San Francisco-based Medicare Advantage health plan Clover Health has developed an innovative in-home primary care program which incorporates genomic testing as a way to reduce hospital readmissions and improve care outcomes.
The 550-person company, which was founded in 2013, has raised $425 million as part of its effort to insure Medicare Advantage patients using data science as a way to cut costs and promote preventative care.
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It’s well known that a small segment of Medicare beneficiaries drive a large portion of the programs cost, specifically those with complex and chronic conditions. Clover’s in-home care primary care program is an effort to reduce hospital admissions and provide more continuous care through personal check-ins, active monitoring and home-based lab and radiological testing.
According to Clover Health CTO Andrew Toy, instead of relying on dated actuarial tables, the company can use their proprietary machine learning model to determine which patients should be included in the program, which is voluntary and offered at no additional cost to members.
“The way I feel about this as a technologist is if we are able to narrow our targeting, we can deploy much more expensive programs to certain high-risk populations and that will lead to better outcomes,” Toy said in a phone interview.
Care is mainly provided by a physician-led team of Clover Health clinicians consisting of PCPs, nurses, social workers, medical assistants and care coordinators. Currently Clover’s in-home primary care program has 760 enrolled patients.
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The new initiative is buoyed by a partnership with Seattle-based genomics company YouScript, which takes a precision medicine approach to medication by using patient genomic data to adjust dosage and prescriptions to prevent negative side effects and adverse interactions.
“YouScript’s technology simulates a team of clinical pharmacists delivering evidence-based guidance in real time, and this in-home program validates our impact at scale,” YouScript CEO Kristine Ashcraft said in a statement. “We are excited to work with Clover Health, to provide the tools necessary to identify and positively impact the most at-risk patients, while bending the healthcare cost curve.”
The idea of using genomic data in care decisions can leave some patients squeamish, but Toy said the company frames its use of the information around improving care and outcomes.
According to Clover around 90 percent of the patients approached to do pharmacogenomic testing have agreed to it
“We’re not going to use gene testing everywhere. We orient ourselves toward care so if you have a metabolic disorder that leads to adverse effects, how do we solve that problem?” Toy said. “Part of our role is the allocation of capital so wherever we allocate a Medicare dollar, we ask the question of whether it’s having an effect and whether it’s being put to good use.”
Medicare Advantage is a growth market for the healthcare industry, with enrollment expected to increase 8 percent year-over-year nationwide. That potential has led to increased competition in the space from upstarts like Oscar Health, Devoted Health and Bright Health, as well as established payers like UnitedHealthcare and Anthem.
Recently Clover Health announced its intention to expand to a number of new markets in 2019 to boost its 30,000-person membership base in Georgia, New Jersey, Pennsylvania and Texas.
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