Conference Transcript - CLOV 2026-03-10

Operator

Good morning, everybody. I think this is day two or three, technically I guess it started Sunday, day one, two, three of the Lyran Global Healthcare Conference. My pleasure to have the team from Clover Health here today. Ryan, Peter, thanks for joining us. I think, Peter, you wanted to run through some slides for a little bit and then we can get into some Q&A.

Peter Kuipers, CFO

Well, we're happy to be here with. Thank you for inviting us. Yeah, we'll start with a number of slides and then we'll do Q&A. Let's start with high-level framing. So we at Clover, we are an AI-powered Medicare Advantage plan. Technology for us is at the core of the design. Around 10 years ago, we designed the business model to start with clinical outcomes and technology supporting PCPs. at the point of care, at the time of care, enabling better health outcomes by earlier diagnoses, earlier and better treatment, better health outcomes, and also at lower total cost That model has been working now for a number of years in a repeatable manner. We scale it. You can see the last couple of years we have been EBITDA profitable. We're guiding this year with Conviction to also be GAAP net income profitable for 2026, while growing over 50 percent. This is fairly exceptional, we believe, from a delivery and execution perspective. And I'll go into what the underlying cohort economics and dynamics are to deliver these We have a strong market position. We have over 95% member retention, which we believe is market-leading. And we're also the number one PPO plan in the nation on quality HEDIS scores for the second year in a row. So this slide lays out the differences of our business model versus traditional Medicare Advantage players. So we focus to enable the clinician to perform at the top of their license, again enable them to earlier and better diagnose, treat earlier and better, with better health outcomes. And we do this on a wide network, which is differentiated, most of the market is on HMO work. We also do not delegate any risk, which means that we bear the burden in year one of new members that are unprofitable in year one, but are increasingly profitable as cohorts mature. So that's the downside, if you will. But we've demonstrated that for a number of years now that we can grow at a very high rate, take market share, and sustain even if they're profitable. So that is exceptional. I want to go back to the aging as well. So year one, we do take the loss of the new members, although that loss, as you see in the materials that we've published, is decreasing year over year. So we get to new members earlier. We make sure they get better care earlier as well. We don't delegate risk. It means that we take the loss in year one. However, we also get the full upside as cohorts mature, and that is a super important distinction to remember. We are also differentiated in a way that we have our own MD-led home care division that takes over the care, from a PCP perspective, for the highest acuity members in our population. And then lastly, again, the combination of growth and EBITDA profitability is exceptional in the industry. Here actually is an actual screenshot of the technology Clover Assistant. This is used by PCPs at the point of care, at the time of care. Clover Assistant connects over 100 data sources, medical data, most EHRs, most major EHRs, most pharma, most claims, most labs as well. But it goes beyond data. You can interchange and have interoperability with data, but data is just data. We have years and years of large data sets, use clinical data for real outcomes, so we have learned, the models have learned over time, and the software, the platform services and captures the key items and synthesizes for PCPs what to look for and what questions to ask. It enables them to perform the top of their license so that chronic diseases can be diagnosed earlier, treated earlier and better for better health outcomes. Our proprietary ML and AI models also deliver care management suggestions. The PCP still is responsible and makes the clinical choice for the treatment plan. However, we enable the physician not to only get a second opinion, a third opinion, etc., etc., thousands of opinions, essentially. are synthesized in our care management recommendations. This is all real-time at the point of care. We've published a number of white papers on diabetes, CHF, CKD, COPD, demonstrating that from an A-B testing perspective, if you look at a group that was not covered by Clover Assistant Technology versus a group that was, generally these chronic diseases are diagnosed almost 18 months to 36 months earlier, and, of course, also treated earlier. Results of that, of course, are better health outcomes. How do we measure that? Significant, significant reductions in hospitalizations or readmissions is one marker, for example. Here are the results. I won't go into the details on 25 or kind of 26. I would say, directionally, we are demonstrating, we