Clover Health Investor Day Presentation Deck

Made public by

sourced by PitchSend

13 of 41

Category

Healthcare

Published

November 2020

Slides

Transcriptions

#1Clover Health A Deeper Dive Confidential#2Disclaimer This presentation has been prepared for use by Social Capital Hedosophia Holdings Corp. III ("SCH") and Clover Health Investments, Corp. ("Clover") in connection with their proposed business combination. This presentation is for information purposes only and is being provided to you solely to assist investors in making their own evaluation with respect to the proposed business combination between SCH and Clover. This presentation is not intended to be all-inclusive or to contain all the information that a person may desire in considering an investment in SCH and is not intended to form the basis of any investment decision in SCH. You should consult your own legal, regulatory, tax, business, financial and accounting advisors to the extent you deem necessary, and must make your own investment decision and perform your own independent investigation and analysis of an investment in Social Capital and the transactions contemplated in this presentation. This presentation shall neither constitute an offer to sell or the solicitation of an offer to buy any securities, nor shall there be any sale of securities in any jurisdiction in which the offer, solicitation or sale would be unlawful prior to the registration or qualification under the securities laws of any such jurisdiction. NEITHER THE SECURITIES AND EXCHANGE COMMISSION NOR ANY STATE OR TERRITORIAL SECURITIES COMMISSION HAS APPROVED OR DISAPPROVED OF THE SECURITIES OR DETERMINED IF THIS PRESENTATION IS TRUTHFUL OR COMPLETE. Industry and Market Data. The data contained herein is derived from various internal and external sources. No representation is made as to the reasonableness of the assumptions made within or the accuracy or completeness of any projections or modeling or any other information contained herein. Any data on past performance or modeling contained herein is not an indication as to future performance. SCH and Clover assume no obligation to update the information in this presentation. Further, these financials were prepared by Clover in accordance with private Company AICPA standards. Clover is currently in the process of uplifting its financials to comply with public company and SEC requirements. Trademarks. SCH and Clover own or have rights to various trademarks, service marks and trade names that they use in connection with the operation of their respective businesses. This Presentation may also contain trademarks, service marks, trade names and copyrights of third parties, which are the property of their respective owners. The use or display of third parties' trademarks, service marks, trade names or products in this Presentation is not intended to, and does not imply, a relationship with SCH or Clover, or an endorsement or sponsorship by or of SCH or Clover. Solely for convenience, the trademarks, service marks, trade names and copyrights referred to in this Presentation may appear without the TM, SM, Ⓡ or Ⓒ symbols, but such references are not intended to indicate, in any way, that SCH or Clover will not assert, to the fullest extent under applicable law, their rights or the right of the applicable licensor to these trademarks, service marks, trade names and copyrights. Forward Looking Statements. This presentation contains certain forward-looking statements within the meaning of the federal securities laws with respect to the proposed transaction between SCH and Clover. These forward-looking statements generally are identified by the words "believe," "project," "expect," "anticipate," "estimate," "intend," "strategy," "future," "opportunity," "plan," "may," "should," "will," "would," "will be," "will continue," "will likely result," and similar expressions. Forward- looking statements are predictions, projections and other statements about future events that are based on current expectations and assumptions and, as a result, are subject to risks and uncertainties. Many factors could cause actual future events to differ materially from the forward-looking statements in this document, including but not limited to: (i) the risk that the transaction may not be completed in a timely manner or at all, which may adversely affect the price of SCH's securities, (ii) the risk that the transaction may not be completed by SCH's business combination deadline and the potential failure to obtain an extension of the business combination deadline if sought by SCH, (iii) the failure to satisfy the conditions to the consummation of the transaction, including the adoption of the Agreement and Plan of Merger (the "Merger Agreement"), dated as of October 5, 2020, by and among SCH, Asclepius Merger Sub Inc. and Clover, by the shareholders of SCH, the satisfaction of the minimum trust account amount following redemptions by SCH's public shareholders and the receipt of certain governmental and regulatory approvals, (iv) the lack of a third party valuation in determining whether or not to pursue the proposed transaction, (v) the inability to complete the PIPE investment in connection with the transaction, (vi) the occurrence of any event, change or other circumstance that could give rise to the termination of the Merger Agreement, (vii) the effect of the announcement or pendency of the transaction on Clover's business relationships, operating results and business generally, (viii) risks that the proposed transaction disrupts current plans and operations of Clover and potential difficulties in Clover employee retention as a result of the transaction, (ix) the outcome of any legal proceedings that may be instituted against Clover or against SCH related to the Merger Agreement or the transaction, (x) the ability to maintain the listing of SCH's securities on a national securities exchange, (xi) the price of SCH's securities may be volatile due to a variety of factors, including changes in the competitive and highly regulated industries in which SCH plans to operate or Clover operates, variations in operating performance across competitors, changes in laws and regulations affecting SCH's or Clover's business and changes in the combined capital structure, (xii) the ability to implement business plans, forecasts, and other expectations after the completion of the proposed transaction, and identify and realize additional opportunities, and (xiii) the risk of downturns and a changing regulatory landscape in the highly competitive healthcare industry. The foregoing list of factors is not exhaustive. You should carefully consider the foregoing factors and the other