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Evernorth brings the power of wonder and relentless

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innovation to create world class pharmacy, care, and

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benefit solutions.

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Barriers to care can lead to gaps in

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care, which can drive up the total cost

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of care. Our capabilities work seamlessly together to

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create innovative pharmacy care and benefit solutions for

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today and tomorrow.

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Our connected health services make the treatment, prediction,

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and prevention of health care's most complex conditions

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easier and more accessible as we drive organizations

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and people forward.

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This is Haley Recker with the Becker's Payer

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Podcast, and we are recording live at the

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Becker's third annual spring payer issues roundtable.

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Today, I am thrilled to be joined by

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doctor Damanjeet Chaabi, who is the vice president

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of clinical affairs at Clover Health.

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Thank you so much, doctor, for joining me

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today. Can you go ahead and introduce yourself

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and a little bit about your background?

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Sure.

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So happy to be here.

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I'm Damanjeet

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Chaubey, vice president of clinical affairs at Clover

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Health, trained as an internal medicine and palliative

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care.

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I continue to practice medicine,

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and have few decades of health care experience

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in a variety of, physician leadership positions

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on both on the health care system side

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and now with Clover Health.

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Really, what I'm passionate about is everything that

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solves

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for

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how to deliver the best

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quality of care to our Medicare beneficiaries.

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I'm happy to be at Becker's,

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share my experiences,

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and learn from my esteemed colleagues.

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Well, thank you so much for that brief

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introduction. I'm really excited to get into our

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discussion today. To kick things off, balancing affordability

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and quality is a constant challenge for health

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plans. How is your organization

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innovating to manage the cost of care while

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maintaining or improving member outcomes?

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So that's a that's a great question. And,

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we at Clover

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have been very successful

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in managing this challenge,

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affordability

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and quality,

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because our approach

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is really unique,

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in the sense that

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our approach in managing the health of our

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members

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is unique and differentiated

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from traditional MA,

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approaches.

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Firstly,

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we are a tech centric model

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focused on improving clinical care

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outcomes via software,

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which is our Clover Assistant platform.

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So our approach is clinical. It is physician

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enablement

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via AI powered technology

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through our Clover Assistant platform. And it's just

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not focusing, you know, just on basic

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insurance tech process.

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So this is a very, you know, different

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process.

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Next, I think our care strategy.

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It is rooted

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in early disease identification,

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management,

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and care treatment by our clinicians

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who use global assistant technology.

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It's more of a proactive process

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rather than a delayed or a reactive

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typical health care process.

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Thirdly, I feel that our network construct

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is a wide open PPO plan, which is

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unique.

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We are not focused on risk delegation,

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and most importantly,

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we believe strongly

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in providing

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longitudinal

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home based care

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for our most at risk population

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by physicians

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who are using our Clover Assistant

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power technology.

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We are not just focused on one time

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visits. We believe in longitudinal

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care management

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for our members.

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And because of all these reasons,

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I think, for our year today, 02/2024,

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performance,

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we've been able to achieve industry standard

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leading MCR of 7075.6%

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and an insurance

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benefit expense ratio

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of about 80.6%

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in 2024.

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We have also grown at the same time.

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However, in a measured pace,

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continuously innovating,

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achieving profitability

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in 2022,

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and with a steady growth in our membership

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in 2025.

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So we are very, very excited about our

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future,

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you know, kind of, like, implementing

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our,

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unique approach to managing Medicare.

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Well, I'd love to go a little bit

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deeper into quality of care. You know, the

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regulatory landscape is always changing.

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So what best practices or tools does your

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organization rely on to keep quality of care

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at the forefront?

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Again,

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you know, I think, what I would like

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to say to answer that question

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is that the answer is

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a tech centric clinical

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delivery model of care and a benefit design

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of an open network.

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So we wanna engage with all stakeholders,

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including patients and our providers,

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and we believe

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strongly

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that consumers

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prefer PPO plans

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that allow them to see physicians

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that they have existing relationships

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with. What's unique about Clover

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is that 90 of our membership is in

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a PPO plan with a 3.5

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star rating for 2025

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and a four star rating for 2026.

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Clover Health also has been rated,

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4.94,

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but really a five star on HEDIS measures

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for star rating year 2025.

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So that speaks about quality.

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And I think it's so important that we

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think about

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we wanna meet the members where they are,

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that we need for them to see the

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physicians that care take care of them,

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and which is very unique.