have demonstrated that we can grow significantly materially above the market, take market share, have 95 percent plus retention, which is very, very important for member satisfaction, longitude of care also for our members, and, of course, also financially. It really underpins the core economics. So from a membership perspective, we expect to grow roughly 50 percent, revenue also growing about 50%, a significant increase in EBITDA that we have conviction in. And then also for this year, we have conviction that we will deliver our first full year of GAAP net income profitability. So here's a click down on the core economics. On the left side you see new members, on the right side you see returning members as a So you can see in 24 and 25, the loss per member per month for a new member. That is decreasing. The loss is decreasing. So acquisition cost is decreasing. We get to new members earlier. We get them on care management plans earlier as well, specifically the high acuity patients. All the returning members, there you see, of course, the power of the model. Once PCPs get to our members earlier, better treatment, better health outcomes, over time, it's also lower total cost of care. And that's where you see the margin expansion. So there's a lot of earnings power in the model. You can estimate different growth rates in the future over multiple years. We've given the data points here. There's a lot of earnings power in the model here. For 26, on the right side, you see the drivers of the growth on the profitability perspective four star payment year we have in 2026 that said I want to be really clear that we have designed the model to be efficient and profitable and growing at the same time also three and a half stars so four star is a tillow in for 26 but we're not dependent on the four star rating of Of course, there is the final rate notice for data service 26, which is favorable. Again, we have leading member retention at 95 percent plus. We're extending and expanding the Clover Assistant coverage. We are now the market leader in the state of New Jersey from a PPO plan perspective, individual PPO plan perspective. We're really happy and excited, actually, about the growth that we had during the last AAP, the growth actually was executed in specifically the areas where we wanted the growth, where we have PCP coverage already, where we have the panels already, where we have home care, where we already have members. So that expansion, if you will, of the membership base in the right geographies, in the right plans, we're excited about. First indications in the year already, we talked about it on the earnings call. a couple of weeks ago, definitely showed that the member profile from an MMR perspective is in line with what we planned for. So we're really pleased there. And then lastly, we will continue, we are continuing to be more efficient from an STNA perspective. We delivered a couple of basis points of leverage on STNA this year, again last year. And then this year, we're aiming to be 100 to 150 basis points of additional leverage on SDNA as well. So we're excited about executing this year. We're excited about the new members joining us. We're excited about scaling the business. Here's another click down just on the cohort economics as well. On the left side, you see the cohort economics for the total member group. So, that includes members that are covered by PCPs that are using our software, our Clover Assistant platform, but also the around 30 percent that is not covered by PCPs using the software. So, also, there you see the gross profit expansion on a weighted total basis. If we then click down and really look only at the group, the 70 percent, roughly, that is covered by Clover Assistant, you really see the expansion here of a couple hundred basis points every single year and the last if you model that out from a visual perspective you can see the leverage it's growing membership driven by the 95% retention driven by the lowering of total cost of care over time very powerful model in earnings weeks ago we said that we believe that we can compound earnings over time as well over the next couple of years so we're excited about where we are we're excited about executing we're excited about bringing what we believe is the best healthcare and Medicare Advantage to more and more members. Not a specific page in the deck here, but we're also extending the possibility of using our software for other health plans and risk-bearing providers as well. What we said in the earnings comments was that our near-term target is to have an equal number of patients or members covered by the third-party software offering that we have called Clover, sorry, counterpart, the counterpart business, to equal to the number of members that we have in the plan. And that's in the near term. Not by the end of the year, but also not three years out. So with that, we're happy about the growth, happy about the earnings potential, happy about execution in 26.

