Businessmodel of Clover Health

Customer Segments

Clover Health operates in the same market as traditional healthcare insurance businesses. It services are designed to help provide affordable care to members of the general consumer market. Clover Health’s insurance offerings falls under Medicare Advantage, a federal program for people aged 65 and over who have certain disabilities, which lets private insurance companies administer their health coverage.

Recent reports suggest that the Company, in particular, targets sufferers of a few chronic diseases, including type 2 diabetes, chronic obstructive pulmonary disease, and congestive heart failure, which can often lead to expensive treatments and procedures that are often preventable.

Currently, Clover Health appears to serve exclusively a domestic customer base in the US, collaborating with healthcare providers across New Jersey and Texas.

Value Propositions

Clover Health provides value to its customers in the following ways:

• Its broad healthcare coverage, with the Company providing extensive medical coverage to its members, including prescription and vision coverage, gym memberships, primary care coverage, collaborating with a range of healthcare providers and medical service companies;
• Its data-driven service, with the Company utilising data and analytics technology to assess the needs and concerns of each individual client, in order to provide a tailored and accurate service;
• Its affordability, with the Company offering affordable medical coverage plans, spanning low-cost basic plans to more expensive, but cost-effective, Premier and Prestige plans that provide a greater degree of coverage;
• Its specialist personal care teams and trained personnel, with the Company employing a team of nurse practitioners, medical assistants, and others healthcare professionals that visit members in between formal visits to the doctor;
• Its healthcare management service, with the Company taking care of medical administration for its members, assisting customers in selecting appropriate doctors and scheduling appointments, as well as finding transportation to and from appointments. ### Channels

Clover Health operates a website at www.cloverhealth.com, through which it provides information on its health plans, coverage options, provider, and additional services. The Company also provides an online channel through which customers are able to enrol in the Company’s various health plans. Clover Health also employs a team of sales personnel that are organised regionally. These sales representatives are able to sell plans and services directly customers over the phone

Clover Health additionally operates a network of enrolment centres across its operating regions, where customers can enrol in-person. It provides direct medical care to its customers through its in-house team of medical professionals, including nurse practitioners and trained medical assistants, who make house visits to members. The Company also provides care indirectly through its network of participating healthcare providers, including physicians, pharmacies, clinics, and eye care specialists.

Customer Relationships

Clover Health enables customers to enrol in its health plans on a self-service basis, through the Company’s website. Members are also able to access various forms and documentation through the Company’s website, including member claim submission forms, enrolment forms, and plan details.

Clover Health also provides a more tailored service through its in-house sales force, who are able to consult directly with customers and provide advice and information on the most appropriate plans for each individual members. The Company offers personal care to its members through its team of nurse practitioners and medical assistants, who provide in-person care at its members’s homes. It also provides care indirectly through its network of participating healthcare providers, physicians, specialist care professionals, and other medical professionals.

Customers can access a range of online support resources through the Company’s website, including policy information and guides to enrolment and disenrollment. Customers are also able to contact the Company’s support staff, either over the phone or via an online contact form, in order to receive personalised assistance. Additionally, Clover Health operates social media accounts, including with Twitter and Facebook, through which it is able to interact directly with customers.

Key Activities

Clover Health is a US-based medical insurance and medical services provider. The Company provides a range of health coverage plans to members, which are specifically targeted at consumers aged over 65 years of age who have chronic illnesses or certain disabilities, under the government-funded Medicare Advantage program. The Company collaborates with a range of healthcare providers – including physicians, clinics, specialist care providers, and eye care providers – across New Jersey and Texas.

Clover Health also employs a number of nurse practitioners and trained medical assistant, who are able to provide at-home care to members in between visits to formal medical facilities. Clover Health additionally manages the appointment schedules of its members and assist in identifying appropriate medical professionals.

Key Partners

Clover Health works alongside a range of companies and organisations in the development, delivery and implementation of its solutions. These partners include:

• Healthcare and Medical Partners, comprising a range of healthcare providers, physicians, specialist care providers, clinics and hospitals, and other medical organisations that provide care to members of the Company’s various health insurance plans;
• Supplier and Vendor Partners, comprising a range of suppliers of tools, equipment, services, and technology that are utilised across the Company’s enterprise in support of its services, as well companies to which certain function can be outsourced; and
• Financial and Funding Partners, comprising the Company’s investor and financiers, that provide funds to the Company as it continues to grow its customer base and expand its operations across the US. Clover Health partners with a range of hospitals across New Jersey and Texas, including Kessler Rehabilitation Centre, Bayonne Medical Centre, Hackensack University Medical Centre, St. Joseph’s Regional Medical Centre, and Englewood Hospital and Medical Centre.

Key Resources

Clover Health’s key resources are its data analytics platform and technologies, its medical equipment, its online platform, its IT and communications infrastructure, its network of participating healthcare providers, its sales and marketing channels, and its personnel – notably its teams of healthcare professionals.

While Clover Health utilises data analytics technology as a key part of its services, search of records published by the US Patent and Trademark Office identified no patent applications filed in Clover Health’s name.

Cost Structure

Clover Health incurs costs in relation to the development and implementation of its health plans, the maintenance of its online platform, the maintenance of its IT and communications infrastructure, the procurement of medical supplies and equipment, the management of its partnerships and providers, the operation of its sales and marketing channels, and the retention of its personnel.

Revenue Streams

Clover Health generates revenue through the provision of health insurance and healthcare services to customers under US Government’s federal Medicare Advantage program. The Company derives revenue in two principal streams:

• Revenue derived through the payment of premiums by the government under the Medicare Advantage program; and
• Revenue derived from health coverage subscriptions. Clover Health offers insurance plans at three different levels. This includes a basic plan that does not incur a monthly cost, as well a more extensive plans at the Premium and Prestige level, which cost around $40 and $178 per month respectively.

Clover Health remains a privately-owned company and therefore is not obliged to publish its financial results online. Recent reports do not make estimates as to the current annual revenue figures of the Company.