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You know, most plans focus on an HMO,

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delivery model,

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but we don't. But we are still able

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to maintain quality by even giving wide access

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to our members. So that's first. And secondly,

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we engage with our providers.

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We are our care platform that's our Clover

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Assistant,

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CA technology,

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which is the leader in clinical AI.

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We synthesize

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hundred plus data sources,

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including electronic health records,

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pharmacy data, physician notes,

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lab data, claims data,

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and generate insights

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from more than hundred propriety models that deduplicate,

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they normalize the data, they enrich the clinical

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data repository,

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and they surface the most

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relevant and meaningful,

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suggestions

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to the clinicians

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at the time of that

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patient encounter.

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So when I see patients

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using Clover Assistant,

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I can see a consolidated view,

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of the patient's specific insights.

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Right? What are their existing medical problems?

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What are their medications?

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Review their medications.

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Have they filled them? When did they fill

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them? Are there any gaps?

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Did they

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get admitted to the hospital? Did they ever

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go and receive ED care, their recent labs,

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their discharge notes? And, you know, I am

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able to review

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their care gaps. So all of this

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and some more, because of our AI based

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model, we are even able to present to

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the clinicians,

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feed the risk of future adverse events or

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suspected diagnoses

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that'll help with timely diagnosis and treatment,

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you know, for our members.

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Focus on preventative care,

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focus on medication adherence,

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and other quality measures.

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As a physician,

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I feel that nothing is more important

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than timely diagnosis and treatment,

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for my patient. And I can make the

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best decisions for my patients if I have

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the right information

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when I actually see them.

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Because of this, you know, technology that we

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have,

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our Clover Home Care cohort,

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those are physicians,

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managing our patients

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using CA technology,

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have shown significantly

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improved

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MCR,

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you know, for our highest equity population

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through managing them at home, focusing on readmission

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prevention,

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and also looking and assessing for unknown and

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emerging risk. So empowering every physician with technology

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to identify,

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manage,

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treat chronic conditions earlier

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leads to higher clinical care,

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better outcomes at lower cost.

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We publish white papers that support proof of

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concept for some of the disease conditions that

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are so commonly prevalent,

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in our population such as diabetes and chronic

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kidney disease.

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For example,

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we've

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shown that by using our CA technology,

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you can actually diagnose diabetes earlier.

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We can actually manage it better with lower

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blood sugars, lower use of insulin,

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and lower instances of hypoglycemia.

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That is profoundly meaningful

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for any physician.

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CA has also used,

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you know, has also correlated very well with

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medication adherence.

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So I think in a sense, what I

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would say is even though that the regulatory

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landscape can change,

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if you have the best practices

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and the

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tools to take care of your members,

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good results are just inevitable

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and,

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will eventually lead to good outcomes.

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Well, that was just fascinating, and thank you

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for going into such great detail there. I

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wanna pivot the conversation a little bit. So

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looking ahead, what do you see as the

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biggest opportunity for payers to lead the charge

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in transforming care delivery and driving better outcomes

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for all stakeholders?

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And how can leaders take a step in

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this direction now?

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Excellent question. I feel that the biggest opportunity,

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in transforming care delivery for better outcomes

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is home based care for managing chronic disease

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conditions.

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Whilst this may not sound very novel because

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home based care has existed

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in a variety of ways for decades,

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but the approach

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has largely been to meet some short term

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organizational

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goals,

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be it in a post discharge,

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transition of care visit, a thirty day readmission

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prevention program,

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and some common value based contractual process measures.

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Most time, patients are lost to follow-up

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after the initial outreach, and we do not

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see a huge impact at a national level

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except

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where organizations

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have taken some bold steps

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creating health care delivery models that are more

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comprehensive,

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holistic, and longitudinal in nature. So I feel

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there are several aspects to this,

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that I would really like to, you know,

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kind of,

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focus on. One, I think technology.

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Right? Technology is really important

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because it is surfacing

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the right information

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for clinicians

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managing the patients at home.

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The right technology tools,

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including connectivity, which can be a huge issue

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in the rural remote areas,

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is a huge benefit in managing our members'

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expectations.

