6 ms·

Clover Health, an insurance startup trying to use data to keep customers healthy

84 points by daddy_drank 10y ago

gmarx 10y ago
Poor article. The first example they give (trying to reduce the risk of developing diabetes in an 83 yo by switching her to brown rice) is stupid, wishful thinking. Then several paragraphs which could be shortened to "they use data to improve patient outcomes". Finally towards the middle they mention some good examples of data driven interventions. Looks like a promising company if you skip most of the article :)
bkudria 10y ago
Our Tech blog has some more in-depth dives into what we do and how: https://technology.cloverhealth.com/ https://technology.cloverhealth.com/
- mtw 10y ago
  I skimmed through the posts but apart from the website that uses Django and marketing that needs analytics, it's not clear how you use tech? I was hoping there would be insights or code on the "inputs/outcomes" seen on the title I'm doing http://outcomereference.com/ http://outcomereference.com/ so i'm esp. interested in this
tcbawo 10y ago
I hope that we see technology and analysis used to improve outcomes rather than to screen or filter the customer pool. I worry that this will happen without protections in place.
- bkudria 10y ago
  One of the nice benefits of being a Medicare Advantage provider is that there is a set comprehensive of member-oriented regulations and protections in place that force us to benefits the member. In this case, the government pays us on a risk-adjusted basis (based on CMS-set risk-adjustment factors.) We are therefore incentivized to comprehensively collect and document every member's risk, so that we are able to manage their medical expenses. (Also worth noting: we are required by law to spend 85% of our payments directly on member care.)
roymurdock 10y ago
Uncle Sam pays Clover a monthly fee for each Medicare Advantage customer the startup enrolls. The amount varies depending on where the person lives, but it averages $850 before adjusting for chronic conditions or healthy habits, the Medicare Rights Center says. Clover uses the money to pay members’ bills and generates almost all its revenue from whatever is left over after reimbursing doctors, hospitals, labs, pharmacies and other points of care. The company offers plans with no monthly premiums or ones that go as high as $225. Clover says the amount it gets from those payments and copays isn’t significant. So it sounds like the company's biz model is to send nurses out in the field to get senior citizens to enroll in Medicare, check up on them and collect data, and sell them healthy lifestyle products (gym memberships, cooking classes, etc.). As a 23 year old I'm not sure if this is any different than what big insurance co's do for their Medicare enrollees. The actual tech part seems to be the web portal/CMS (Django) and the storage and management of this tangential customer data that is generated with each visit: Clover uses Python for all of our backend coding so using a pipeline orchestration tool that is itself written in Python is valuable for us. Airflow meets that requirement and it’s the tool we’ve chosen to manage all of our pipelines. Here's the actual coverage sheet if you want to compare with your/your parent's plans: https://cdn.cloverhealth.com/filer_public/c4/a8/c4a894d0-000e-47b8-873e-92bd323db9bb/benefitssummary_carepointplan_2017.pdf https://cdn.cloverhealth.com/filer_public/c4/a8/c4a894d0-000... Deductibles (excluding prescription drugs) are $6,700 annually. Someone maxing out prescription charges would spend an additional $5,000 per year. I'm not sure how that compares to a traditional provider. Tangentially: I think we've almost stretched the definition of the word "startup" into oblivion at this point. It doesn't mean anything to me anymore.
- ubernostrum 10y ago
  (I work at Clover) As a 23 year old I'm not sure if this is any different than what big insurance co's do for their Medicare enrollees. The difference is most insurers would say something like "OK, out of X thousand Medicare-age people, Y of them will have this expensive health problem over the next year, are we profitable when that happens?". We say "OK, how can we identify the people most at risk of that and use preventive care to head it off?" So while most insurers just take the statistics as a given and budget for it, we're trying to change the statistics. storage and management of this tangential customer data I think you vastly underestimate how much low-hanging fruit there is in this field, and how difficult getting and maintaining good data (so you can find the things you can do) really is :)
dr_ 10y ago
Interesting but they are not the only ones doing this. United and aetna are collecting data as well, and also employ nurses that follow patients into their homes or other settings. The data operation is what is emphasized in this article, but it really remains to be seen how much the data can have an impact on people's overall health - preventing hospitalizations, making sure patients take their medications etc. maybe it can guide clover and let them determine where to allocate manpower - but in the end it's still the manpower that matters. from my experience, a lot of it depends on having the right family, and perhaps community, support structure in place.
john_gaucho 10y ago
I'm very interested / concerned about what is going to happen to the insurance industry as companies get more and more data about their clients. I'm a fairly healthy person (at least right now), and I'm not sure how I feel about it.
foolinaround 10y ago
What we need to see is the ability for the patients to be able to own and transfer that data ( like a Google takeout ).
- demolish 10y ago
  not sure that would work really - could lead to falsified medical records to claim from state/drug abuse/(falsely) claiming mental illness in an attempt to absolve people of crimes in court etc
yourapostasy 10y ago
This orientation towards data is admirable, but likely is an impossibly uphill climb without a corresponding emphasis upon expanding collected types of data. Which is expensive. And is why US insurance companies---who pay for this kind of data out of tests---won't be leading the charge towards a data-centric or Big-Data-centric health outcomes evolution in the medical field. The mainstream medical field has not yet recognized the possibilities, either. Let's take the Type 2 diabetes example given in the article. No mention is made of putting a Continuous Glucose Monitor on the 83-year old patient, to graphically show in real time the impact white rice has upon her blood sugar. No mention is made of five additional antibodies tests to identify Latent Autoimmune Diabetes in Adults (LADA), which looks a lot like Type 2 in its early stages, but likely needs to be treated as Type 1 as early as feasible according to some very recent research. No mention is made of regular tracking of her HbA1c, fructosamine (gives a 14-day instead of ~115 day window into long-term blood sugar management), and 1,5-anhydroglucitol (indicates time spent with hyperglycemia). Not to speak of doing those three areas on a regular, monthly/quarterly basis. It is very rare in the US to do all of that even on an annual basis; at best, the common practice is HbA1c once a year. While metabolic syndrome leading to diabetes is a huge drain on US insurers, aggressive data-led syndrome reversion is de facto not recognized by either the mainstream medical field nor insurance industry. There is lots more data they could gather than what I mentioned here, but all they did instead was suggest "try to eat brown instead of white rice". She should try not eat rice (and other carb-heavy food) at all for a month, and see if that improves her blood sugar numbers. While the fitness community has already empirically identified that diet is 90% of success unless you are a genetic anomaly, the food, medical and insurance industries still push the idea upon patients they need to go out and exercise more, and only tinker around the edges of their diets (unless you are fasting/caloric-restricting, going very low-carb, going vegetarian, going raw food, etc., most Americans idea of a diet change by adding a couple salads a week, picking "low fat" packaged food and so on is just tinkering). This doesn't even get into monitoring controlled changes in habits, measuring the impact upon the data, and using those results to guide further changes. Nor have we even touched upon the lack of incentives in the US for companies seeking to "disrupt" medicine through holistic, integrated process changes instead of "product" like pharma or medical devices: if company X can provably intake Y number of customers with say, metabolic syndrome or even Type 2 diabetes, and achieve a reversion rate of Z% with negligible (<5%) backsliding 5+ years out from date of reversion, monetizing that proprietary process is limited to either being a provider (in which case you're squeezed by the insurance companies with take-it-or-leave-it negotiations) or an insurer (in which case you're too spread out covering other ailments to really capitalize upon the proprietary knowledge). I suspect the lack of incentive structures is similar in nations with national health plans.