risks and uncertainties described in the "Risk Factors" section of SCH's registration on Form S-1 (File No. 333-236776), the registration statement on Form S-4 relating to the business combination (the "Registration Statement") filed by SCH with the Securities and Exchange Commission (the "SEC") on October 20, 2020 (File No. 333-249558) and other documents filed by SCH from time to time with the SEC. These filings identify and address other important risks and uncertainties that could cause actual events and results to differ materially from those contained in the forward-looking statements. Forward-looking statements speak only as of the date they are made. Readers are cautioned not to put undue reliance on forward-looking statements, and Clover and SCH assume no obligation and do not intend to update or revise these forward-looking statements, whether as a result of new information, future events, or otherwise. Neither Clover nor SCH gives any assurance that either Clover or SCH or the combined company will achieve its expectations. 2#3Disclaimer (Cont'd) Use of Projections and Illustrative Presentations. The financial projections, estimates, targets and illustrative presentations in this presentation are forward-looking statements that are based on assumptions that are inherently subject to significant uncertainties and contingencies, many of which are beyond SCH's and Clover's control. While all projections, estimates, targets and illustrative presentations are necessarily speculative, SCH and Clover believe that the preparation of prospective or illustrative information involves increasingly higher levels of uncertainty the further out the projection, estimate, target or illustrative presentation extends from the date of preparation. The assumptions and estimates underlying the projected, expected, target or illustrative results are inherently uncertain and are subject to a wide variety of significant business, economic and competitive risks and uncertainties that could cause actual results to differ materially from those contained in the financial projections, estimates and targets. The inclusion of financial projections, estimates, targets and illustrative presentations in this presentation should not be regarded as an indication that SCH and Clover, or their representatives, considered or consider the financial projections, estimates, targets and illustrative presentations to be a reliable prediction of future events. Further, illustrative presentations are not necessarily based on management projections, estimates, expectations or targets but are presented for illustrative purposes only. Use of Non-GAAP Financial Metrics. This presentation includes certain non-GAAP financial measures (including on a forward-looking basis) such as Adjusted EBITDA, Adjusted EBITDA Margin and Adjusted Revenue. These non-GAAP measures are an addition, and not a substitute for or superior to measures of financial performance prepared in accordance with GAAP and should not be considered as an alternative to net income, operating income or any other performance measures derived in accordance with GAAP. Reconciliations of non-GAAP measures to their most directly comparable GAAP counterparts are included in the Appendix to this presentation. Clover believes that these non-GAAP measures of financial results (including on a forward-looking basis) provide useful supplemental information to investors about Clover. Clover's management uses forward looking non-GAAP measures to evaluate Clover's projected financial and operating performance. However, there are a number of limitations related to the use of these non-GAAP measures and their nearest GAAP equivalents. For example other companies may calculate non-GAAP measures differently, or may use other measures to calculate their financial performance, and therefore Clover's non-GAAP measures may not be directly comparable to similarly titled measures of other companies. See the footnotes on the slides where these measures are discussed and the Appendix for reconciliations of these non-GAAP financial measures to the most directly comparable GAAP measures. Additionally, to the extent that forward-looking non-GAAP financial measures are provided, they are presented on a non-GAAP basis without reconciliations of such forward-looking non-GAAP measures due to the inherent difficulty in forecasting and quantifying certain amounts that are necessary for such reconciliations. Additional Information and Where to Find It. This presentation relates to a proposed transaction between Clover and SCH. This document does not constitute an offer to sell or exchange, or the solicitation of an offer to buy or exchange, any securities, nor shall there be any sale of securities in any jurisdiction in which such offer, sale or exchange would be unlawful prior to registration or qualification under the securities laws of any such jurisdiction. SCH has filed the Registration Statement with the SEC, which includes a document that serves as a prospectus and proxy statement of SCH, referred to as a proxy statement/prospectus. A proxy statement/prospectus will be sent to all SCH shareholders. SCH also will file other documents regarding the proposed transaction with the SEC. Before making any voting decision, investors and security holders of SCH are urged to read the Registration Statement and all other relevant documents filed or that will be filed with the SEC in connection with the proposed transaction as they become available because they will contain important information about the proposed transaction. Investors and security holders are able to obtain free copies of the Registration Statement and all other relevant documents filed or that will be filed with the SEC by SCH through the website maintained by the SEC at www.sec.gov. The documents filed by SCH with the SEC also may be obtained free of charge at SCH's website at https://socialcapitalhedosophiaholdings.com or upon written request to 317 University Ave, Suite 200, Palo Alto, California 94301. Participants in Solicitation. SCH and Clover and their respective directors and executive officers may be deemed to be participants in the solicitation of proxies from SCH's shareholders in connection with the proposed transaction. A list of the names of such directors and executive officers and information regarding their interests in the business combination is set forth in the Registration Statement. You may obtain free copies of these documents as described in the preceding paragraph. 