CloverHealth’s combination of data analysis and preventative care aims to reduce hospitalisation and large medical bills for the elderly and disabled

Country: USA

Year: 2014

Concept

  • Clover Health’s data driven approach collects and analyses lab data and radiology results to evaluate patients’ health and identify common issues, chronic illnesses or misuse of prescription medication
  • With the aim of reducing costly hospitalisation, nurse practitioners or social workers can visit the patient’s home for a check-up, advice, and carry out vital medical tests that may be missing from the patient’s file
  • Built on the back of MediCare Advantage, a private health insurance for persons with disabilities or those over 65 years of age that lets private insurance companies administer coverage, Clover Health has managed to double its user enrolment in just a few months
  • Currently only available in a few New Jersey counties, Clover Health has plans for nation-wide expansion which may take time due to different county and state regulations

Consumer Benefits

  • Cost reduction for patient and insurer:
    • Monitoring patient profiles from the start reduces insurance claims later on
    • Helping patients avoid hospitalisation saves Clover Health on average $10 000 per visit
    • Through a system of co-paying, on average Clover patients pay less per treatment
  • Provide preventative care:
    • Prescription follow-up: as the payer, Clover has access to prescription data and can monitor the frequency of ordered prescriptions e.g. if a patient is on a 30-day refill and hasn’t reordered in the last 35 days, Clover can intervene and provide advice
    • Reduce hospitalisation: Clover’s leverage on data has resulted in a near 50% decrease in hospital visits in the first half of 2015, according to its founder

How To Use

  • Interested users can sign up through Clover’s website

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Key takeaways

  • Data-driven health care has proven results and detects problems before they arise
  • In the fragmented US healthcare system, Clover Health aims to reverse the unsustainable, long-term spending trend
  • Regulatory hurdles will slow Clover Health’s growth and national expansion
  • By targeting vulnerable populations, Clover Health provides financial/health inclusion