84 points by daddy_drank 10y ago

gmarx 10y ago

Poor article. The first example they give (trying to reduce the risk of developing diabetes in an 83 yo by switching her to brown rice) is stupid, wishful thinking. Then several paragraphs which could be shortened to "they use data to improve patient outcomes". Finally towards the middle they mention some good examples of data driven interventions. Looks like a promising company if you skip most of the article :)

bkudria 10y ago

Our Tech blog has some more in-depth dives into what we do and how: https://technology.cloverhealth.com/ https://technology.cloverhealth.com/

mtw 10y ago
I skimmed through the posts but apart from the website that uses Django and marketing that needs analytics, it's not clear how you use tech? I was hoping there would be insights or code on the "inputs/outcomes" seen on the title I'm doing http://outcomereference.com/ http://outcomereference.com/ so i'm esp. interested in this

tcbawo 10y ago

I hope that we see technology and analysis used to improve outcomes rather than to screen or filter the customer pool. I worry that this will happen without protections in place.

bkudria 10y ago
One of the nice benefits of being a Medicare Advantage provider is that there is a set comprehensive of member-oriented regulations and protections in place that force us to benefits the member. In this case, the government pays us on a risk-adjusted basis (based on CMS-set risk-adjustment factors.) We are therefore incentivized to comprehensively collect and document every member's risk, so that we are able to manage their medical expenses. (Also worth noting: we are required by law to spend 85% of our payments directly on member care.)

roymurdock 10y ago

Uncle Sam pays Clover a monthly fee for each Medicare Advantage customer the startup enrolls. The amount varies depending on where the person lives, but it averages $850 before adjusting for chronic conditions or healthy habits, the Medicare Rights Center says. Clover uses the money to pay members’ bills and generates almost all its revenue from whatever is left over after reimbursing doctors, hospitals, labs, pharmacies and other points of care. The company offers plans with no monthly premiums or ones that go as high as $225. Clover says the amount it gets from those payments and copays isn’t significant. So it sounds like the company's biz model is to send nurses out in the field to get senior citizens to enroll in Medicare, check up on them and collect data, and sell them healthy lifestyle products (gym memberships, cooking classes, etc.). As a 23 year old I'm not sure if this is any different than what big insurance co's do for their Medicare enrollees. The actual tech part seems to be the web portal/CMS (Django) and the storage and management of this tangential customer data that is generated with each visit: Clover uses Python for all of our backend coding so using a pipeline orchestration tool that is itself written in Python is valuable for us. Airflow meets that requirement and it’s the tool we’ve chosen to manage all of our pipelines. Here's the actual coverage sheet if you want to compare with your/your parent's plans: https://cdn.cloverhealth.com/filer_public/c4/a8/c4a894d0-000e-47b8-873e-92bd323db9bb/benefitssummary_carepointplan_2017.pdf https://cdn.cloverhealth.com/filer_public/c4/a8/c4a894d0-000... Deductibles (excluding prescription drugs) are $6,700 annually. Someone maxing out prescription charges would spend an additional $5,000 per year. I'm not sure how that compares to a traditional provider. Tangentially: I think we've almost stretched the definition of the word "startup" into oblivion at this point. It doesn't mean anything to me anymore.

