Clover Health Investments, Corp 8-K, filed Jan 13, 2025
Clover Health Investments, Corp. (CLOV)
8-K
2025-01-13
For: 2025-01-13
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April 06, 2026
About this 8-K
Clover Health Investments, Corp filed this 8-K on January 13, 2025.
Items reported
- Item 7.01: Regulation FD disclosure
- Item 9.01: Financial statements and exhibits
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
FORM 8-K
CURRENT REPORT
Pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934
Date of Report (Date of earliest event reported): January 13, 2025
CLOVER HEALTH INVESTMENTS, CORP.
(Exact name of Registrant as Specified in Its Charter)
(State or Other Jurisdiction | (Commission File Number) | (IRS Employer | ||||||
of Incorporation) | Identification No.) | |||||||
Address Not Applicable(1) | Address Not Applicable(1) | ||||
| (Address of Principal Executive Offices) | (Zip Code) | ||||
Not Applicable(1)
(Registrant’s Telephone Number, Including Area Code)
Not Applicable
(Former Name or Former Address, if Changed Since Last Report)
Check the appropriate box below if the Form 8-K filing is intended to simultaneously satisfy the filing obligation of the registrant under any of the following provisions:
Securities registered pursuant to Section 12(b) of the Act:
Trading | ||||||||||||||
Title of each class | Symbol(s) | Name of each exchange on which registered | ||||||||||||
Indicate by check mark whether the registrant is an emerging growth company as defined in Rule 405 of the Securities Act of 1933 (§ 230.405 of this chapter) or Rule 12b-2 of the Securities Exchange Act of 1934 (§ 240.12b-2 of this chapter).
Emerging growth company ☐
If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. ☐
(1) We are a remote-first company. Accordingly, we do not maintain a headquarters. For purposes of compliance with applicable requirements of the Securities Act of 1933, as amended, and the Securities Exchange Act of 1934, as amended, stockholder communications required to be sent to our principal executive offices may be directed to the email address: secretary@cloverhealth.com, or to our agent for service of process at The Corporation Trust Company, 1209 Orange Street, Wilmington, Delaware 19801.
Item 7.01. Regulation FD Disclosure.
On December 17, 2024, Clover Health Investments, Corp. (the “Company”) issued a press release announcing that its Chief Executive Officer, Andrew Toy, will present at the 43rd Annual J.P. Morgan Healthcare Conference on Wednesday, January 15, 2024, at 4:30 p.m. Eastern Time. A live webcast of the presentation will be accessible through the investor relations section of the Company’s website. The slide presentation to be used during the presentation is attached hereto as Exhibit 99.2 and incorporated herein by reference.
On January 13, 2025, the Company issued a press release announcing preliminary Medicare Advantage Annual Election Period ("AEP") results, a copy of which is attached hereto as Exhibit 99.1 and is incorporated herein by reference.
The information set forth in this Item 7.01 (including Exhibit 99.1 and Exhibit 99.2) shall not be deemed “filed” for purposes of Section 18 of the Securities Exchange Act of 1934, as amended (the “Exchange Act”), or otherwise subject to the liabilities of that section, nor shall it be deemed incorporated by reference in any filing under the Securities Act of 1933, as amended, or the Exchange Act, except as expressly set forth by specific reference in such a filing.
