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This is Haley Recker with the Becker's Payer
Podcast, and we are recording live at the
Becker's third annual spring payer issues roundtable.
Today, I am thrilled to be joined by
doctor Damanjeet Chaabi, who is the vice president
of clinical affairs at Clover Health.
Thank you so much, doctor, for joining me
today. Can you go ahead and introduce yourself
and a little bit about your background?
Sure.
So happy to be here.
I'm Damanjeet
Chaubey, vice president of clinical affairs at Clover
Health, trained as an internal medicine and palliative
care.
I continue to practice medicine,
and have few decades of health care experience
in a variety of, physician leadership positions
on both on the health care system side
and now with Clover Health.
Really, what I'm passionate about is everything that
solves
for
how to deliver the best
quality of care to our Medicare beneficiaries.
I'm happy to be at Becker's,
share my experiences,
and learn from my esteemed colleagues.
Well, thank you so much for that brief
introduction. I'm really excited to get into our
discussion today. To kick things off, balancing affordability
and quality is a constant challenge for health
plans. How is your organization
innovating to manage the cost of care while
maintaining or improving member outcomes?
So that's a that's a great question. And,
we at Clover
have been very successful
in managing this challenge,
affordability
and quality,
because our approach
is really unique,
in the sense that
our approach in managing the health of our
members
is unique and differentiated
from traditional MA,
approaches.
Firstly,
we are a tech centric model
focused on improving clinical care
outcomes via software,
which is our Clover Assistant platform.
So our approach is clinical. It is physician
enablement
via AI powered technology
through our Clover Assistant platform. And it's just
not focusing, you know, just on basic
insurance tech process.
So this is a very, you know, different
process.
Next, I think our care strategy.
It is rooted
in early disease identification,
management,
and care treatment by our clinicians
who use global assistant technology.
It's more of a proactive process
rather than a delayed or a reactive
typical health care process.
Thirdly, I feel that our network construct
is a wide open PPO plan, which is
unique.
We are not focused on risk delegation,
and most importantly,
we believe strongly
in providing
longitudinal
home based care
for our most at risk population
by physicians
who are using our Clover Assistant
power technology.
We are not just focused on one time
visits. We believe in longitudinal
care management
for our members.
And because of all these reasons,
I think, for our year today, 02/2024,
performance,
we've been able to achieve industry standard
leading MCR of 7075.6%
and an insurance
benefit expense ratio
of about 80.6%
in 2024.
We have also grown at the same time.
However, in a measured pace,
continuously innovating,
achieving profitability
in 2022,
and with a steady growth in our membership
in 2025.
So we are very, very excited about our
future,
you know, kind of, like, implementing
our,
unique approach to managing Medicare.
Well, I'd love to go a little bit
deeper into quality of care. You know, the
regulatory landscape is always changing.
So what best practices or tools does your
organization rely on to keep quality of care
at the forefront?
Again,
you know, I think, what I would like
to say to answer that question
is that the answer is
a tech centric clinical
delivery model of care and a benefit design
of an open network.
So we wanna engage with all stakeholders,
including patients and our providers,
and we believe
strongly
that consumers
prefer PPO plans
that allow them to see physicians
that they have existing relationships
with. What's unique about Clover
is that 90 of our membership is in
a PPO plan with a 3.5
star rating for 2025
and a four star rating for 2026.
Clover Health also has been rated,
4.94,
but really a five star on HEDIS measures
for star rating year 2025.
So that speaks about quality.
And I think it's so important that we
think about
we wanna meet the members where they are,
that we need for them to see the
physicians that care take care of them,
and which is very unique.
You know, most plans focus on an HMO,
delivery model,
but we don't. But we are still able
to maintain quality by even giving wide access
to our members. So that's first. And secondly,
we engage with our providers.
We are our care platform that's our Clover
Assistant,
CA technology,
which is the leader in clinical AI.
We synthesize
hundred plus data sources,
including electronic health records,
pharmacy data, physician notes,
lab data, claims data,
and generate insights
from more than hundred propriety models that deduplicate,
they normalize the data, they enrich the clinical
data repository,
and they surface the most
relevant and meaningful,
suggestions
to the clinicians
at the time of that
patient encounter.
So when I see patients
using Clover Assistant,
I can see a consolidated view,
of the patient's specific insights.
Right? What are their existing medical problems?
What are their medications?
Review their medications.
Have they filled them? When did they fill
them? Are there any gaps?
Did they
get admitted to the hospital? Did they ever
go and receive ED care, their recent labs,
their discharge notes? And, you know, I am
able to review
their care gaps. So all of this
and some more, because of our AI based
model, we are even able to present to
the clinicians,
feed the risk of future adverse events or
suspected diagnoses
that'll help with timely diagnosis and treatment,
you know, for our members.
Focus on preventative care,
focus on medication adherence,
and other quality measures.
As a physician,
I feel that nothing is more important
than timely diagnosis and treatment,
for my patient. And I can make the
best decisions for my patients if I have
the right information
when I actually see them.
