Insurtech Insights
Knowing when to scale your insurtech startup – Interview with Andrew Toy, CTO at Clover Health
Knowing when to scale your insurtech startup – Interview with Andrew Toy, CTO at Clover Health
In August of 2021, we interviewed Andrew Toy (President, CTO and Board Member at Clover Health) and here’s what he had to say to our Future50.

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ITI: When you were setting up Clover Health, what were the central problems that you were looking to solve?
Andrew: Generally, in healthcare, incentives aren’t aligned across providers, payors and most importantly, consumers. Put another way, business value doesn’t correlate with consumer value; and the entire value chain doesn’t line up properly. This disproportionately impacts the uninsured, underinsured, and individuals facing greater challenges from social determinants of health.
 
At Clover, we never had the goal of simply building a better insurance company. Rather, the health insurance mechanism is a tool we can use to solve one of the biggest problems in healthcare – the misalignment of financial incentives and patient outcomes – and it provides us with a business model that would benefit from solving that problem. Put another way, we realized early on that the best way to fix healthcare is from within. Health insurers have exceptional leverage and access to data, which gives them an outsized ability to shape how the broader healthcare system works. Insurance is where the power is, and we want to take that power and put it back in the hands of patients and physicians.
 
 
 
ITI: How is the insurance market different now to when you were at Series A?
Andrew: The Medicare Advantage market has grown rapidly over the last several years. When we started Clover in 2014, 30% of people on Medicare were enrolled in a Medicare Advantage plan, according to data from the Centers for Medicare and Medicaid Services (CMS). According to a report from Better Medicare Alliance, as of March 2021, 42% of all Medicare beneficiaries were enrolled in a Medicare Advantage plan – that’s 26.5 million Americans – and it’s expected to increase to more than 50% of the total Medicare market by 2030. Unsurprisingly, there’s also been an explosion of new entrants in the space. From insurers to healthcare exchanges, the number of available Medicare Advantage plans is higher than ever before. According to medicareresources.org, there are now approximately 3,550 plans available nationwide.
 
Unsurprisingly, there’s also been an explosion of new entrants in the space. From insurers to healthcare exchanges, the number of available Medicare Advantage plans is higher than ever before. According to medicareresources.org, there are now approximately 3,550 plans available nationwide.
 
 
ITI: What advice did you wish you had when your company was at an early stage?

Andrew: Make sure you deeply understand the business models of your customers. So often, what kills companies in this space is the lack of comprehension around where their revenue will come from. You have to understand how your customers make money to become a valuable component of the ecosystem.

That’s why, instead of staying at my last role at Google and working on healthcare there, I’m building technology within an insurance company. I believe we can truly leverage technology to its full potential to help all our members get better outcomes and lower costs, without having to worry about sales cycles or software licensing revenues. 


This interview was featured as part of our Future50 Americas book, uncovering the  50 insurtech unicorns of the future. See them all here. 
 

I’m convinced that the Clover Assistant – our proprietary technology platform that we give to primary care physicians for free to aid in clinical decision-making – wouldn’t function outside of an insurer (Clover). Providers wouldn’t pay for it, the IT departments in hospitals wouldn’t understand the value of it, and other insurers tend to be more focused on trying to offload medical risk than on actual clinical technology. Our entire model is constructed the way it is because, again, we understand the intricacies of the system and the needs of every player in it.

The result of our approach? Clover allows me to make technology designed to create action and improved decisions by physicians every day, which I believe will ultimately lead to better health outcomes and lower costs for our members.

 

ITI: What was the most difficult decision that you have had to make while growing the company?

Andrew: Deciding when to scale. Every Series A company will have to cross the bridge at one point or another, and the decision can make or break you. It’s very tempting to scale your company based on funding and opportunity versus maintaining discipline and being data-driven and thoughtful about what’s working and what’s not.

 
ITI: How do you know when your company is ready to scale up to the next level?

Andrew: Once you’ve found product-market fit, the market almost sucks you into scaling, whether or not you feel prepared to do so. You know your company is ready to scale when it feels like you’re being forced to scale faster than feels comfortable.

If you’re trying to convince others, or even yourself, that you should scale, it means you haven’t found product-market fit yet.


ITI: What would be your central piece of advice to our Future50 founders?

Andrew: Believing what other founders tell you about how well their company is doing is like believing that every photo you see on Instagram is a true reflection of that person’s life. These stories are almost always exaggerated to keep morale up, and should never make you feel like you’re falling behind or that they know what they’re doing more than you. Remember what your goals are, stay true to your mission and ignore the noise.

 
About Clover Health

Clover Health (Nasdaq: CLOV) is an innovative technology company and next-generation risk-bearing organization aiming to achieve health equity for all Americans. While their mission is to improve every life, they particularly focus on seniors who have historically lacked access to affordable high quality healthcare.

They aim to provide great care, in a sustainable way, by having a business model built around improving medical outcomes and lowering avoidable costs. Clover Health takes a holistic approach to understanding the health needs and social risk factors of their customers. This strategy is underpinned by the company’s proprietary software platform, the Clover Assistant, which is designed to aggregate patient data from across the health ecosystem to support clinical decision-making by providing physicians with real-time, personalized recommendations at the point of care. Clover offers two models of care: affordable Medicare Advantage plans with extensive benefits; and care coordination for Original Medicare beneficiaries through Direct Contracting.

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