This report contains forward-looking statements within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended. Forward-looking statements include statements regarding future events and Clover Health's future results of operations, financial condition, market size and opportunity, business strategy and plans, and the factors affecting our performance and our objectives for future operations. Forward-looking statements are not guarantees of future performance and you are cautioned not to place undue reliance on such statements. In some cases, you can identify forward looking statements because they contain words such as "may," "will," "should," "expects," "plans," "anticipates," "going to," "can," "could," "should," "would," "intends," "target," "projects," "contemplates," "believes," "estimates," "predicts," "potential," "outlook," "forecast," "guidance," "objective," "plan," "seek," "grow," "if," "continue" or the negative of these words or other similar terms or expressions that concern Clover Health's expectations, strategy, priorities, plans or intentions. Forward-looking statements in this report include, but are not limited to, the following: statements regarding the Company's Annual Election Period results and 2025 market growth and their anticipated effects on the Company's financial performance, the anticipated number of Clover Health Insurance members, Adjusted EBITDA profitability, and the Company’s Star Ratings and its affect on future membership growth and profitability, as well as the statements contained in the quotations of our executive officers and other expectations as to future performance, operations and results. Forward-looking statements regarding our Adjusted EBITDA profitability are based on our current targets which are preliminary and are derived from our 2025 financial outlook. These statements are subject to known and unknown risks, uncertainties and other factors that may cause our actual results, levels of activity, performance or achievements to differ materially from results expressed or implied by forward-looking statements in this report. Forward-looking statements involve a number of judgments, risks and uncertainties, including, without limitation, risks related to: our expectations regarding results of operations, financial condition, and cash flows; our expectations regarding the development and management of our Insurance business; our ability to successfully enter new service markets and manage our operations; anticipated trends and challenges in our business and in the markets in which we operate; our ability to effectively manage our beneficiary base and provider network; our ability to maintain and increase adoption and use of Clover Assistant, including the expansion of Clover Assistant for external payors and providers under the brand name Counterpart Assistant; the anticipated benefits associated with the use of Clover Assistant, including our ability to utilize the platform to manage our medical care ratios; our ability to maintain or improve our Star Ratings or otherwise continue to improve the financial performance of our business; our ability to develop new features and functionality that meet market needs and achieve market acceptance; our ability to retain and hire necessary employees and staff our operations appropriately; the timing and amount of certain investments in growth; the outcome of any known and unknown litigation and regulatory proceedings; any current, pending, or future legislation, regulations or policies that could have a negative effect on our revenue and businesses, including rules, regulations, and policies relating to healthcare and Medicare; our ability to maintain, protect, and enhance our intellectual property; general economic conditions and uncertainty; persistent high inflation and interest rates; and geopolitical uncertainty and instability. Additional information concerning these and other risk factors is contained under Item 1A. “Risk Factors” in our most recent Annual Report on Form 10-K filed with the Securities and Exchange Commission (the "SEC") on March 14, 2024, as such risks may be updated in our subsequent filings with the SEC. The forward-looking statements included in this report are made as of the date hereof. Except as required by law, Clover Health undertakes no obligation to update any of these forward-looking statements after the date of this report or to conform these statements to actual results or revised expectations.
Item 9.01. Financial Statements and Exhibits.
(d) List of Exhibits
| Exhibit No. | Description | ||||
| 99.1 | |||||
| 99.2 | |||||
| 104 | Cover Page Interactive Data File (embedded within the Inline XBRL document) | ||||
SIGNATURE
Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized.
| Clover Health Investments, Corp. | ||||||||||||||
| Date: | January 13, 2025 | By: | /s/ Peter Kuipers | |||||||||||
| Name: | Peter Kuipers | |||||||||||||
| Title: | Chief Financial Officer (Principal Financial Officer and Principal Accounting Officer) | |||||||||||||
Clover Health Reports 27% Growth in Medicare Advantage Membership, Surpassing 100,000 Lives After Strong Annual Election Period
•Robust plan benefits powered member growth, mainly driven by switchers from other plans
•Company will focus on balancing profitability with strategic investments in growth and technology to take advantage of strong market opportunity
•~95% of Clover’s January 1, 2025 membership is in its flagship 4 Star PPO plan
Wilmington, DE, January 13, 2025 – Clover Health Investments, Corp. (Nasdaq: CLOV) (“Clover,” “Clover Health” or the “Company”), today announced a 27% year-over-year growth of its Medicare Advantage (MA) membership during the most recent Annual Election Period (AEP). The Company enters 2025 with over 100,000 members, approximately 95% of whom are enrolled in Clover’s flagship 4-Star PPO plan.
“Driven by robust plan benefits and our 4 Star rating, we’ve delivered exceptional member growth, and I feel honored to bring so many new people into our unique model of care,” said Andrew Toy, CEO of Clover Health. “We invest deeply in using technology to improve clinical outcomes through the earlier identification, management and treatment of chronic disease, a clear differentiator from our peers. Looking forward, we will take advantage of the strong market opportunity in front of us, by making strategic investments in growth as well as continuing to widen our AI-powered technology moat.”