3#4Our Ethos Our mission is to improve every life Our strategy is centered around deploying the Clover Assistant to physicians to improve and reduce variability in clinical decision-making Our thesis is that Clover Assistant-powered physicians drive incremental clinical and economic value, supporting our ability to offer consumers wider choice healthcare coverage at a lower cost and also driving lower expenses for the government We believe our platform can reduce costs and improve outcomes across a myriad of programs across healthcare, including Medicare Advantage and FFS Medicare In summary, our strategy is to: 1) Scale Clover Assistant, 2) Drive more value through Clover Assistant, 3) Give a meaningful amount of that value back to consumers and the government, and 4) Keep repeating 1-3 5#5Why Medicare Advantage as Clover's First Market Meaningful Impact as a Medicare Advantage Insurer "Own" and Leverage the Data Stack Opportunity for Economic Alignment Create Better Health Outcomes for Members Consumer-Driven Marketplace Source: CMS, Kaiser Family Foundation, L.E.K. Largest, Undisrupted Market in Healthcare I I 14% CAGR $270bn Medicare Advantage 2019 $1.25tn TAM Overall Medicare $590bn Medicare Advantage 2025 Spurred by aging demographic tailwinds and value to consumers CO 6#6Our Virtuous Growth Cycle 1. Capture and synthesize data 5. Drive strong, market- leading organic membership growth ↑ Clover 4. Share superior economics with members via lower cost and better benefits 2. Apply machine learning to provide data- driven, personalized insights at the point of care via the Clover Assistant Į 3. Improve clinical decision-making to drive better care 7#7Step 1: Our Technical Moat Is Centered Around Our Ability To Connect Data With Action At The Point Of Care Closed loop system Data Data Platform The Clover Assistant As an insurer, we have large amounts of member data from disparate sources We have direct access to personalized, longitudinal data Types of longitudinal data include: claims, medical charts, labs, pharmacy, EHR, and socioeconomic data as well as evidence based protocols We have expanded our data integrations and now process millions of data points per day As a technology company, we've built a single, centralized data platform We invest in R&D to develop a platform that ingests, cleans, and synthesizes data We layer sophisticated analytics, highlighted by Clover's machine learning platform, for fitting and tuning clinically-focused models We've scaled our proprietary software, the Clover Assistant, that drives action Helps to standardize PCP decision-making at the point of care Provides insights to physicians and engages in instantaneous bi-directional data exchange that positions us to continuously iterate on our software 8#8Step 2: We Leverage Our Expert System To Surface Actionable Data At The Point Of Care Our data and focus on actionability... Deep Data Richness Shallow Combining Rich Data With Action Other Payors Limited HCIT Clover Big Tech Data Actionability Engaging ...Allow us to drive value via the Clover Assistant Evidence-Based Protocols Maps personalized clinical data to evidence-based protocols. Value: Incremental data set that helps doctors adhere to standard of care. Early Disease Detection Clinical rules and ML engines surface potential disease prevalence, even when members are asymptomatic. Value: Insight layer enables earlier identification and treatment of conditions. Quality Gap Closure Surfaces opportunities to address cancer screenings, medication adherence reminders, and other gaps in care. Value: Provides not only suggested actions, but also data on outcomes so PCPs can direct members to take appropriate actions. Care Coordination Manages engagement with our complex care program, supports discharge planning, and will support referrals and site of service decisions. Value: Shares utilization data to support care coordination and help ensure members receive the right care in the right setting. 9#9Step 2 Example: How The Clover Assistant Surfaces Evidence-Based Protocols At The Point Of Care 1 2 Provides clinical recommendations help doctors develop evidence-based treatment plans Shares with the physicians the specific reasons why a recommendation is being made Identifies clinical guidelines on treatment protocols 3 applicable to a member's specific conditions and disease burden Identifies potential costs or blockers that could 4 prevent a patient adhering to the proposed clinical recommendations Physicians provide specific information or feedback to 5 Clover on how or why they are treating their patient, our member 1 Type 2 Diabetes: Injectable Therapy for Elevated A1C 5 Clover's latest HbA1C result is 2 10% for this patient. Consider starting or restarting one of the following injectable therapies (*GLP-1 agonists are generally preferred; if starting insulin, long-acting is recommended): Dulaglutide (TRULICITY)* $$$ 98 98 98 98 Glargine (BASAGLAR) $$$ Detemir (LEVEMIR) $$$ Degludec (TRESIBA) $$$ NOVOLIN N $$$ Degludec/Liraglutide (XULTOPHY 100/3.6)* $$$ Medication prescribed 08 Did not prescribe medication 98 Save task 96 98 Semaglutide (OZEMPIC)* $$$ Exenatide (BYDUREON)* $$$ 4 $= lowest patient cost, $$$$$ - highest patient cost, comparative drug costs for patient shown from Clover formulary. Actual cost may change during the year. Liraglutide (VICTOZA)* $$$ Glargine/Lixisenatide (SOLIQUA Please ensure that your patient: - Does not have drug allergies or potential drug-drug interactions. Please use your clinical judgment. 100/33)* $$$ 2 Why we recommend this RELEVANT PATIENT HISTORY A Diagnosis Type 2 diabetes mellitus without complications 07/31/2019 ✓ Medications > REQUIRED ✓ Lab results Expand all CLINICAL GUIDELINES 3 The ADA recommends initiating injectable therapy when a patient's A1C is ≥ 10% to more expeditiously achieve glycemic control. 2019 ADA Standards of Care in Diabetes 10#10Step 2 Example: How The Clover Assistant Surfaces Potential Disease Burden At The Point Of Care 1 Engages in two-way conversation with physicians to determine a member's fulsome disease burden Provides physicians with supporting evidence, 2 including machine learning suggestions, clinical rules, and lab results Recommends next steps to spur proper treatment planning based on clinical evidence, in order to ensure that early detection of disease leads to improved outcomes and costs over time Clover 1 3 CareConnect Chronic Kidney Disease Stage 1 (GFR> 90) Does the patient have any of the following? Stage II (GFR 60-89) Stage III (GFR 30-59) Stage IV (GFR 15-29) Stage V (GFR <15) ESRD (on dialysis) Visits OPTH ordered Summary Patients with CKD stage III and higher have at least a 30% incidence of Hyperparathyroidism. Did you order a PTH? OPTH not ordered Does the patient have chronic kidney_disease? 