clover’s big four

Clover Health has long seen the value-add in offering its MA members home-based care services.

Because of Clover’s unique business model – with a provider group inside a health plan – it’s easier for the company to manage certain member benefits and leverage them for better outcomes.

Priest outlined four key benefits that Clover is paying more attention to than others in order to be proactive with members who need at-home care: food, transportation, home health aides and home security.

“We know there are specific examples in each one of those that have a qualitative clinical benefit for folks who need assistance,” Priest said. “For instance, transportation. If you’re on dialysis and you can’t get to your appointment, you miss the appointment and you’re going into the hospital the next week — automatically. For food, when someone is alone and they come out of the hospital and there’s nothing in the fridge, they’re a heck of a lot more likely to go back to a facility.”

The home-based care benefits work. The issue remains getting the right people to use them.

“I think the real issue around supplemental benefits, at the plan level, is always going to be that a lot of times people who don’t really need them are taking advantage of these benefits [we pay for],” Priest said. “How do you get more specific with putting those benefits to the right folks? For me, it’s kind of easy because I can just prescribe them in the places where I think I need them.”

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