Clover Health Investor Day Presentation Deck slide image

Clover Health Investor Day Presentation Deck

Direct 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
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