2 Connect a patient ?Resources SUPPORTING EVIDENCE Y REQUIRED Patient had lab results related to Chronic Kidney Disease (stage 4): Glomerular filtration rate of 21.0 on 08/28/2020 and 15.0 on 03/19/2020 Legal documents Privacy Policy With the Clover Assistant, accurate risk adjustment comes as a by-product of improved decision- making and, most importantly, leads to earlier treatment of conditions. Terms of Service 11#11Step 2 Example: Machine Learning Enables Proactive Care Planning We democratize machine learning at scale by surfacing 25 specific chronic conditions predicted by our technology. This results in earlier, personalized care planning for our members. Chronic Conditions Surfaced Via ML 1. Congestive Heart Failure 2. Chronic Obstructive Pulmonary Disorder 3. Chronic Kidney Disease 4. Diabetes 5. ...and more Personalized Care Planning Evidence-based medication regimens Specialist referral Hormone level testing Diet education Medication adherence education Physical therapy 12#12Step 3: How We Deploy Engaging Software Useful Clinical Content + Streamlined Workflow Providers leverage CA as a standalone platform outside of low-NPS electronic health record (EHR) systems Providers are reimbursed ~2x the industry reimbursement rate within 4 days on average Reimbursement is fixed and does not modulate up or down based on data inputs Contracted physician practices include small, medium and large independent practices, hospital-owned practices, and IPAs in all 34 current markets (1) Based on estimated CMS 2021 base Medicare reimbursement fee rate for primary care visit. (2) Excludes physicians contracted for Direct Contracting program. Software Engagement At Scale Total Members % of Members That See A PCP Contracted on the Clover Assistant 33% YE2018 33k 59% YE2019 43k 61% 1H2020 57k 70%+ Long-Term Goal In just over 2 years since product launch, we have over 2k highly engaged physicians (²) contracted to use the CA across geographies and practice types. 13#13Step 3: Physicians Value The Clover Assistant In ~2 years since product launch, we've built a broad base of engaged physicians. Given our software-driven approach, we believe we can scale these results rapidly within existing and new markets. Broad Engagement Ease of Use Clinical Value 92% Onboarded PCPs used the CA for 92% of eligible visits in 2019 11% Of surveyed Clover Assistant physicians do not have an EHR 11k+ Care plans managed by the Clover Assistant per month on average(1) +59 Trailing 6-month Net Promoter Score from physician survey 22 E&M codes no longer necessary given Clover Assistant payment structure 2k Medication adjustment Clover Assistant prompts accepted per month on average(2) 3 weeks Physician feedback helps drive new product releases on average every 3 weeks 4 days Of time between Clover Assistant visit completion and payment on average 0.81 Net new diagnoses and care plans confirmed per member via Clover Assistant suggestion(3) 68% Of CA physicians work in practices with 10 or less physicians 1 hour Of onboarding training needed 1,100 bp differential in MCR for Clover Assistant panels vs. non-Clover Assistant PCP panels (1) In 2020 through October. Includes providing education about disease management, prescribing relevant prescriptions, and ensuring that labs are up to date. (2) In 2020 through October. Includes moving a member to longer prescription lengths (shown to increase adherence), adjusting medication intensity in concordance with clinical guidelines, or renewing a prescription that has been lapsed. 14 (3) In 2020 through October. Net new indicates diagnoses of which Clover did not have a record in the year prior.#14Step 3: Swiftly Building Telehealth Into The Clover Assistant Helped To Maintain Preventative Care During COVID-19 Given our closed loop system, we were able to rapidly build and deploy telehealth support directly into the Clover Assistant. This resulted in virtually no COVID-related drop-off in care management visits for members that see a Clover Assistant physician. 1.2 Primary Care Visits Per Member Q1 2020 1.1 1.2 Q2 2020 0.9 ■With Clover Assistant Physician ■With Non-Clover Assistant Physician ● • COVID-specific symptom prompts help identify members in need of additional support from Clover ● Telehealth Features ● Embedded video functionality Invite a member via text or email link 15#15Step 3: Clover Leverages Technology To Impute Best-In- Class Complex Care Protocols At Scale Cost Structure Member Identification Member Engagement Care Delivery Approach Typical MA Insurer With 3rd Party Vendors ~5% of membership account for 40%+ of costs Complex care savings shared with vendors Eligible members identified via 3rd party vendors with access to latent claims data Via 3rd party vendors, often creating friction with members' chosen providers Brick-and-mortar care Clover With The Clover Assistant ~5% of membership account for 40%+ of costs Complex care savings retained by Clover Eligible members identified immediately via closed loop system Via conversations and collaboration with members' chosen PCPs Asset-light, software-driven care at the Home Clover generates program savings across a greater scale of the eligible population by having more accurate identification and higher engagement. 16#16How We Measure The Clover Assistant's Impact At Clover, we take a physician-centric view to measure the impact of our platform given that it is, at this stage, a physician-facing platform As such, when measuring key metrics such as Medical Care Ratio (MCR), we compare the panels of Clover Assistant-powered PCPs to those of PCPs that are not yet powered by the Clover Assistant We believe we can raise the standard of care for Clover Assistant-powered PCPs, relative to other PCPs, because the Clover Assistant provides: ● Additional personalized data beyond what is in their EHR Recommendations with respect to evidence- based protocols Views into care gaps Reduced payment bureaucracy 17#17Step 3: Improved Decision-Making Yields Enhanced Outcomes And Unit Economics 93.8% 89.2% Returning Member MCRs FY2019 93.0% 82.0% Q1 2020 With Non-Clover Assistant Physician With Clover Assistant Physician Illustrative w/ Clover Assistant Physician (at 4.0 Stars and Competitor Plan Design) (1,2) The Clover Assistant has helped to drive an 1,100 bp differential in Q1 2020 MCR Our Q1 2020 Clover Assistant MCR of 82% supports our ability to offer a 3.0 Star PPO product at lower than HMO costs Our platform is still in its early innings. Since launch in July 2018, we have released new features on average every three weeks and are onboarding new physicians year-round We believe there is meaningful incremental reduction in MCR beyond even Star ratings improvements Note: MCR is not a direct equivalent of the federal MLR. CMS does not