ubernostrum 10y ago
(I work at Clover) As a 23 year old I'm not sure if this is any different than what big insurance co's do for their Medicare enrollees. The difference is most insurers would say something like "OK, out of X thousand Medicare-age people, Y of them will have this expensive health problem over the next year, are we profitable when that happens?". We say "OK, how can we identify the people most at risk of that and use preventive care to head it off?" So while most insurers just take the statistics as a given and budget for it, we're trying to change the statistics. storage and management of this tangential customer data I think you vastly underestimate how much low-hanging fruit there is in this field, and how difficult getting and maintaining good data (so you can find the things you can do) really is :)

dr_ 10y ago

Interesting but they are not the only ones doing this. United and aetna are collecting data as well, and also employ nurses that follow patients into their homes or other settings. The data operation is what is emphasized in this article, but it really remains to be seen how much the data can have an impact on people's overall health - preventing hospitalizations, making sure patients take their medications etc. maybe it can guide clover and let them determine where to allocate manpower - but in the end it's still the manpower that matters. from my experience, a lot of it depends on having the right family, and perhaps community, support structure in place.

john_gaucho 10y ago

I'm very interested / concerned about what is going to happen to the insurance industry as companies get more and more data about their clients. I'm a fairly healthy person (at least right now), and I'm not sure how I feel about it.

foolinaround 10y ago

What we need to see is the ability for the patients to be able to own and transfer that data ( like a Google takeout ).

demolish 10y ago
not sure that would work really - could lead to falsified medical records to claim from state/drug abuse/(falsely) claiming mental illness in an attempt to absolve people of crimes in court etc

yourapostasy 10y ago

This orientation towards data is admirable, but likely is an impossibly uphill climb without a corresponding emphasis upon expanding collected types of data. Which is expensive. And is why US insurance companies---who pay for this kind of data out of tests---won't be leading the charge towards a data-centric or Big-Data-centric health outcomes evolution in the medical field. The mainstream medical field has not yet recognized the possibilities, either. Let's take the Type 2 diabetes example given in the article. No mention is made of putting a Continuous Glucose Monitor on the 83-year old patient, to graphically show in real time the impact white rice has upon her blood sugar. No mention is made of five additional antibodies tests to identify Latent Autoimmune Diabetes in Adults (LADA), which looks a lot like Type 2 in its early stages, but likely needs to be treated as Type 1 as early as feasible according to some very recent research. No mention is made of regular tracking of her HbA1c, fructosamine (gives a 14-day instead of ~115 day window into long-term blood sugar management), and 1,5-anhydroglucitol (indicates time spent with hyperglycemia). Not to speak of doing those three areas on a regular, monthly/quarterly basis. It is very rare in the US to do all of that even on an annual basis; at best, the common practice is HbA1c once a year. While metabolic syndrome leading to diabetes is a huge drain on US insurers, aggressive data-led syndrome reversion is de facto not recognized by either the mainstream medical field nor insurance industry. There is lots more data they could gather than what I mentioned here, but all they did instead was suggest "try to eat brown instead of white rice". She should try not eat rice (and other carb-heavy food) at all for a month, and see if that improves her blood sugar numbers. While the fitness community has already empirically identified that diet is 90% of success unless you are a genetic anomaly, the food, medical and insurance industries still push the idea upon patients they need to go out and exercise more, and only tinker around the edges of their diets (unless you are fasting/caloric-restricting, going very low-carb, going vegetarian, going raw food, etc., most Americans idea of a diet change by adding a couple salads a week, picking "low fat" packaged food and so on is just tinkering). This doesn't even get into monitoring controlled changes in habits, measuring the impact upon the data, and using those results to guide further changes. Nor have we even touched upon the lack of incentives in the US for companies seeking to "disrupt" medicine through holistic, integrated process changes instead of "product" like pharma or medical devices: if company X can provably intake Y number of customers with say, metabolic syndrome or even Type 2 diabetes, and achieve a reversion rate of Z% with negligible (<5%) backsliding 5+ years out from date of reversion, monetizing that proprietary process is limited to either being a provider (in which case you're squeezed by the insurance companies with take-it-or-leave-it negotiations) or an insurer (in which case you're too spread out covering other ailments to really capitalize upon the proprietary knowledge). I suspect the lack of incentive structures is similar in nations with national health plans.