Clover Health, an insurance startup trying to use data to keep customers healthy

I've left some longer comments elsewhere in this thread about the problems with typical insurers. There's a lot of low-hanging fruit out there, which many of them aren't equipped to take advantage of because of how they're structured, and don't particularly desire to take advantage of anyway. Like I said originally, a lot of insurers are content to look at the average risk, figure out a way to be profitable in spite of it, and call it a day, because the economics of Medicare Advantage have allegedly been "solved" in that sense.

The way I see it, the premise of Clover is asking what would happen if you removed the corporate-organization barriers and the organizational disinclination to do much beyond just processing claims. All those easy preventive-care wins suddenly become real options, for example. And as the insurer you have all the data to identify gaps and potential problems. For example: you know someone has a prescription because you see the pharmacy claims. And you know if they stop filling it because you stop getting claims. That's a potential problem that's easy to identify, and you have the staff to get in touch and find out what happened; maybe it's as simple as finding a pharmacy that's easier for them to get to, or a service that will pick up and deliver without requiring regular trips to the pharmacy. Sometimes it's the complexity of a particular medication regime (especially since often it just comes in the form of written instructions with little context), and clinical staff or pharmacists pharmacists take a look and come up with better explanations and adherence plans.

And really, just the easy obvious stuff is so copious that I suspect it's going to be years before we run out of it and have to worry about trying to come up with new ideas -- it's just that most insurers are not structured to take advantage even of stuff that's known to be helpful for people, so nobody's ever seen what happens when you try.

Still this is an industry entirely living off regulatory capture.

I'm not really sure what you mean by this. I'm not privy to exactly why Clover's in the Medicare space, but my inclination is that it's because Medicare provides a stable, existing and relatively well-known space to operate in, and precisely because of how it's structured and regulated it provides a few things already packaged up that you don't have to bootstrap or which aren't quite as hard to bootstrap. And although it is heavily regulated, I've seen no evidence that the regulatory structure is designed to exclude competitors or preserve existing players; for example, in January of this year, Cigna (hardly a disruptive new player) was hit with sanctions that temporarily remove their ability to enroll new members into their Medicare Advantage plans. Everything I've seen of the regulatory environment is that it's designed to ensure the safety of Medicare enrollees and to push Medicare Advantage insurers to take good care of them.