regulate MCR, but does put an 85% minimum threshold on MLR. Unlike MCR, MLR takes into account, in its numerator, quality improvement expenditures, which would include Clover's investment in technology for clinical care capabilities. (1) Theoretical minimum MCR for this Star rating. In practice, Clover will cede some margin back to members in the form of more obvious plan designs, consistent with our growth strategy. (2) Based on company analysis of plan design differential, including out-of-pocket cost differential and cost differential of offering an HMO vs. a PPO. 18#18Step 3: Improved Decision-Making Yields Enhanced Outcomes And Unit Economics (Cont'd) 93% Non-CA Q1 2020 Medical Care Ratio of Returning Members 7% Differential driven by less acute events (e.g., since launch of our complex care program, 1,900 bps improvement in MCR for enrolled population (2); 12% lower inpatient admissions for members who see a CA PCP(3)) Differential driven by disease burden capture (e.g., in 2020, 22k new diagnosis and treatment plans confirmed via technology (¹) 4% Revenue Differential Medical Expense Differential 1,100 basis point lower MCR(4) 82% CA Illustrative CA Long- Term Expected Future Impact: Medium Term Revenue Improvement: Incrementally driven by Stars and continuous improvement of our machine learning models and decision rules that identify net new conditions Medium Term Medical Expense Improvement: Incrementally driven by referral management, including site of service decisions, and improved enrollment into Clover's complex care program Long Term Medical Expense Improvement: In addition to cost of care feature development, improvement in cost curve over time given care management that focuses on preventative care and adherence to standard of care (1) In 2020 through October. Represents net new diagnoses surfaced and confirmed via machine learning and clinical rules within our technology platform. Compared to propensity-matched control group from May 2017 to Q1 2020. (2) (3) Compared to members who see a non-CA PCP. Figures represent Q1 2020 results. (4) Compared to members who see a non-CA PCP. Figures represent Q1 2020 results. MCR = Medical Expenses / Premium Revenue. 19#19Step 3: Further Upside To Economics With Stars While Clover is rated at 3.0 Stars today, we intend to achieve 4+ Stars over time. The Clover Assistant is expected to be a significant driver of our success given our release of Stars features over the past year. (1) H2 2019 Initial Stars features rolled out including cancer screenings and flu shot reminders as well as prompt for physicians to address HOS survey measures such as discussing fall risk and urinary incontinence July 2018 Launch of the Clover Assistant with no Stars features H2 2020 Rollout of features to support alc control, medication adherence, and transition in care measures H1 2020 Further HEDIS features released, such as alert for medication reconciliation post discharge and prompt to address Diabetic Retinopathy exam. Also support for mail order given COVID. I COVID impact on HEDIS and survey measures has limited efforts to drive Stars rating Future Releases Releases are expected to continue to address clinical measures as well as incorporate survey education Regulatory Tailwinds Government support for calculation methodology changes including 1) local, rather than national, comparisons, and 2) alternative weighting methodology for social risk factors, which are insufficiently accounted for currently We estimate an improvement from 3.0 to 3.5 Stars and from 3.5 Stars to 4.0 Stars would each yield ~500 bps (total of ~1,000 bps) improvement in revenue to be reinvested into more benefits for our members, consistent with our growth strategies. Based on recommendations from the Medicare Payment Advisory Commission, an independent, non-partisan legislative branch agency. The agency released a report to Congress in June 2020 titled, "Medicare and the Health Care Delivery System," in which the Stars program is discussed. 20#20Step 4: Designing "Obvious" Plans Five Burning Questions Is my PCP in the network? Is my hospital in the network? Is my specialist in the network? Are drugs covered? What is the plan going to cost me? Open Access Narrow Upending the Trade-off: Access vs Cost Low Clover Typical HMOs We offer plans with the access of a PPO at lower than HMO costs. Typical PPOS Incumbents Annual Cost High 21#21Step 4: Providing Better Care At A Lower Cost Illustrative Out of Pocket Costs(¹) Clover PCP Copay Specialist Copay Drug Deductible OTC Allowance Avg. Annual Cost Avg. Lifetime Cost $0 $5-$20 $150 - $200 (5) $346 $1,871 $13,094 Competitor $5 $25 - $45 $200 - $240 $25 $2,257 $15,801 Savings $5 (100%) $20-$40 (80%-89%) $0 - $90 (0% -38%) $387 $2,707 17% cost savings Note: Assumes lifetime of 7 years (1) Company analysis. Competitor column represents MA plans offered by the competitor with largest market share in the five counties where Clover has the most members. (2) Kaiser Family Foundation. (3) Calculated assuming a 20% coinsurance rate applied to the estimated 2021 primary care visit cost of $103 and level 5 E/M visit cost of $148 respectively (from CMS). (4) 2016 average out-of-pocket spending on medical and long-term care services (from Kaiser Family Foundation). (5) Members with the federal low-income subsidy (LIS) pay $0; $200 represents an average that is comparable to our competitors after considering the LIS. Medicare $21(3) $30(3) $651(2) $0 $3,166(4) $22,162 41% cost savings 22#22Step 5: Our Plans Position Us To Capture Growth From Secular Tailwinds Total Medicare Population Medicare Advantage Population Individual, Non-SNP MA Population 2019 62mm 22mm 15mm Clover today only offers plans in markets that service 3.1mm lives The Medicare Advantage market is expected to grow 14% annually from $270bn to $590bn Clover has over 50% take rate across established markets(1) 2025E 73mm 34mm 24mm(2) Between market growth, take rate in existing markets, and new market expansion, we believe Clover has multiple levers to enable sustained above-average growth for many years to come. (1) Take rate defined as Clover's net membership growth as a percentage of the market's net membership growth from December to May in a given period (i.e., prior to and after the impact of the Annual Election and Open Enrollment periods). We define established markets to include markets in which we have over 500 members in December (i.e., prior to the reference period). Our established markets currently represent 13 of our 34 counties, as of 2020. Clover currently offers only individual, non-SNP MA plans and thus uses individual, non-SNP market sizes to calculate market share and take rate. Source: CMS. 23 (2) Assuming Individual, non-SNP MA market as a percentage of total MA holds from 2019 to 2025.