[Startup News] Battling Trump’s Healthcare Crisis Through Innovative Insurance Plans

Anthony Mosavi
December 3, 2020

As one might expect, the Trump administration’s thrust for smaller government spending has had great consequences for the elderly. As a result of the expenditure cuts, investments in Medicare Advantage plans seem to be on the rise. This private health insurance coverage aims to supplement what is lacking in the federal government’s offerings. 

Clover Health is one insurance provider attempting to address the healthcare crisis with their innovative Medicare Advantage plans, which aim to make private healthcare more accessible for senior citizens through the use of risk assessment technologies.

The Agency for Healthcare Research and Quality has recognized that unnecessary hospitalizations of seniors are a major hurdle for healthcare insurance companies. The agency observes that many conditions are preventable with sufficient outpatient care, proper diagnosis, and steps toward better health management. 

Seeking to improve on what health insurance companies have delivered in the past, Clover Health aims to provide the type of care and pricing that enables seniors to be properly diagnosed and cared for, thus encouraging seniors to seek out medical attention at the first signs of illness or injury and effectively mitigating risk for further complications down the line.

Increased enrollment

Enrollment in Medicare Advantage plans exceeded 20 million in 2018. Exacerbated by the aging population, this trend looks set to rise through the tail end of Trump’s first term, with enrollments set to reach an all-time high of 26.9 million beneficiaries

Rather astonishingly, the number of people aged 65 and above will almost double from 52 million in 2018 to 95 million by 2060. With this figure in mind, it’s clear that the foundations for truly accessible healthcare for seniors must be implemented quickly.

Global thrust

In the meantime, Clover Health’s technology-based approach to tackling the impact of the rapidly aging demographic (and Trump’s admonishment of it) is a welcome feature. Machine learning has been used by the company to process client data so that patients at a higher risk of health complications and hospitalization can be identified early, and risk can be mitigated accordingly. 

Although Clover Health covers several states in the US, the impact of their machine learning technology seems to be global

One of the strategic connections to emerge from this global interest is with Cathay Life, a Taiwanese health insurance company. Clover Health's predictive data models are now integrated into Cathay Life's systems to predict the potential for hospitalization amongst their patients. Such connections take Clover Health beyond US borders. 

Clover Health also recently launched a new research wing, 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. 

Moreover, the company has been providing COVID-19 diagnostic lab testing during the pandemic, and waiving any associated co-pays or cost-shares for members. Partnering with Quest, they claim to have enabled members access to some of the first diagnostic lab tests in the US. 

Funding focus

Since launching in 2012, the company’s unique approach to Medicare Advantage 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 onboard. As a result of these investments, the company's value has surpassed $1.2 billion. 

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