Clover Health Investor Day Presentation Deck
Direct Contracting Expected Economics
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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
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