#23Step 5: Achieve Significant Market Share Our take rate has translated into significant market share gains in our established markets, even when competing against large incumbents. 60% 50% 40% 30% 20% 10% H 2013 2014 Market Share In Clover's Established Markets(¹) 2015 2016 2017 ■Clover United Health ■CVS/Aetna Horizon BCBS 2018 2019 2020 Our attention has been focused on our initial, now established markets. With the capital from this transaction, we believe that we can scale our model more rapidly - accelerating our potential growth trajectory in 2023+ by adding millions of Medicare-eligibles to our addressable population. Source: CMS (1) We define established markets to include markets in which we have over 500 members in December (i.e., prior to the reference period). Our established markets currently represent 13 of our 34 counties, as of 2020. Market share defined as plan members as a percentage of the individual, non-SNP market in defined counties. 24#24Our Virtuous Growth Cycle Extends Beyond MA Clover Assistant Organic MA Growth The Clover Assistant helps enable us to underwrite best-in-class plans, supporting our nation-leading growth among MA plans with over 50k members. Partnerships Our ethos and technology have earned us partnership opportunities that can further spur our virtuous growth cycle (e.g., Walmart co-branding). Direct Contracting Through DC, the Clover Assistant is expected to help us improve care for seniors enrolled in Original Medicare. Adjacent Markets Our technology platform can address other adjacent areas in the long-term. While we've begun our efforts in Medicare Advantage, we believe the Clover Assistant can scale in many ways. 25#25Direct Contracting Platform Opportunity Clover has applied to be a risk-bearing Direct Contracting Entity (DCE) under Global Risk as part of the upcoming Direct Contracting (DC) program scheduled to launch April 2021 Designed to support outcomes improvement in an open network MA PPO environment, the Clover Assistant, we believe, is uniquely suited to address the opportunity in DC Value to physicians include access to the Clover Assistant for care management support, no need to take risk, and an opportunity to earn ~40% more for primary care visits We can quickly scale this opportunity nationally and, in 2021, expect to partner with physicians across 8 states, 3 of which we don't currently offer MA plans in Illustrative Provider Medicare Panel 25 Clover members 120 Other MA patients Clover Xu Dia Cand condisse 100 Modi depresve darder, tiple die gewe CAD-ayat forudsealerrikraduction Video Call 255 Original Medicare patients Our play in DC is a natural extension of the Clover Assistant platform, adding significantly more lives under management from a physician panel. 26#26Go To Market Strategy Medicare Advantage Direct Contracting B2B Contract with physicians to adopt the Clover Assistant platform B2B Claims alignment automatically attributes a portion of a contracted physician panel as lives & + B2C Acquire Medicare Advantage members through direct to consumer channels B2C Voluntary alignment via Medicare beneficiaries electing to align with Clover's DCE Lives managed require both B2B and B2C acquisition Lives managed largely captured via B2B with about 60-75% of 2021 lives expected to be attributed via claims 27#27Go To Market Strategy (Cont'd) In under a year of preparing for Direct Contracting, we contracted with PCPs to use the Clover Assistant for a significant number of lives under management in 2021, with expected opportunity for high growth in the future. 10 months Of contracting in 2020 ahead of launch >1,500 Individual PCPs contracted >50% Acceptance rate with independent practices >1k Unique beneficiaries per signed contract on average 200k Expected total lives in 2021 with 100% CA coverage >120k Expected 2021 lives attributed via claims alignment 8 States with contracted physicians in 2021 500k+ Projected total lives in 2022 with 100% CA coverage 28#28Geographic Expansion Synergistic Across Products 1 Launch Direct Contracting Identify markets with significant Medicare opportunity Contract with physicians to use the Clover Assistant Grow lives via claims and voluntary alignment 2 Develop Network Adequacy for Medicare Advantage Identify markets with limited legacy plan differentiation Expand to adjacent MA counties Build upon DC relationships in MA markets to develop network 3 Launch Obvious MA Plans $0 premiums & low/no copays Open network with same in- and out-of network costs for physician visits Grow lives given obvious value proposition to consumers 4 Expand Provider Networks Continuously add strong partners at attractive rates to strengthen member choice and cost of care Enhanced platform scale across products expected to improve contracting We believe our focus on open networks and software-driven care management makes this playbook among the most scalable in all of healthcare. 29#29Direct Contracting Expected Economics ● ● ● Expected Economics Benchmark: Established by looking at historical claims data for specific members (claims-based alignment) or a regional Rate Book (voluntary alignment) multiplied by a member's risk score Revenue: Portions of the benchmark estimated for reimbursement of Participant Providers and a portion of the estimated savings generated from Preferred Providers Margins: Six months after year end, actual costs pooled and compared to benchmark, with any net savings beyond government targets then remitted to the DCE • As a reference point, an analysis on MSSPs(¹) by Avalere found that, on average, physician- led ACOs produced almost 7 times the amount of Medicare savings per beneficiary than hospital-led ACOS Levers for Success Drive to near 100% Clover Assistant participation; features delivered at scale are expected to support savings, such as: Referral management to preferred entities with lower cost/better quality - Site of service decision support such as discharge planning Referral to Complex Care • No cap for medical expense savings Operating expense burden less than in Medicare Advantage • Ability to share savings with physicians if they meet clinical and quality metrics tied to cost of care Illustrative Savings Opportunity Unique value via the Clover Assistant: based on our analysis of fee for service data, we believe there is an opportunity to drive up to ~1,500 bps of savings to the Federal Medicare program, even excluding preferred provider arrangements at better rates than Medicare and benefit of medium- and long-term savings from clinical value driven by the Clover Assistant Movement of inpatient visits to