Uncle Sam pays Clover a monthly fee for each Medicare Advantage customer the startup enrolls. The amount varies depending on where the person lives, but it averages $850 before adjusting for chronic conditions or healthy habits, the Medicare Rights Center says. Clover uses the money to pay members’ bills and generates almost all its revenue from whatever is left over after reimbursing doctors, hospitals, labs, pharma…
(I work at Clover) As a 23 year old I'm not sure if this is any different than what big insurance co's do for their Medicare enrollees. The difference is most insurers would say something like "OK, out of X thousand Medicare-age people, Y of them will have this expensive health problem over the next year, are we profitable when that happens?". We say "OK, how can we identify the people most at risk of that and use pr…
Clover Health, an insurance startup trying to use data to keep customers healthy
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Re: Clover Health, an insurance startup trying to use data to keep customers healthy
#12Uncle Sam pays Clover a monthly fee for each Medicare Advantage customer the startup enrolls. The amount varies depending on where the person lives, but it averages $850 before adjusting for chronic conditions or healthy habits, the Medicare Rights Center says. Clover uses the money to pay members’ bills and generates almost all its revenue from whatever is left over after reimbursing doctors, hospitals, labs, pharma…
For example, if the deductible was $6700, a 6 day hospital stay would cost $6700 out of pocket. Because it is a $290 per day co-pay, it will cost $1740 out of pocket. There is a tidy difference there.
Re: Clover Health, an insurance startup trying to use data to keep customers healthy
#13Earlier quoted context omitted.
(I work at Clover) As a 23 year old I'm not sure if this is any different than what big insurance co's do for their Medicare enrollees. The difference is most insurers would say something like "OK, out of X thousand Medicare-age people, Y of them will have this expensive health problem over the next year, are we profitable when that happens?". We say "OK, how can we identify the people most at risk of that and use pr…
Every health plan has been doing this for years. They too have treasure troves of data... they have care coordinators, patient centered medical homes, etc. So, how are you actually trying to change the statistics?
I processed insurance claims for over five years and that was not my observation. Granted, it was one company, I processed accident claims and it was supplemental coverage. But when I was there, I was initially encouraged by the trend towards adding "wellness benefits" because I had naïve fantasies this meant they were working towards getting people healthier.
Nope. It was entirely about "If we offer specific tests and call them wellness benefits, we have higher retention."
That was it. There was zero interest in actually making customers healthier. And I was horrified and I am pretty cynical these days.
So, I guess, I am wondering if you have supporting evidence? (Links to articles, stats, etc?)
Re: Clover Health, an insurance startup trying to use data to keep customers healthy
#14Let's take the Type 2 diabetes example given in the article.
No mention is made of putting a Continuous Glucose Monitor on the 83-year old patient, to graphically show in real time the impact white rice has upon her blood sugar.
No mention is made of five additional antibodies tests to identify Latent Autoimmune Diabetes in Adults (LADA), which looks a lot like Type 2 in its early stages, but likely needs to be treated as Type 1 as early as feasible according to some very recent research.
No mention is made of regular tracking of her HbA1c, fructosamine (gives a 14-day instead of ~115 day window into long-term blood sugar management), and 1,5-anhydroglucitol (indicates time spent with hyperglycemia).
Not to speak of doing those three areas on a regular, monthly/quarterly basis. It is very rare in the US to do all of that even on an annual basis; at best, the common practice is HbA1c once a year. While metabolic syndrome leading to diabetes is a huge drain on US insurers, aggressive data-led syndrome reversion is de facto not recognized by either the mainstream medical field nor insurance industry.
There is lots more data they could gather than what I mentioned here, but all they did instead was suggest "try to eat brown instead of white rice". She should try not eat rice (and other carb-heavy food) at all for a month, and see if that improves her blood sugar numbers. While the fitness community has already empirically identified that diet is 90% of success unless you are a genetic anomaly, the food, medical and insurance industries still push the idea upon patients they need to go out and exercise more, and only tinker around the edges of their diets (unless you are fasting/caloric-restricting, going very low-carb, going vegetarian, going raw food, etc., most Americans idea of a diet change by adding a couple salads a week, picking "low fat" packaged food and so on is just tinkering).
This doesn't even get into monitoring controlled changes in habits, measuring the impact upon the data, and using those results to guide further changes. Nor have we even touched upon the lack of incentives in the US for companies seeking to "disrupt" medicine through holistic, integrated process changes instead of "product" like pharma or medical devices: if company X can provably intake Y number of customers with say, metabolic syndrome or even Type 2 diabetes, and achieve a reversion rate of Z% with negligible (<5%) backsliding 5+ years out from date of reversion, monetizing that proprietary process is limited to either being a provider (in which case you're squeezed by the insurance companies with take-it-or-leave-it negotiations) or an insurer (in which case you're too spread out covering other ailments to really capitalize upon the proprietary knowledge). I suspect the lack of incentive structures is similar in nations with national health plans.
Re: Clover Health, an insurance startup trying to use data to keep customers healthy
#15What we need to see is the ability for the patients to be able to own and transfer that data ( like a Google takeout ).
Re: Clover Health, an insurance startup trying to use data to keep customers healthy
#16This orientation towards data is admirable, but likely is an impossibly uphill climb without a corresponding emphasis upon expanding collected types of data. Which is expensive. And is why US insurance companies---who pay for this kind of data out of tests---won't be leading the charge towards a data-centric or Big-Data-centric health outcomes evolution in the medical field. The mainstream medical field has not yet r…
Are there any papers / data-sets that demonstrate this? If so, could you share here or at my email (see profile)? Would be greatly appreciated it. It's been my hunch this is true, but haven't seen the evidence for it.