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For example,

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you have to think about,

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are people getting into an acute exacerbation of

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their chronic disease? How will we find that

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out? Can we actually do better remote monitoring,

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better point of care testing,

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and how can our own,

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you know, ML based,

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clover resistant platform

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help in proactively

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identifying

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who's at risk, when are they gonna exacerbate,

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and how can we manage that and reduce

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their risk. So one of the things that

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I think is so important is utilizing technology

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to reduce burdensome processes

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via

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AI scribing perhaps,

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reducing the burden of documentation and billing for

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physicians so that they can actually focus on

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patient care,

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and make a huge difference in the Medicare's,

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you know, in our Medicare population.

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Second, I think, is skilled workforce.

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Do we have the right clinical workforce,

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that can manage the, chronic disease at home?

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It's really important to invest

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in training,

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skill building,

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and the right ratios of the n b

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you know, MD physicians,

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nurse practitioner,

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and nurse and nurses.

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This is really critical,

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because vis a vis a cost containment strategy

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where

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this ratio of the n MD,

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NP, and nurse is being compromised

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cost for quality. So I would say that

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we really need to relook at how we

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manage with what skills we manage, and then

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only we'll see a huge difference.

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Thirdly, I would say that people need to

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invest in access to medical care. Right? I

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think home based care can solve for access

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to care with the right time, you know,

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with the right team at the right time

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using technology, especially in rural areas.

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I think there was a recent KFF report

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that highlighted

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the paucity of specialist care,

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specifically

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in Georgia.

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And interestingly, we just recently launched a clinical

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program,

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longitudinal

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based, home based,

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comprehensive

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longitudinal

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clinical care model in Georgia. And I can

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tell you through my personal experience

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that it is profoundly impacting.

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Patients are so happy

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to see an MD and a nurse practitioner

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in their home

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helping manage their chronic conditions,

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awarding ED visits and hospitalizations,

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and actually navigating

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and helping them make the right health care

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decisions

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involving their caregivers,

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so that,

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the right decision is made and the next

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action item occurs,

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smoothly.

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So I feel that

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coordination of care,

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you know, is really important, and leaders can

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support,

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promote,

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building these sustainable

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00:14:19,110 --> 00:14:20,809
home based chronic care,

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programs

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above and beyond,

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00:14:24,434 --> 00:14:26,455
you know, what are the standard care management,

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00:14:27,634 --> 00:14:28,695
you know, processes,

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00:14:29,475 --> 00:14:31,014
today. This requires

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00:14:31,555 --> 00:14:32,215
a reset.

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00:14:32,754 --> 00:14:33,495
It requires,

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00:14:34,434 --> 00:14:35,254
more investment.

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00:14:36,059 --> 00:14:36,720
It requires

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00:14:37,179 --> 00:14:39,259
a unique way of,

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00:14:39,820 --> 00:14:41,040
you know, operating.

401
00:14:41,500 --> 00:14:44,019
And it actually requires not only investment, but

402
00:14:44,019 --> 00:14:45,519
I think it requires commitment,

403
00:14:46,220 --> 00:14:48,399
to, you know, create sustainable programs.

404
00:14:49,259 --> 00:14:51,120
And then when you see good outcomes,

405
00:14:51,534 --> 00:14:53,315
I think share the wealth,

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00:14:53,774 --> 00:14:55,634
you know, share it with other communities,

407
00:14:56,495 --> 00:14:58,914
and then, you know, we can absolutely

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00:14:59,534 --> 00:15:00,575
make some good,

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00:15:00,975 --> 00:15:01,475
progress.

410
00:15:02,335 --> 00:15:04,254
I think that will what is, you know,

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00:15:04,254 --> 00:15:07,519
that is, what will lead to, or drive

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00:15:07,980 --> 00:15:08,480
appropriate

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00:15:09,100 --> 00:15:10,959
changes in national policies

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because

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00:15:12,139 --> 00:15:15,759
without give having good data showing good outcomes,

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00:15:15,980 --> 00:15:18,575
it's very difficult to influence change at a

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00:15:18,575 --> 00:15:19,154
national level,

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00:15:20,095 --> 00:15:21,875
and that is really what is required.

419
00:15:22,894 --> 00:15:24,035
So thank you.

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00:15:24,495 --> 00:15:26,495
Well, doctor, thank you so much for meeting

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00:15:26,495 --> 00:15:28,654
me with me today. Again, this is Haley

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00:15:28,654 --> 00:15:30,514
Recker with the Becker's Payer podcast

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recorded live at the Becker's third annual spring

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00:15:33,628 --> 00:15:34,848
payer issues roundtable.