appropriate level of care Readmission prevention Utilization in appropriate post-acute setting Complex care management Specialist referral Kidney-disease efficient care (1) Medicare Shared Savings Programs. Source: https://avalere.com/press-releases/physician-led-accountable-care-organizations-outperform-hospital-led-counterparts 30#30Example: The Clover Assistant & Referral Support |v Visits / My list / Visit for Clover Pendleton on 10/13/2020 New for you Patient was recently hospitalized at Carepoint Hospital 10/15/2020 Diagnoses Diabetes Hospitalization Congestive heart failure Care gaps 00 Eye exam for diabetes care Endocrine and metabolic disorders Metformin Hydrochloride 1000mg tablet not picked up by patient 09/29/2020 Medications 白 60 08/22/2020 Find a service Clinical documents New clinical documents available for Diabetes diagnosis < < < Search formulary Find a service for Clover Pendleton What kind of service are you looking for? Labs Search medical lab locations Imaging Search imaging center locations More patient data DME Search durable medical equipment locations Specialists Find a cardiologist, opthamologist, Gl specialist, and more Home health Oncology care management CKD care management Complex care management Skilled nursing facilities > > > > X ← Back Find a medical lab near Clover Pendleton Location 10034 Donaldson Farms O Farm Market Hackettstown Beattystown Long Valley X Mt Dive Township Note: This slide illustrates the functionality that Clover is currently in the process of developing for the Clover Assistant. It is intended as a design concept and does not represent a screenshot of the Clover 31 Assistant in active use today. The final product may evolve and appear significantly different than what appears on this slide. X bod#31Example: The Clover Assistant & Referral Support (Cont'd) |v Visits / My list / Visit for Clover Pendleton on 10/13/2020 New for you Patient was recently hospitalized at Carepoint Hospital 10/15/2020 Diagnoses Diabetes Hospitalization Congestive heart failure Care gaps 00 Eye exam for diabetes care Endocrine and metabolic disorders Metformin Hydrochloride 1000mg tablet not picked up by patient 09/29/2020 Medications 白 60 08/22/2020 Find a service Clinical documents New clinical documents available for Diabetes diagnosis < > < Search formulary Find a service for Clover Pendleton What kind of service are you looking for? Labs Search medical lab locations Imaging Search imaging center locations More patient data DME Search durable medical equipment locations Specialists Find a cardiologist, opthamologist, Gl specialist, and more Home health Oncology care management CKD care management Complex care management Skilled nursing facilities > > > > X ← Back Find a specialist near Clover Pendleton Specialty Gastro Cardiology Gastroenterology Oncology Ophthalmology Orthopaedics Pain Management Note: This slide illustrates the functionality that Clover is currently in the process of developing for the Clover Assistant. It is intended as a design concept and does not represent a screenshot of the Clover 32 Assistant in active use today. The final product may evolve and appear significantly different than what appears on this slide. X#32Example: The Clover Assistant & Complex Care Enrollment III = C Visits / My list / Visit for Clover Pendleton on 10/13/2020 Patient eligibility * Complex care management Studies have shown that physicians are very good at identifying patients with limited life expectancy. We use this information to identify patients who might be eligible for enhanced supportive services at no charge. Would you be surprised if this patient passed away in the next 6 months? Yes, I would be surprised. No, I would NOT be surprised. This patient may be eligible for our Complex Care Management program at no cost. Patient services Complex care management Do you want Clover Health to schedule an appointment with this service? Vendor name is our preferred partner for helping patients manage their complex health situations. They have clinicians who can support your patient with more frequent home visits in addition to your own care management. Yes Next task No Find a service Patient may be eligible for additional CKD care Find a location > Search formulary ← Back Complex care management services Patient location Patient address Donaldson Farms Farm Market Hackettstown S Beattystown NEAR CLOVER PENDLETON Referral score More patient data O A Complex care management vendor name Long Valley x Mt Olive Township Preferred 4.2 ★★★★★ Care management for CKD, including dialysis sites and personal nephrologists 7 miles away X 1 results BLANDENE Note: This slide illustrates the functionality that Clover is currently in the process of developing for the Clover Assistant. It is intended as a design concept and does not represent a screenshot of the Clover 33 Assistant in active use today. The final product may evolve and appear significantly different than what appears on this slide.#33Medicare Advantage vs. Direct Contracting: Illustrative Recap Estimated Overall Benchmark Expected Revenue Gross Margin Goals Expected Operating Expenses Expected Operating Margin Medicare Advantage ~ $1,000 PMPM ~ $1,000 PMPM Long-term MCR targets of 82-83% Decreasing to ~ 11% steady state 6-7% steady state Direct Contracting N $1,000 PMPM Dependent on provider arrangements; ~5% of benchmark in Year 1 (increasing over time) + shared savings settlements Savings of 2% -15% vs. risk- adjustable benchmark Significantly less than MA TBD 34#34Financial Deep Dive#35Financial Highlights Large and growing market Significant opportunity for membership growth as the underlying market grows, we continue to penetrate existing markets, and we add new markets Aligned incentives Economic alignment with members to improve care at lower cost and with Clover Assistant physicians via fixed payment model to avoid moral hazard Predictable revenue stream High annual retention, consistent monthly payments, and visibility into future year financials Margin enhancement over time Long-term margins expected to support attractive plan designs at better-than-industry margins while maintaining better-than-industry growth Strong unit economics Favorable LTV / CAC economics that are expected to continue to enhance with margin improvements Attractive free cash flow generation Given limited capital expenditures, Adjusted EBITDA is a proxy for free cash flow 36#36Components of the Medicare Advantage P&L (1) Premium revenue +Investment & Other Income = Revenue - Medical Expenses = Gross Profit - General & administrative - Salaries & benefits - Other items Income from Operations - Interest Expense - Income taxes = Net Income Calculated from