Clover Health Reduces Unnecessary Hospitalization With Machine Learning and Home Care

Anthony Mosavi
August 8, 2019

***This article is a story curated by SparkAmpLab that can be shared or modified for re-post***

Due to the current Trump administration’s thrust for smaller government spending, investments in private Medicare Advantage seems to be on the rise. Decreasing spending on health care proves to be a greater challenge to the older generation. Clover Health has taken a huge jump to address this crisis and uphold the senior population with their innovative Medicare Advantage plans.

Medicare Advantage is an innovative health insurance plan that comes alongside part C of US Medicare provided by the government. It is a form of HMO (health maintenance organization) and the PPO (preferred provider organization). This is the private coverage that supplements what is lacking in the federal government’s offerings. 

Unnecessary hospitalizations of seniors are a major concern and a hurdle for the healthcare insurance companies. Many of these conditions are preventable with sufficient outpatient care, proper diagnosis, and steps for better health management. The Agency for Healthcare Research and Quality has made this observation as a result of their research. 

Seeking to improve on what health insurance companies have delivered in the past, Clover Health came up with a comprehensive and efficient approach. They provide the type of care and pricing that enables seniors to be properly diagnosed and cared for. When their out of pocket costs are high, people on fixed incomes are less likely to get a health checkup or to visit a doctor. This increases their chances of complications and further hospitalizations that could have been avoided. 

Increased Enrollment Increases Opportunities

A boom in Medicare Advantage plans indicate the increasing need for better medical coverage and the ever expanding options available to seniors. Enrollment in Medicare Advantage plans has exceeded 20 million in 2018 and continues to increase even to this day. This trend is also caused by the aging population here in the United States. 

This demographic reality presents an incremental opportunity for this new startup as they tackle this important need. Their technology based approach to this healthcare need in society is a welcome feature. Seniors concerned about their health as well as their finances are the ones who will benefit most from this Clover Health approach. 

Global Thrust

Although Clover Health is a local company covering several states in the US, the impact of their technology seems to have a global thrust. Their machine learning technology helps measure risks and hopes to use these models to identify patients who are at a higher risk of complications and hospitalization. Such innovative approaches to combining healthcare with technology has caught the attention of health insurance companies in other parts of the world. 

One of those strategic connections is with Cathay Life, a Taiwaneese health insurance company. Clover Health's predictive data models get integrated into Cathay Life's systems to help them to predict the hospitalization possibilities of their patients as well. Such connections take Clover Health across the US borders. 

On the Cutting Edge

Just over a week ago, Clover Health launched a research wing of their business called Clover Therapeutics. They've entered into a research agreement with Genentech, to discover the possibilities of incorporating genomic factors that impact the patient's risk for developing certain diseases. 

This move to stay on the cutting edge among health insurance companies along with their technology expertise is an excellent approach. This perspective may be a key factor to propel the future of Clover Health to further heights. 

Funding Focus

The unique approach to handling medicare advantage by Clover Health has attracted the attention of investors looking to cash in on profitable ventures. Investors such as Greenoaks Capital, Google Ventures, Sequoia Capital and First Round Capital have all jumped on this opportunity. As a result of these investments and the great opportunity that Clover Health has developed, the company's value has hit the $1.2 billion mark. 

From its inception in 2012, Clover Health has steadily increased its funding and its value to its investors. Their development as a company among many health insurance companies has been tremendous with a significant impact in the lives of many people. Thus we see the increasing interest by quality and informed investors into the company. 

Human Touch 

Technology, Machine Learning and AI has its huge benefits in aiding healthcare professionals to do their tasks with more efficency. They maximize technology and go beyond it to give personalized care at the doctors office and in the homes of patients. They observe the condition and situation in the homes to see the factors that may be influencing the health of the patients. This gives them an advantage and helps the patients to stay healthy and enjoy their senior years. 

With an aging population in the US and in many of the developed countries all over the world, Clover Health has an important role to play. In the US alone, those ages 65 and above will almost double from 52 million in 2018 to 95 million in 2060 (the percentage will also rise from 16 to 23 percent). This indicates that there will be a steady rise in the coming years. 

Clover Health’s technology, assessment and the personal touch of caring professionals will be an ongoing impact that will benefit many through the years. This is a welcome benefit for seniors as well as for investors looking for outstanding new startups that are making a difference and set on an upward trajectory. 

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