After telling investors that it would more than quadruple its membership base in a year, insurance startup Clover Health is cutting its projections in half.
The insurance startup now plans to end the year with between 70,000 and 100,000 covered lives from direct contracting, a new payment program launched last by the Centers for Medicare and Medicaid (CMS) services last year, according to its most recent earnings report.
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Last year, when Clover announced plans to go public through a merger with a special-purpose acquisition company backed by “SPAC King” Chamath Palihapitiya, the company told investors it already had 200,000 direct contracting lives under contract for 2021, according to a slide deck.
But its projections call into question the veracity of those shared when the company was looking to go public. In fact, Kevin Fischbeck, an analyst with Bank of America, called out the discrepancy when he asked the company about estimates that it would have nearly half-a-million members covered through direct contracting by 2023.
Clover could only manage a feeble response, with CFO Joe Wagner saying it was “too early to say in future years exactly where we’re going to end up.”
It’s not the only big question that Clover faces about its future. After a scathing report from a short-seller earlier this year, the startup confirmed it had received a request for information from the Department of Justice, which it hadn’t disclosed previously. A day later, the company received notice of an investigation from the Securities and Exchange Commission.
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When asked about the current status of the investigation, co-founder and CEO Vivek Garipalli said it was the company’s policy not to comment on pending inquiries.
In an unusual move, the company fielded questions from Reddit during the investor call, alongside those from analysts.
Clover is one of 53 companies selected to participate in CMS’ direct contracting programs in 2021. The value-based payment models were created under the previous administration, which would allow the startup to strike contracts with doctors who are caring for patients under the traditional Medicare program and manage their care.
Under the new administration, CMS has stopped taking applications for the new direct contracting models, which are slated to launch next year. It also paused the rollout of an alternative model that would tie payments to the population health and cost outcomes for all residents of a specific location.
In the meantime, most of Clover’s business still comes from its Medicare Advantage plans, where it has 66,300 members, an 18% increase year-over-year. It brought in $200.3 million in revenue in the first quarter, up 21%, but its net loss jumped more than 70% to $48.4 million.
The company also decreased its revenue projections from what it originally told investors last year. The startup said it expects to bring in revenue of $810 million to $830 million by the end of 2021, a decrease from its previous projections of $880 million. A small portion of that, just $20 million to $30 million, would come from direct contracting.
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