Clover’s 4-Star rating PPO plan reflects the Company’s deep investment in care quality, with top performance across key HEDIS measures—an industry standard for healthcare quality. This achievement also positions Clover for an anticipated 5% benchmark increase in payment year 2026 (PY26), strengthening the company’s ability to reinvest in improving benefits and further accelerating membership growth.
Jamie Reynoso, CEO of Medicare Advantage at Clover Health, added: “Our foundational investments over the last few years—ranging from enhanced care management to operational efficiencies—are paying off. Keeping a keen focus on improving the health of our members, by being an active participant in their care management, Clover is in an incredibly strong position to continue this above-market growth trajectory while of course maintaining profitability. Our strong membership growth, coupled with the expected 2026 tailwinds of our 4-Star rating and increasing impact of our integrated care model, positions Clover for long-term Medicare Advantage success. We’re excited to keep pushing forward.”
About Clover Health:
Clover Health (Nasdaq: CLOV) is a physician enablement technology company committed to bringing access to great healthcare to everyone on Medicare. This includes a focus on seniors who have historically lacked access to affordable, high-quality healthcare. Our strategy is powered by our software platform, Clover Assistant, which is designed to aggregate patient data from across the healthcare ecosystem to support clinical decision-making and improve health outcomes through the early identification and management of chronic disease. For our members, we provide PPO and HMO Medicare Advantage plans in several states, with a differentiated focus on our flagship wide-network, high-choice PPO plans. For healthcare providers outside Clover Health's Medicare Advantage plan, we extend the benefits of our data-driven technology platform to a wider audience via our subsidiary, Counterpart Health, and aim to enable enhanced patient outcomes and reduced healthcare costs on a nationwide scale. Clover Health has published data demonstrating the technology’s impact on Medication Adherence, as well as the earlier identification and management of Diabetes and Chronic Kidney Disease.
Forward-Looking Statements
This press release contains forward-looking statements within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended. Forward-looking statements include statements regarding future events and Clover Health's future results of operations, financial condition, market size and opportunity, business strategy and plans, and the factors affecting our performance and our objectives for future operations. Forward-looking statements are not guarantees of future performance and you are cautioned not to place undue reliance on such statements. In some cases, you can identify forward looking statements because they contain words such as "may," "will," "should," "expects," "plans," "anticipates," "going to," "can," "could," "should," "would," "intends," "target," "projects," "contemplates," "believes," "estimates," "predicts," "potential," "outlook," "forecast," "guidance," "objective," "plan," "seek," "grow," "if," "continue" or the negative of these words or other similar terms or expressions that concern Clover Health's expectations, strategy, priorities, plans or intentions. Forward-looking statements in this press release include, but are not limited to, the following: statements regarding Annual Election Period results, 2025 market growth and their anticipated effects on the Company’s financial performance, the number of Clover Health's Insurance members, Adjusted EBITDA profitability, and the Company’s Star Ratings and its affect on future membership growth and profitability, as well as the statements contained in the quotations of our executive officers and other expectations as to future performance, operations and results. Forward-looking statements regarding our Adjusted EBITDA profitability are based on our current targets which are preliminary and are derived from our 2025 financial outlook. These statements are subject to known and unknown risks, uncertainties and other factors that may cause our actual results, levels of activity, performance or achievements to differ materially from results expressed or implied by forward-looking statements in this press release. Forward-looking statements involve a number of judgments, risks and uncertainties, including, without limitation, risks related to: our expectations regarding results of operations, financial condition, and cash flows; our expectations regarding the development and management of our Insurance business; our ability to successfully enter new service markets and manage our operations; anticipated trends and challenges in our business and in the markets in which we operate; our ability to effectively manage our beneficiary base and provider network; our ability to maintain and increase adoption and use of Clover Assistant, including the expansion of Clover Assistant for external payors and providers under the brand name Counterpart Assistant; the anticipated benefits associated with the use of Clover Assistant, including our ability to utilize the platform to manage our medical care ratios; our ability to maintain or improve our Star Ratings or otherwise continue to improve the financial performance of our business; our ability to develop new features and functionality that meet market needs and achieve market acceptance; our ability to retain and hire necessary employees and staff our operations appropriately; the timing and amount of certain investments in growth; the outcome of any known and unknown litigation and regulatory proceedings; any current, pending, or future legislation, regulations or policies that could have a negative effect on our revenue and businesses, including rules, regulations, and policies relating to healthcare and Medicare; our ability to maintain, protect, and enhance our intellectual property; general economic conditions and uncertainty; persistent high inflation and interest rates; and geopolitical uncertainty and instability. Additional information concerning these and other risk factors is contained under Item 1A. “Risk Factors” in our most recent Annual Report on Form 10-K filed with the Securities and Exchange Commission (the "SEC") on March 14, 2024, as such risks may be updated in our subsequent filings with the SEC. The forward-looking statements included in this press release are made as of the date hereof. Except as required by law, Clover Health undertakes no obligation to update any of these forward-looking statements after the date of this press release or to conform these statements to actual results or revised expectations.
