The formal notification to CMS, along with requisite written notices to participating physicians, marks a pivotal step in Clover’s pursuit of financial sustainability. Importantly, this decision is carefully crafted to safeguard the interests of ACO REACH beneficiaries, ensuring an uninterrupted commitment to fulfilling all obligations under the program throughout the 2023 performance year.
Andrew Toy, Clover Health’s Chief Executive Officer, (main picture) stated: “When we entered the ACO REACH business in 2021, we felt that expanding our platform to Original Medicare would have a number of benefits, including increasing the number of lives under Clover Assistant management and enabling us to rapidly increase the number of physicians we worked with directly. And, while we were successful in those goals, we have not seen a clear line to profitability in this business and it has also become quite clear that, over the same period of time, we have made far greater and swifter strides on our path to profitability in our Medicare Advantage insurance business.”
Toy continued: “We remain extremely excited about the success of our Medicare Advantage insurance business in 2023 and intend to focus our resources on building that business and continuing to invest in Clover Assistant as part of our path to profitability. We remain focused on our goal to deliver a sustainable, profitable Clover Heath to our members and investors. This is another step in that direction. As we have said previously, we continue to expect meaningful tailwinds in 2024 from a number of favorable drivers, including efficiencies from our previously announced partnership with UST HealthProof, our robust care management assets, and the continued maturation of Clover Assistant.”
He added: “Overall, this narrower focus gives us even greater optimism that Clover Health can deliver profitability on an Adjusted EBITDA basis for full-year 2024.”