Report sheds light on Clover Health’s financial struggles, strategy missteps


https://www.fiercehealthcare.com/payer/clover-health-struggles-lab-bills-medicare-advantage-members?mkt_tok=eyJpIjoiWVRNeE1HSTFPREkwTmpsbSIsInQiOiJtcHFUTmw4bU5UWE0rbE44Q0ExcUc5cEI5SSt0UVdcL0ZYVDllbUhMN3VNXC9ab2JTTlwvKzVYOXMyTmVmRlwvZjJ2VzNZWmp5Z2VJeERzVytyWUZOdkVyRmdnVWNWSEV6SVhkSWVHSFljSkhRV05rMUt5WFwvemVvM2dsMEpUeW1rYUx2In0%3D&mrkid=959610

Clover Health, the Medicare Advantage startup with a data-driven strategy, is struggling financially and operationally—and in some cases, members have paid the price.

Such is the conclusion of a new report from CNBC, which relied on interviews with six anonymous former Clover employees and advisers. Here are some highlights of what they told the publication:

  • To obtain leverage over LabCorp and Quest Diagnostics in its bid to collect patient data, Clover delayed paying bills for its members’ lab tests. Some members were then “harassed with bills” from the labs—though Clover eventually paid the lab bills after learning the full extent of the issue.
  • Clover has missed its internal financial targets and other growth goals. For example, while an investor said the company predicted early on that it would book $500 million in revenue from premiums by the end of 2017, a PwC analysis found that its annual revenue is actually closer to $270 million. Its membership growth has also fallen well short of its early projections.
  • The insurer experienced a bug in one of its core software projects, which was supposed to create a list of members ranked from sickest to healthiest to call and remind about getting an annual checkup. The glitch reversed the list, resulting in Clover representatives calling the healthiest members first for several months.
  • Marco Rogers, a former senior engineer at Clover, stirred controversy online when he discussed the company’s approach to people of color. In a series of now-deleted tweets, Rogers said he was “passive aggressively pushed out by people who found me ‘adversarial.’”

Clover Health declined to comment about the claims made by CNBC’s sources. However, those are not the only struggles that Clover has had, according to previous reporting by FierceHealthcare. In 2016, the Centers for Medicare & Medicaid Services fined the company after receiving a “high volume of complaints” from new enrollees who were denied services by out-of-network providers after being told by Clover that they could see any provider they wished.

And last month, Clover co-founder and Chief Technology Officer Kris Gale stepped down from his post. Gale, who remains an adviser for the company, helped “build a foundation from which we can realize the true potential of this business,” Clover Health CEO Vivek Garipalli said in a previous statement.

However, Clover’s vision for using data analytics to disrupt the health insurance industry has won the San Francisco-based company a significant amount of investment capital. In a funding round in May, it raised $130 million, putting its total value at $1.2 billion. The insurer also began serving Medicare customers in Georgia, Texas and Pennsylvania in 2018, a significant expansion since it previously sold plans in only New Jersey.

 

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