Press Contact:
Andrew Still-Baxter
press@cloverhealth.com
Investor Relations Contact:
Ryan Schmidt
investors@cloverhealth.com
JP Morgan Presentation 2025 January 2025 Slide Deck vF For 8-K / IR Site LGTMs: Date: Peter K. LGTM Legal (Karen / Peter R.) LGTM Andrew T. LGTM
2 Disclaimer This presentation and the accompanying oral presentation include forward-looking statements, including, without limitation, statements regarding future events and Clover Health Investments, Corp.’s (“Clover Health,” “we,” “our,” or “us”) expectations regarding Adjusted EBITDA profitability, Adjusted SG&A, Insurance BER (non-GAAP measures, as defined herein), targeted revenue, MCRs, the Company’s Annual Election Period results and 2025 market growth and their anticipated effects on the Company’s financial performance, the anticipated number of Clover Health Insurance members, the Company’s Star Ratings and its effect on future membership growth and profitability, as well as the statements contained in the quotations of our executive officers and other expectations as to future performance, operations and results. These forward-looking statements are subject to a number of risks, uncertainties and assumptions, including those described under Item 1A. “Risk Factors” in the Company’s most recent Annual Report on Form 10-K filed with the Securities and Exchange Commission (the “SEC”), filed with the SEC on March 14, 2024, as such risk factors may be updated in our subsequent filings with the SEC. In light of these risks, uncertainties and assumptions, the forward-looking events and circumstances discussed in this presentation and the accompanying oral presentation may not occur and actual results could differ materially and adversely from those anticipated or implied in the forward-looking statements. Forward-looking statements are not guarantees of future performance and you are cautioned not to place undue reliance on such statements. The forward-looking statements included in this presentation and the accompanying oral presentation are made as of the date hereof. Except as required by law, Clover Health undertakes no obligation to update any of these forward-looking statements after the date hereof or to conform these statements to actual results or revised expectations. In addition to U.S. Generally Accepted Accounting Principles (“GAAP”) financial measures, this presentation includes certain non-GAAP financial measures including Adjusted EBITDA, Adjusted SG&A and Insurance BER. These non-GAAP financial measures are provided to enhance the reader’s understanding of Clover Health’s past financial performance and our prospects for the future. Non-GAAP financial measures are supplemental to and should not be considered a substitute for financial information presented in accordance with GAAP and should be read only in conjunction with our consolidated financial statements prepared in accordance with GAAP. A reconciliation of historical non-GAAP measures to historical GAAP measures is included in the Appendix of this presentation.