membership multiplied by monthly per member payment; payment amount varies, reflecting multiple factors at an individual level, including demographics, health status (higher revenue to care for sicker members), new vs returning MA status (new members' health status is often not available or accurately documented) Current projections include less than 1% of MA premiums Cost of health care services delivered to members (e.g., doctor visits, hospital stays, prescription drugs, etc.); typically modestly higher in 1Q and 4Q relative to 2Q and 3Q While Gross Margin is a key profitability metric, industry also looks at Medical Care Ratio (MCR) (¹) defined as Medical Expenses / Premium Revenue Includes professional and consulting fees, particularly in support of operations, sales and marketing costs, including broker commissions, software expenses, license and other overhead costs Includes cost of wages and benefits for Clover employees (including stock-based compensation) Depreciation & Amortization (minimal), other non-recurring expenses Interest Expense relates to term loan and convertible securities NOLS expected to significantly reduce tax burden through at least 2025 MCR is not a direct equivalent of the federal MLR. CMS does not regulate MCR, but does put an 85% minimum threshold on MLR. 37#37Annual Historical Financial Results (in millions) Counties Average Membership YOY Growth (%) Total Revenue YOY Growth (%) Total Medical Costs YOY Growth (%) Gross Profit Gross Margin (%) MCR, Gross Operating Expenses(3) Other Income (Expenses) 2018A Net Loss 19 31,485 $358(1) $343(2) $15 4.1% 97.1% 2019A 26 41,165 31% $462 29% $450 31% $12 2.5% 98.8% Membership growth largely driven by further market share penetration across existing markets from 11% to 13%5), but also supported by new market expansion into 7 more counties Our Medicare covered medical expenses increased by 1.2% between 2018 and 2019 as compared to 4.5% for overall Original Medicare expenses for a comparable population over the same period (6) $188 $186 ($29) ($190) ($202) ($364) Adjusted EBITDA (4) ($177) ($175) Adjusted EBITDA Margin (%) (50.1%) (38.3%) (1) (2) Represents a non-GAAP financial measure. Non-GAAP Total Revenue differs from Total Revenue on a GAAP basis by adjusting for $67mm in ceded premiums. Represents a non-GAAP financial measure. Non-GAAP Total Medical Costs differ from Total Medical Costs on a GAAP basis by adjusting for $64mm in ceded claims. Operating Expense includes Salaries and Benefits and General and Administrative Expenses per GAAP presentation (3) (4) Adjusted EBITDA is a non-GAAP financial measure defined by us as net loss before interest expense and amortization of notes and securities discounts, provision for income taxes, depreciation and amortization expense, change in fair value of warrants expense, loss (gain) on derivative, restructuring cost, stock-based compensation expense and health insurance industry fee. Adjusted EBITD Margin is defined Adjusted EBITDA divided by Gross Premium Revenue. See Reconciliation in Appendix for historical numbers. 38 (5) Reflect individual, non-SNP market of 19 markets Clover offered plans in 2018 (6) Calculated based on internal Clover data on Non-ESRD Members vs. PMPM's as published in the CMS Final 2021 Rate Announcement, Dated April 6, 2020 Operating expenses supported building the infrastructure to improve healthcare outcomes and experiences for our members, and year-over-year expenses were reduced by approximately 24% per member Increase in other expenses driven by non-cash accounting impacts relating to convertible securities issued in 2019#38Recent Historical Financial Results (in millions) Counties Average Membership Growth Q3 YTD 20 vs. Q3 YTD 19 (%) Total Revenue(¹) Growth Q3 YTD 20 vs. Q3 YTD 19 (%) Medical Costs Growth Q3 YTD 20 vs. Q3 YTD 19 (%) Gross Profit Gross Margin (%) MCR, Net Q120A 55,444 $166 $146 $20 11.6% 89.4% $50 $2 Q220A Q320A ($28) ($22) (13.2%) 56,782 $172 $120 $52 30.5% 70.1% $41 ($6) $5 57,315 $29 16.9% $169 $145 $24 14.2% 86.7% $46 $35 $13 YTD 20A 34 Operating Expenses(2) Other Income (Expenses) Net (Loss) Income Adjusted EBITDA (3) Adjusted EBITDA Margin (%) (1) Total Revenue includes Premium Revenue (Net) and Other/Investment Income. (2) Operating Expense includes Salaries and Benefits and General and Administrative Expenses per GAAP presentation (3) Adjusted EBITDA is a non-GAAP financial measure defined by us as net loss before interest expense and amortization of notes and securities discounts, provision for income taxes, depreciation and amortization expense, change in fair value of warrants expense, loss (gain) on derivative, restructuring cost, stock-based compensation expense and health insurance industry fee. Adjusted EBITD Margin is defined Adjusted EBITDA divided by Gross Premium Revenue. 39 (4) Reflect individual, non-SNP market of 19 markets Clover offered plans in 2018. ($18) (10.9%) 56,519 39% $507 46% $411 22% $96 18.9% 81.9% $137 $31 ($10) ($11) (2.2%) Membership growth supported by existing markets, with further market penetration of 2018 existing markets to 16%(4), and supported by new market expansion into 8 more counties Q1 MCR improvement from 2019 driven by impact of Clover Assistant and other key medical expense reduction initiatives Q2 MCR extraordinarily impacted by COVID-19 Q3 MCR remains slightly depressed as a result of lingering COVID impacts in July and August, but September utilization approached pre- COVID levels Approximately 29% reduction in operating expenses per member year- over-year through Q3 YTD; quarterly seasonality reflects impact of marketing and commissions in Q1 Adjusted EBITDA impacted in Q2 by full release of 2019 Premium Deficiency Reserve. Q3 differential to Net Income largely driven by Gain on Derivative, which is excluded

Download to PowerPoint

Download presentation as an editable powerpoint.

Related

Fiscal 3Q Investor Presentation image

Fiscal 3Q Investor Presentation

Healthcare

FY23 Full-Year Results Presentation image

FY23 Full-Year Results Presentation

Healthcare

Healthcare Network P&L Statement and Expansion Projects image

Healthcare Network P&L Statement and Expansion Projects

Healthcare

Accreditation and Quality Assurance Overview image

Accreditation and Quality Assurance Overview

Healthcare

Investment Highlights image

Investment Highlights

Healthcare

Investor Presentation image

Investor Presentation

Healthcare

IDEAYA Biosciences Interim IDE397 Phase 1 Clinical Data and Q1 2022 Corporate Update image

IDEAYA Biosciences Interim IDE397 Phase 1 Clinical Data and Q1 2022 Corporate Update

Healthcare

BioAtla Investor Presentation Deck image

BioAtla Investor Presentation Deck

Healthcare