3 ms·

I put in qualifiers to ensure Clover has an out here, I really am rooting for you and all the other startups looking to improve health outcomes. However, nothin

I put in qualifiers to ensure Clover has an out here, I really am rooting for you and all the other startups looking to improve health outcomes. However, nothing I've read about the business model tells me that Clover is spending $2500+ per month on all the tests with a CGM, possibly a personal trainer for weight lifting, and possibly a personal coach daily to tackle really tough periods like carb flu and fasting, to aggressively counter metabolic syndrome the moment it is detected, for 12-18 months, then scaling back to about that much every other month for the next 12-18 months, then to about that much every third month for the next three years. Consistently get people through those five years with no backsliding on the current key diagnostic metrics for metabolic syndrome, and you'll be in what is currently a tiny sub-1%-fraction population that have reverted and kept reverted over that duration. While an acute cost, if you catch patients in their 20-40s and do this, it represents a steal over chronic costs and late-stage costs. Do it consistently, and it represents a disruptive change of the cost model status quo. The business model of a US health insurer in this situation frankly sucks, however. If Clover successfully manages a reversion outcome with aggressive short-term techniques for a chronic condition, then nothing prevents the patient from switching away to a cheaper insurer afterwards. Clover puts in all the hard work, and another insurer reaps the actuarial benefits. That has to be fixed, because all the big killers of patients, insurer profits and medical budgets in the developed nations are the biological analogs of Advanced Persistent Threats, and not amenable to fixes developed for acute situations (which as a civilization we're really good at addressing).

ubernostrum 10y ago
if you catch patients in their 20-40s That's a big "if" for a Medicare Advantage insurer, since we can't enroll someone unless they're eligible for Medicare. Although it's possible to become Medicare-eligible prior to age 65, it's much less common, and some of the ways it happens make someone ineligible to enroll in a Medicare Advantage plan (for example, someone with end-stage renal disease is Medicare-eligible regardless of age, but unless already enrolled in one cannot join a Medicare Advantage plan -- they must opt for traditional Medicare instead). So by the time a typical diabetic becomes eligible for a Medicare Advantage plan, the intense regimes you're talking about don't (as far as I know) offer any realistic chance of reverting. Which means most of the effort instead goes into proper management techniques to prevent progression and complications.

ubernostrum 10y ago

if you catch patients in their 20-40s That's a big "if" for a Medicare Advantage insurer, since we can't enroll someone unless they're eligible for Medicare. Although it's possible to become Medicare-eligible prior to age 65, it's much less common, and some of the ways it happens make someone ineligible to enroll in a Medicare Advantage plan (for example, someone with end-stage renal disease is Medicare-eligible regardless of age, but unless already enrolled in one cannot join a Medicare Advantage plan -- they must opt for traditional Medicare instead). So by the time a typical diabetic becomes eligible for a Medicare Advantage plan, the intense regimes you're talking about don't (as far as I know) offer any realistic chance of reverting. Which means most of the effort instead goes into proper management techniques to prevent progression and complications.