3 Investor Presentation from ~1 Year Ago(1) PPO Plan PY25: 3.5 Stars / PY26: 4.0 Stars(3) Counterpart Health Launch Our Goals: 12 Month Lookback (1) The slide screenshot of the page titled “Goals for 2024 and Beyond” comes from the Clover Health presentation at the 42nd Annual J.P. Morgan Conference, filed on January 10, 2024 here, and on the Company’s investor relations website. (2) Adjusted EBITDA is a non-GAAP financial measure. We define Adjusted EBITDA as Net Income (Loss) from continuing operations before before depreciation and amortization, loss on investment, stock-based compensation, premium deficiency reserve expense (benefit), restructuring (recoveries) costs, and non-recurring legal expenses and settlements. Please refer to the Appendix for a reconciliation of Adjusted EBITDA to Net Income (Loss) from continuing operations, the most directly comparable GAAP measure. (3) Clover Health maintained a 3.5 Star Rating for payment year 2025, and improved its Star Rating to 4.0 Stars for payment year 2026 for its flagship PPO plan. (4) Clover Health continued to deliver strong top-line Revenue growth as of the year-to-date 3Q24 period. Medicare Advantage membership growth as of the beginning of January 2025, as compared to January 2024. Material Adj. EBITDA Profitability(2) Top-Line Growth; ~27% January YoY Membership Growth(4)
Clover’s Next Phase: Growth 4 2018 2022 2025 & Beyond Growth Profitability Innovation
5 Our Vision Empower Every Physician with Technology to Identify, Manage & Treat Chronic Diseases Earlier Earlier Diagnosis & Treatment Earlier Disease Management Higher Quality Clinical Care Affordable & Accessible Care
Physician enablement technology, powered by AI Longitudinal care for highest risk via Clover Assistant powered, MD-led pods 6 A Different Approach to Empowering Accessible & Affordable Healthcare Technology-Centric Care Platform We enable value-based outcomes for fee-for-service physicians Built for an aging population and the future of Medicare Clinical outcomes improved while reducing total cost of care Better Chronic Disease Management
7 Care Platform: Clover Assistant is the Leader in Clinical AI Millions of clinical documents, collected & reconciled Synthesis of 100+ Data Sources Robust IP and patent portfolio(1) Insights from >100 Proprietary Models Surfacing relevant clinical suggestions at time of encounter Clinical Orientation, Dynamic Actions Claims Data PCP & Specialist Charts EHR Data Pharmacy Data Lab Data Evidence-Based Protocols Early Diagnosis & Treatment Patient-Specific Insights & Next Steps Care Gaps: Preventative + Chronic Care Medication Adherence Transitional Care & ADT Population Health Management Data Deduplication / Normalization Enriched Clinical Data Repository Post-Discharge Encounter Mappings Machine Learning (ML) Models for Diagnosis Suspecting (1) Including patents for Machine learning models for diagnosis suspecting and Prospective medication fillings management, among many more that can be found here. Empowering physicians to practice medicine using their clinical judgement
Clover Home Care Cohort has Significantly Improved MCR from 2021 to 2024(1) Care Platform: Differentiated Home Care at Critical Moments Higher Disease Acuity Lower Disease Acuity Clover Assistant Powered Network PCPs Care Intensity (1) Our data shows that since 2021, MCRs for members enrolled in our In-Home Care program (highest acuity population) have decreased over a 3 year period. Longitudinal, MD-led, primary care in the home for highest acuity population Readmission prevention and post-acute Assessment visits for unknown / emerging risk Clover Home Care 8
Rank Quality: Clover Leads the Nation on HEDIS Measures(1) 9 (1) Clover Health’s Medicare Advantage PPO plans received a score of 4.94 on HEDIS for the Plan Year 2025, Payment Year 2026 Star ratings. For plans with over 2,000 members, Clover’s PPO received the highest score in the entire country on core HEDIS measures. The Company achieved an overall 4.0 Star Rating for financial Payment Year 2026 for its PPO plans. (2) Including plans with publicly available reported data on at least 10 HEDIS measures. (3) Combined HEDIS rates alone are not an official CMS domain score. Calculations for overall number use MY23 HEDIS measure rates and assigned measure Star and weight. Data and Methodology. Represents weighted average of HEDIS Weighted Raw Score across all PPO/HMO plans under parent company of public peers. Plan(2) Contract Plan Type HEDIS Weighted Raw Score Life-Weighted Average HEDIS Raw Score(3) Clover Health rated 4.94 / 5 Stars on HEDIS Measures for Star Rating Year 2025(1) Top 10 HEDIS-Scoring Plans