Re: Clover Health, an insurance startup trying to use data to keep customers healthy
#17Earlier quoted context omitted.
(I work at Clover) As a 23 year old I'm not sure if this is any different than what big insurance co's do for their Medicare enrollees. The difference is most insurers would say something like "OK, out of X thousand Medicare-age people, Y of them will have this expensive health problem over the next year, are we profitable when that happens?". We say "OK, how can we identify the people most at risk of that and use pr…
Every health plan has been doing this for years. They too have treasure troves of data... they have care coordinators, patient centered medical homes, etc. So, how are you actually trying to change the statistics?
Also most insurance companies aren't really set up to do preventive work to the extent we do (which involves home visits from nurses and other clinical staff, staying in touch and proactively reaching out when there seem to be problems, etc. etc.), largely because they consist of essentially competing divisions which each own a subset of the data and responsibilities and jealously guard against every other division. I worked in a company like that, once upon a time -- everyone had very clearly-defined limits to their responsibilities (well beyond what privacy rules required) and even just contacting someone in a different department to make them aware of a problem or pass along a suggestion would trigger turf-war consequences.
I'm very happy to now be working with the opposite of that.
Finally, it's worth noting that although there are a lot of dismissive comments about tech in this thread (and some of it I can understand -- most of what we do is internal-facing and harder to promote as a result), the perspective inside is pretty different. It's true there's not a ton we're doing that's cutting edge and "sexy" tech (though we have open-sourced some neat tools for temporalizing SQLAlchemy's ORM), but that's because health care hasn't yet caught up to just the boring everyday things we take for granted.
There's an example that really drove it home for me, from about six months ago. Claims are obviously a big part of what we're about, and so we have an internal team that reviews processed claims for accuracy. They have to check against a pretty complex set of Medicare claim-processing rules, part of which involves rules about combinations of medical procedures (i.e., Procedure A might be allowed but only if alongside Procedure B, or A might only be allowed without B, or A and B might just be independent and can both appear or not appear). The canonical source for that data is... gigantic Excel spreadsheets of all the procedure codes and rules. And so the claims-review team would open up Excel, type in a code, wait five minutes while it churned to find the code, then repeat for the next code, etc.
An engineer saw this and spun up a two-day project to ingest those spreadsheets (on an ongoing basis, since they change over time) into a database and wrap a search interface around them which allowed punching in all the codes and getting back a list of rules and an indicator of whether they'd been violated.
To tech people that's so mundane it almost puts you to sleep, and makes you say "wait, that's it?". But to healthcare people, it was a gigantic step forward. So many people from health backgrounds came from places that never let them work side-by-side with tech staff and figure out what was possible (or where all tech was outsourced to vendors with opaque planning and feature-request processes), which is why so much of healthcare tech feels decades out of date.
So just having tech and medical/insurance people in the same room, working and talking together every day, acts as a pretty impressive multiplier compared to traditional insurance companies.
Re: Clover Health, an insurance startup trying to use data to keep customers healthy
#18This orientation towards data is admirable, but likely is an impossibly uphill climb without a corresponding emphasis upon expanding collected types of data. Which is expensive. And is why US insurance companies---who pay for this kind of data out of tests---won't be leading the charge towards a data-centric or Big-Data-centric health outcomes evolution in the medical field. The mainstream medical field has not yet r…
Most of the tests you mention above are wasteful for your typical Medicare Advantage enrollee. There's a ton of low hanging fruit for a start-up like Clover to make a meaningful impact. Trying to change human behavior through diet or exercise is incredibly difficult, especially for those from disadvantaged communities or of lower socioeconomic status. Kudos to Clover to trying to make a marginal impact on that front; most insurance plans wouldn't do anything.
Re: Clover Health, an insurance startup trying to use data to keep customers healthy
#19This orientation towards data is admirable, but likely is an impossibly uphill climb without a corresponding emphasis upon expanding collected types of data. Which is expensive. And is why US insurance companies---who pay for this kind of data out of tests---won't be leading the charge towards a data-centric or Big-Data-centric health outcomes evolution in the medical field. The mainstream medical field has not yet r…
You might want to take care here -- to be honest I don't know all the things we do in home visits for diabetes assessment (though I am working a few desks over from the person building the next version of our diabetes assessment, so I could find out but then I'm unsure whether I can publicly detail the whole thing), but I'm pretty sure no matter how many things there are, an article like this one isn't going to go into enough deep medical detail to satisfy you :)
Re: Clover Health, an insurance startup trying to use data to keep customers healthy
#20Earlier quoted context omitted.
Every health plan has been doing this for years. They too have treasure troves of data... they have care coordinators, patient centered medical homes, etc. So, how are you actually trying to change the statistics?
This isn't my first insurance company. The typical experience in insurance is that those tools mostly only come out once someone already has the expensive problem, and are used to manage the cost of it after the fact, rather than prevent it from happening in the first place. Also most insurance companies aren't really set up to do preventive work to the extent we do (which involves home visits from nurses and other c…
What you are doing is far more interesting. It was pretty obvious that there is a lot one can do with data, assuming you can deal with the HIPAA limitations. One ill person is hard to get much from, but 10000 is different story.