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Startup Clover Health bets that improved use of data will equal better care

September 18, 2015 | By
Tools

Make way for yet another startup in the health insurance space--this time, it's a company that wants to harness claims data to improve clinical outcomes for older patients.

Previously funded solely by its founders, San Francisco-based Clover Health now has raised $100 million to pursue its mission of using technology to build clinical profiles of members, identify gaps in care and fill those gaps, Kris Gale, the company's chief technology officer, tells Tech Crunch.  

The company hopes to compete with traditional insurers in the Medicare space, which Gale says don't do enough to leverage their data. To accomplish this, Clover uses software models to automatically identify high-risk patients as well as care issues, such as medication noncompliance, and calls on social workers and nurse practitioners that it employs to intervene.

"This is info that's available to us because we're the payer," Gale says. "The doctor that prescribed gave them a piece of paper that's now on [the patient]. The doctor doesn't know if they're getting that filled unless they're asking them regularly. That's part of the data advantage."

The federal government pays Clover Health customers' Medicare premiums, and because healthier members mean lower premiums, this incentivizes Clover to improve its members' clinical outcomes, according to the article. Currently, the company is most focused on intervening with patients who have type 2 diabetes, chronic obstructive pulmonary disease and congestive heart failure, all costly conditions.

Clover Health differentiates itself from fellow health insurance startup Oscar Health because of its emphasis on the technology behind its business model, the article notes. It also targets older patients instead of the young crowd Oscar caters to. Oscar, however, just received a $32.5 million investment from Google Capital.

Another newcomer to the health insurance industry is HoneyInsured, a company started by two young Harvard graduates that operates as a broker and uses data analysis to guide health insurance plan purchases.

To learn more:
- read the article

Related Articles:
Google Capital invests $32.5M in Oscar
Startup aims to sweeten process of shopping for health insurance
Oscar Health has the funding, but now needs customers
Predictive analytics help Humana identify gaps in care

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