10 Quality: Leader in Readmission Prevention Measures Source: CMS Part C and D Performance HEDIS Measurement Data (1) Measurement scores above represents Clover Health's score on identified HEDIS measures from MY2023 for its PPO Plan (Contract H5141) as compared to the national median measurement scores of all plans. Medication Reconciliation Post-Discharge ~1,900 bps Better than National Median(1) Plan All-Cause Readmissions ~300 bps Better than National Median(1) Transitions of Care ~2,800 bps Better than National Median(1) Follow-up after Emergency Department Visit for People with Multiple High-Risk Chronic Conditions ~1,600 bps Better than National Median(1) Our care management platform allows for the right activity to begin at the right points in time
11 Our Technology-Driven Approach is Working 2 1 34 5 Grow Membership & Clover Assistant Usage Deliver Better AI Driven Clinical Recommendations Improve Health Outcomes & Quality of Life Reduce the Total Cost of Care Reinvest in Member Benefits
Our Opportunity
13 Medicare Advantage Membership(1) This Year: ~27% MA Membership Growth(1) (1) Medicare Advantage (MA) Membership as of the beginning of January for the years beginning 2024 and 2025. (2) Clover Health is currently paid on 3.5 Stars for Payment Year 2024 and 2025. Clover Health will be paid on 4.0 Stars for its flagship PPO plans in Payment Year 2026. The Company achieved a 4.0 Star Rating for Payment Year 2026 for its PPO plans. % of members in PPO plans is based on the month beginning January 2025 Clover Insurance membership. Positioned Well to Manage 2025 Membership ~95% of members enrolled in Clover 4-Star plan(2) Majority of new members switching from other MA plans Over 2/3s of net member growth in core NJ markets Expanded Home Care footprint in Georgia Strong retention + well-managed profitable cohort of returning members
14 Source: CMS, Kaiser Family Foundation. Note: Medicare and Medicare Advantage Enrollment in millions. (1) National market data from CMS CPSC data from December 2018 – December 2023: Within Medicare Advantage, PPO plans grew 2.3x the rate of HMO plans. Penetration percentages excludes other plan types, such as National PACE and PFFS. Meaningful Runway for MA Expansion MA Market Growth Consumers Prefer PPO Plans(1)Significant NJ Opportunity (1) (1) 63M 65M 68M 71M 75MMedicare Enrollment:
New Revenue Opportunity: Counterpart Health Brings Clover’s Care Model to More Plans & Providers 15(1) For returning Clover MA members whose PCPs use CA as compared to those whose PCPs do not. Strong product market fit with compelling pipeline Complementary offering to drive growth & profitability beyond Clover’s core MA markets Health outcomes improved via earlier identification, management, & treatment of disease More clinicians empowered with AI-powered proven technology New SaaS & Tech-Enabled Services revenue streams with low startup costs Improving Clinical Quality Improving MCR by 1,000+ bps(1)
Looking Ahead
Balance Profitability & Reinvestments: Continue to maintain Adjusted EBITDA(1) profitability, with thoughtful investment for growth into 2026 (including 4 Star benchmark tailwind)(2) Our Focus for 2025 17 Membership & Revenue Growth: Take advantage of MA market opportunity due to competitor pullback Better Clinical Quality & Outcomes: Maintain 4 Stars(2) and increase beneficiaries receiving CA powered care (1) Adjusted EBITDA is a non-GAAP financial measure. Please refer to Non-GAAP Financial Measures provided in the Appendix for a reconciliation of Adjusted EBITDA to Net Loss from continuing operations, the most directly comparable GAAP measure. 2024 Guidance is based on guidance provided in the Company’s November 6, 2024 earnings press release. (2) Clover Health is currently paid on 3.5 Stars for Payment Year 2024 and 2025. Clover Health will be paid on 4.0 Stars for its flagship PPO plans in Payment Year 2026. The Company achieved a 4.0 Star Rating for Payment Year 2026 for its PPO plans. % of members in PPO plans is based on the month beginning January 2025 Clover Insurance membership. Counterpart Health Expansion: Equip more clinicians, in more markets, with CA technology
Appendix