Because of this, you know, technology that we
have,
our Clover Home Care cohort,
those are physicians,
managing our patients
using CA technology,
have shown significantly
improved
MCR,
you know, for our highest equity population
through managing them at home, focusing on readmission
prevention,
and also looking and assessing for unknown and
emerging risk. So empowering every physician with technology
to identify,
manage,
treat chronic conditions earlier
leads to higher clinical care,
better outcomes at lower cost.
We publish white papers that support proof of
concept for some of the disease conditions that
are so commonly prevalent,
in our population such as diabetes and chronic
kidney disease.
For example,
we've
shown that by using our CA technology,
you can actually diagnose diabetes earlier.
We can actually manage it better with lower
blood sugars, lower use of insulin,
and lower instances of hypoglycemia.
That is profoundly meaningful
for any physician.
CA has also used,
you know, has also correlated very well with
medication adherence.
So I think in a sense, what I
would say is even though that the regulatory
landscape can change,
if you have the best practices
and the
tools to take care of your members,
good results are just inevitable
and,
will eventually lead to good outcomes.
Well, that was just fascinating, and thank you
for going into such great detail there. I
wanna pivot the conversation a little bit. So
looking ahead, what do you see as the
biggest opportunity for payers to lead the charge
in transforming care delivery and driving better outcomes
for all stakeholders?
And how can leaders take a step in
this direction now?
Excellent question. I feel that the biggest opportunity,
in transforming care delivery for better outcomes
is home based care for managing chronic disease
conditions.
Whilst this may not sound very novel because
home based care has existed
in a variety of ways for decades,
but the approach
has largely been to meet some short term
organizational
goals,
be it in a post discharge,
transition of care visit, a thirty day readmission
prevention program,
and some common value based contractual process measures.
Most time, patients are lost to follow-up
after the initial outreach, and we do not
see a huge impact at a national level
except
where organizations
have taken some bold steps
creating health care delivery models that are more
comprehensive,
holistic, and longitudinal in nature. So I feel
there are several aspects to this,
that I would really like to, you know,
kind of,
focus on. One, I think technology.
Right? Technology is really important
because it is surfacing
the right information
for clinicians
managing the patients at home.
The right technology tools,
including connectivity, which can be a huge issue
in the rural remote areas,
is a huge benefit in managing our members'
expectations.
For example,
you have to think about,
are people getting into an acute exacerbation of
their chronic disease? How will we find that
out? Can we actually do better remote monitoring,
better point of care testing,
and how can our own,
you know, ML based,
clover resistant platform
help in proactively
identifying
who's at risk, when are they gonna exacerbate,
and how can we manage that and reduce
their risk. So one of the things that
I think is so important is utilizing technology
to reduce burdensome processes
via
AI scribing perhaps,
reducing the burden of documentation and billing for
physicians so that they can actually focus on
patient care,
and make a huge difference in the Medicare's,
you know, in our Medicare population.
Second, I think, is skilled workforce.
Do we have the right clinical workforce,
that can manage the, chronic disease at home?
It's really important to invest
in training,
skill building,
and the right ratios of the n b
you know, MD physicians,
nurse practitioner,
and nurse and nurses.
This is really critical,
because vis a vis a cost containment strategy
where
this ratio of the n MD,
NP, and nurse is being compromised
cost for quality. So I would say that
we really need to relook at how we
manage with what skills we manage, and then
only we'll see a huge difference.
Thirdly, I would say that people need to
invest in access to medical care. Right? I
think home based care can solve for access
to care with the right time, you know,
with the right team at the right time
using technology, especially in rural areas.
I think there was a recent KFF report
that highlighted
the paucity of specialist care,
specifically
in Georgia.
And interestingly, we just recently launched a clinical
program,
longitudinal
based, home based,
comprehensive
longitudinal
clinical care model in Georgia. And I can
tell you through my personal experience
that it is profoundly impacting.
Patients are so happy
to see an MD and a nurse practitioner
in their home
helping manage their chronic conditions,
awarding ED visits and hospitalizations,
and actually navigating
and helping them make the right health care
decisions
involving their caregivers,
so that,
the right decision is made and the next
action item occurs,
smoothly.
So I feel that
coordination of care,
you know, is really important, and leaders can
support,
promote,
building these sustainable
home based chronic care,
programs
above and beyond,
you know, what are the standard care management,
you know, processes,
today. This requires
a reset.
It requires,
more investment.
It requires
a unique way of,
you know, operating.
And it actually requires not only investment, but
I think it requires commitment,
to, you know, create sustainable programs.
And then when you see good outcomes,
I think share the wealth,
you know, share it with other communities,
and then, you know, we can absolutely
make some good,
progress.
I think that will what is, you know,
that is, what will lead to, or drive
appropriate
changes in national policies
because
without give having good data showing good outcomes,
it's very difficult to influence change at a
national level,
and that is really what is required.
So thank you.
Well, doctor, thank you so much for meeting
me with me today. Again, this is Haley
Recker with the Becker's Payer podcast
recorded live at the Becker's third annual spring
payer issues roundtable.