Operator

Can we go back to the cohort slide for a minute? I just want to make sure that I can't read the footnote here. I just want to make sure I get the—no, no, no, not this one. Yes, this one right here. When I look at the differential in MCR, is that taking year one—like, what's the definition of year one, two, three, four, just to make sure I get this right?

Peter Kuipers, CFO

Is this the— So, year four is the—that's the member group that's in their fourth year of being with Clover. How far back does that go?

Operator

GREG BRUDNICKI, This goes back, think about, we got history, probably eight, nine years, We don't show year five, six, seven, eight here, but it's the— And if I could see, like, the dots around, like, year four, the clusters, how tight are Is it pretty tight around 20 percent?

Peter Kuipers, CFO

It's directionally very predictable. GREG BRUDNICKI, It runs that clockwork from a cohort perspective. So the key, again, is the 95% plus retention, making sure that we, of course, have expanded PCP coverage, and then keep building the platform from a technology perspective.

Operator

Let's maybe go back to AEP. You guys have had a very strong year in terms of overall membership growth. Both you cited, you know, 95% retention, which is certainly better than what we hear from many of the other traditional MA plans around, you know, 85-ish. Or 80% even. Or even 80%. Just any other observations you could share on the new members that you're picking up? You know, are there any particular plans that you feel like you're seeing more of those lives? and maybe just commentary around traditionally what do you see in terms of RAF on those switchers? Just any other thoughts would be helpful.

Peter Kuipers, CFO

Yeah, so what we saw in the last AEP, so again, that's the growth season, October through December last year, and these members joined January 1, 26. 85% of the new members are actually switchers that have a medical history that we can obtain also, of course, from the plan that they leave. that actually is about 500 basis points higher than the last AP, so it shows that our benefit of plan design and offering of the network design and the clinical benefits are very, very compelling in the market. From a kind of characteristics of the group joining, what we see in the MMRs for January and February is essentially spot on in what we planned from a member perspective. And then we're also happy about where the members joined. Again, And it's an expansion of the areas that we were already in. So the member panels expand, already have PCP coverage there, and already have home care there. So the power of the network and the model really shows. Okay.

Operator

Do you see more switching in New Jersey? When you look at just the New Jersey market, I'm curious. Are you seeing more members switching from HMO to PPO or some of your new members? the majority is still PPO switches okay you said something about the MMO MMR file yeah talking about the January premium payments and stuff exactly yeah February as well okay in February so all consistent with what you would have thought that gives you a really good call for you and insight into the risk adjustment on those those members it's okay yeah how are you feeling about how you priced this year and the underlying expectations around cost trend based on what you've seen thus far?

Peter Kuipers, CFO

Yeah, so for the bid for 26, we've applied, of course, underwriting discipline. We've priced similar to the general FFS fee-for-service trends and did not assume a trend improvement from that perspective. So we feel good about how we priced.

Operator

What was cost trend? Remember, remind me, cost trend last year, what was it?

Peter Kuipers, CFO

Well, for us, for medical, so Part C, so excluding pharmacy, for us it was slightly below 5%. And I believe the industry was high single digits, maybe depending on the mix.

Operator

Could be also been low double digit. So let's just say five to keep it easy. And then you bid, I think, this year for something greater than five on medical costs, right?

Peter Kuipers, CFO

Exactly. Yeah, we're not disclosing the exact percentage, but yes.

Operator

Any color around pharmacy trend last year and expectations this year?

Peter Kuipers, CFO

It's the second year of the IRA changes, of course. I think, you know, most plants are probably learning with the new model as well. So I think I would say we have initiatives around pharmacy, on PBM, as far as transparency, on pricing, on rebates, on velocity, on formulary management. So we definitely see improvements also for us there.

Operator

Okay. And it sounds like you feel good about what you're seeing in terms of cost trend thus far. I actually want to spend a second on the home care division. I don't think investors, at least that I speak to, probably have a full appreciation for what you've developed there around your capabilities. So maybe just elaborate a bit on what you're doing, maybe how that strategy has evolved over time.

Peter Kuipers, CFO

Yeah, thank you for that. That's a great question. So for the highest acuity patients in our membership group, we actually have our home care division, led by doctors, mostly MDs, that actually take over the primary care of this patient, of this member, actually visits the patient at the home. So that is really direct care. And then also, our own physicians are using the same software, the same Clover Assistant platform. So the full medical history is there. The best recommendations are there as well. So that is a big distinction versus other players in the market as well. And we believe this leads to better health outcomes as well, of course.

Operator

So all physicians, are you not sending home health aides or nurses as well? The pods are led by NDs and DOs. Got it. Stars, let's maybe talk about this for a minute. You're going to get your quality bonus payment this year. How do we think about the incremental flow through that you get? It's never the five. It's less than the five. There's some math there. It's in the threes, and it depends. There's weird stuff that goes on in that calculation. But you're also, at the same time, making investments. So I'm trying to think about what that net potential tailwind is that you're going to get this year.