Longitudinal care to most at-risk; via CA-powered Physician-led pods Clover’s Approach Clinical, physician enablement, AI-Powered technology Earlier disease identification & management & subsequent care treatment Not focused on Risk Delegation Wide network PPO; Focused on affordability / accessibility Home Care Technology Differentiated, Tech-Centric Model Focused on Improving Clinical Care Outcomes via Software 19 Risk Delegation / Capitation Care Strategy (1) Represents third quarter year-to-date MCR and BER ratios for Clover Health, as well as most recent results of other public companies with “Traditional MA Plan” approaches that have reported results as of the time of this slide deck publication. (2) Insurance Benefits expense ratio (“BER”) is a non-GAAP financial measure. We calculate our Insurance BER by taking the total of Insurance net medical expenses incurred and quality improvements, and dividing that total by premiums earned on a net basis, in a given period. Please refer to Non-GAAP Financial Measures provided in Appendix A in the November 6, 2024 earnings press release for a reconciliation of BER to Insurance Net medical claims incurred, net, the most directly comparable GAAP measure. Network Construct Outsourced one-time visits; Primarily rely on nurses & nursing assistants Traditional MA Approaches InsurTech, back-office & administrative Delayed / reactive healthcare, and/or downstream risk delegation Large focus / reliance Majority HMO approach; Narrow choice Industry-leading loss ratios; MCR: 75.6% | BER: 80.6%(2) YTD 2024 Performance(1) Mid to high 80% loss ratios
20 Well-Rounded Management Team of Technology Experts & Seasoned Managed Care Professionals Vivek Garipalli Executive Chairman ______________________________________________________________________________________________ >20 years of healthcare & financial leadership Andrew Toy Chief Executive Officer __________________________________________________________________________________________________________________________________ >20 years of technology & healthcare leadership Peter Kuipers Chief Financial Officer _____________________________________________________________________________ >25 years of financial & technology leadership Jamie Reynoso Divisional CEO of Medicare Advantage _____________________________________________________________________________ >30 years of healthcare leadership Brady Priest Divisional CEO of Home Care _____________________________________________________________________________ >20 years in industry Aric Sharp Divisional CEO of Value Based Care _____________________________________________________________________________ >25 years in industry Conrad Wai Chief Technology Officer _____________________________________________________________________________ >15 years of technology experience Rachel Fish Chief People Officer _____________________________________________________________________________ >15 years in industry Wendy Richey Chief Compliance Officer _____________________________________________________________________________ >40 years in industry Karen Soares General Counsel _____________________________________________________________________________ >20 years of legal experience Theresa Mirell SVP, Business Enablement _____________________________________________________________________________ >15 years in industry
Designed to improve quality of care Having Supported Clinical Decision-Making for Thousands of Practitioners 21 Novel clinical insights at point-of-care Enhanced care coordination 100+ AI / ML models powering treatment recommendations Captures & synthesizes data from 100+ sources Generating millions of clinically oriented and personalized insights
22Note: Kidney Function measured via GFR (Glomerular Filtration Rate). (1) “Clover Assistant Use and Diagnosis and Progression of Chronic Kidney Disease” www.cloverhealth.com/clinicalcare/ckd Earlier Diagnosis Leads to Earlier Treatment Example: Chronic Kidney Disease ~1.5 years CA Patients Non-CA Patients Diagnosed CKD Stage 3 Diagnosed CKD Stage 3 Time (Years) CKD is diagnosed earlier and disease trajectory improves in patients seen by providers using Clover Assistant(1) K id ne y Fu nc tio n (G FR )
23 Note: This slide reflects our examination of data from Clover Health members who had no previously recorded diagnosis of diabetes, were flagged by the ‘at-risk’ algorithm in Clover Assistant, and where the clinician had a visit informed by Clover Assistant data (2018 - 2022) and the clinician confirmed diabetes. (1) Represents percentage (%) of pre-existing diagnoses similar in the two groups. (2) “Clover Assistant Use and Diagnosis, Treatment, and Progression of Diabetes” www.cloverhealth.com/clinicalcare/diabetes Days Since Clover Assistant Visit M em be rs N ew ly D ia gn os ed w ith D ia be te s (1 ) Earlier Diagnosis Leads to Earlier Treatment Example: Diabetes Patients started on oral diabetic medications after Clover Assistant raised potential diabetes diagnosis for physician consideration(2) D ia be te s M ed ic at io n Fi lls
