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Clover – Upending Health Insurance

In Action Summary

Clover is lowering health insurance premiums and reducing the claims ratio through a combination of patient-centred analytics and preventive care

Clover is lowering health insurance premiums and reducing the claims ratio through a combination of patient-centred analytics and preventive care

As the health insurance industry increasingly consolidates, digital front runners are starting to focus on making it more efficient for physicians to better serve patients and hospitals. San Francisco-based startup, Clover Health, wants to make insurance more affordable for consumers and easier for physicians to administer. To this end, Clover is lowering health insurance premiums and reducing the claims ratio through a combination of patient-centred analytics and preventive care.

Founded in 2014, Clover Health tracks inputs from a policy holder’s medical history and insurance claims. Specifically, the company’s algorithms and software identify the most at-risk patients by working on this data, and Clover Health then works with them to help them become healthier – for example, to encourage them to take their prescription medication or to manage their chronic diseases. Its nurse practitioners visit patients’ homes, and coordinate necessary tests that may be missing in the patient’s profile. If successful, Clover Health reduces its overall costs by reducing the rate of hospitalization.

Helping patients avoid hospitalization saves the company an average of $10,000. If a patient is hospitalized, nurses will visit after surgery to ensure that patients take the proper medications daily after-surgery.

At the core we’re using data and software to build clinical profiles of people, identify gaps in care, and fill those gaps in care. We have a small team that will do targeted interventions to drive improved health outcomes of people.  Every in-patient hospital admission we can prevent by filling these gaps in care, this ends up being a positive for us.
– Kris Gale, Clover Health’s CTO

Clover’s primary competition comes in the form of traditional Medicare insurance companies such as United Healthcare. However those companies aren’t collecting data from patients in order to reduce the level of in patient stays through preventative care. This differentiation is reflected in the fact that Clover Health has recently raised $100 million and will use the funds to expand its operations.

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