24 Earlier Diabetes Treatment Leads to: Note: This slide reflects our examination of data from Clover Health members who had no previously recorded diagnosis of diabetes, were flagged by the ‘at-risk’ algorithm in Clover Assistant, and where the clinician had a visit informed by Clover Assistant data (2018 - 2022) and the clinician confirmed diabetes. (1) “Clover Assistant Use and Diagnosis, Treatment, and Progression of Diabetes” www.cloverhealth.com/clinicalcare/diabetes Better Management of Blood Sugar(1) Lower Use of Insulin(1) Lower Instances of Hypoglycemia(1) Oral Meds Started Oral Meds Started Non-CA Patients CA Patients Time (Years) B lo od S ug ar In di ca to r (H bA 1c ) Non-CA Patients CA Patients Pe rc en ta ge T ak in g In su lin Days Since Oral Meds Started Non-CA Patients CA Patients Pe rc en ta ge w ith H yp og ly ce m ia E ve nt Days Since Oral Meds Started
Medication fills increased by ~5% on the day of the Clover Assistant visit and remained ~3% higher 90 days post-visit among patients previously non-adherent to their medications for diabetes, high blood pressure, and high cholesterol(1) Days Since Visit 25 Note: Analyses examined data from Clover Health Medicare Advantage plan members from 2018, 2019, 2022, and 2023. We intentionally excluded data from 2020 and 2021 to minimize the impact of the COVID-19 pandemic’s disruption of the healthcare system, including medication-related behaviors. (1) “Clover Assistant Use and Medication Adherence for Common Chronic Conditions” www.cloverhealth.com/clinicalcare/medadherence Pe rc en t w ith M ed ic at io n Fi ll Clover Assistant Correlated with Improved Medication Adherence CA with Medication Adherence Feature CA without Medication Adherence Feature
26(1) The table above includes non-GAAP measures. Non-GAAP financial measures are supplemental and should not be considered a substitute for financial information presented in accordance with GAAP. For a detailed explanation of these non-GAAP measures, see Appendix A in the November 6, 2024 earnings press release. CLOVER HEALTH INVESTMENTS, CORP. RECONCILIATION OF NON-GAAP FINANCIAL MEASURES INSURANCE BENEFITS EXPENSE RATIO, NET (NON-GAAP) RECONCILIATION (in thousands)(1) Non-GAAP Financial Measures
27(1) The table above includes non-GAAP measures. Non-GAAP financial measures are supplemental and should not be considered a substitute for financial information presented in accordance with GAAP. For a detailed explanation of these non-GAAP measures, see Appendix A in the November 6, 2024 earnings press release. CLOVER HEALTH INVESTMENTS, CORP. RECONCILIATION OF NON-GAAP FINANCIAL MEASURES ADJUSTED EBITDA (NON-GAAP) RECONCILIATION (in thousands)(1) Non-GAAP Financial Measures (continued)
28 About Non-GAAP Financial Measures We use non-GAAP measures in this presentation, including Adjusted EBITDA, Adjusted SG&A, and Insurance BER. These non-GAAP financial measures are provided to enhance the reader’s understanding of Clover Health’s past financial performance and our prospects for the future. Clover Health’s management team uses these non-GAAP financial measures in assessing Clover Health’s performance, as well as in planning and forecasting future periods. These non-GAAP financial measures are not computed according to GAAP, and the methods we use to compute them may differ from the methods used by other companies. Non-GAAP financial measures are supplemental to and should not be considered a substitute for financial information presented in accordance with GAAP and should be read only in conjunction with our consolidated financial statements prepared in accordance with GAAP. Readers are encouraged to review the reconciliations of these non-GAAP financial measures to the comparable GAAP measures, which are included in the Appendix of this presentation, together with other important financial information included in our filings with the SEC and on the Investor Relations page of our website at investors.cloverhealth.com. For a description of these non-GAAP financial measures, including the reasons management uses each measure, please see Appendix A in the Company’s earnings press release, dated November 6, 2024: "Explanation of Non-GAAP Financial Measures."