Peter Kuipers, CFO

So it's baked into the guidance, the tailwind, first of all. And you're right, there's a certain tradeoff and add back to the benefits. So it's not a full flow-through. We haven't broken it out, but it's definitely a significant tailwind year-over-year.

Operator

Okay. You had a slide in there talking about the G&A leverage this year. Any more investments that we should be mindful of that you're making that are perhaps different than prior years?

Peter Kuipers, CFO

Yeah. So in the earnings call a couple of weeks ago, we did emphasize that we want to retain flexibility on SG&A, specifically as we see opportunities and accelerated momentum momentum on the counterpart side. So in the current economic environment in MA, other players might and will, we think, need the help of our platform. So as that momentum continues, we might decide to incrementally invest in counterparts and accelerate. And to be clear, so the product development in R&D is actually classified geographically within SG&A from a definition perspective. So that's included there as well.

Operator

Maybe just spend a minute on Counterpart. You announced that you were creating an external commercial SaaS product, and I know that you've made some inroads with resparing groups, perhaps some health plans and others. There hasn't been a lot of new news flow, but I know there's a lot of activity. So maybe just a general update around the traction that you're seeing in the marketplace and confidence that we may see, you know, some business wins this year.

Peter Kuipers, CFO

Yes, from a momentum perspective, we're excited about the momentum that we see, not only in the pipeline, but also engagements that we're scaling, and the networks that we're building from that perspective and the adoption that we see, we think about the adoption in a couple different layers. So first it's the logo. We cannot always disclose the logo from an NDA perspective. So first get the logo, then get PCP practices signed up to use the software, and then those PCP practices will have members come in, covered by this logo, the plan, if you will, for a first visit. And then, of course, the flywheel starts to run and rotate and accelerate. And then we'll sign up more PCP practices. We might expand to other regions, right? So like if you look at Metrics, the way I look at it from a CFO head perspective and capital allocation perspective, first it's the logo. Second, it's the number of practices of PCPs. Then it's the number of members covered theoretically by the software. Then those members come in. then they're truly covered by it, and our economic model starts to work, and then over time, the geographical areas can expand as well, right? So what we said publicly is that we believe that the number of members or patients covered by counterpart will equal the number of members in our own MA plan in the near term. So not three years, also not the end of the year. We believe it's somewhere in between. You can also look at the open positions that we have and where we hire. that could give you an indication of the traction as well. So, again, excited there. It's not big enough from just a revenue perspective, but the other metrics that I just talked about are tracking to ultimately also disclose kind of financial metrics.

Operator

So if I'm a—I get it on, like, the risk—like, if I'm a risk-bearing medical group, I see how this is like clearly deployed you know right there with the physicians that are employed aligned affiliated with the medical group. If I'm a health plan I use counterpart. How do I incentivize the physicians to use the technology to drive the outcomes that you want? Is it a similar economic model to like how you use it today?

Peter Kuipers, CFO

Exactly.

Operator

It's the same model. yeah okay um advanced notice we're obviously sitting here within less than a month of probably getting the the final rate notice um disappointing i'd say to the majority of participants stakeholders within the industry and investors there were some that actually called it um what's generally your expectations and thoughts as we kind of head into april So, yeah, just on the number itself, the expectation for the final rate notice, we haven't kind of given the number.

Peter Kuipers, CFO

I know others are thinking between 200 basis points and maybe in the upside case up to 500 basis points of a higher final rate notice versus the preliminary rate notice. We're not necessarily commenting on what we feel. It likely will be slightly higher, we believe. That said, though, we're not relying, from our model perspective that we just talked about and walked through, on annual rate increases. We actually welcome, from a strategic perspective, an almost flat rate increase, because it will show the strength of our model.

Operator

And so your view on the—your basic—we're less cyclical as it relates to kind of the annual rate environment, and that's driven by your confidence level on cohorts and cost trend and being able to do all of— exactly that stuff yeah yeah we have favorable unit economics and that's the strength of our growth yeah and cms proposed you know this unlinked chart review thing and you feel pretty confident that you're not going to see as much of a headwind as the one and a half percent number or whatever um maybe just elaborate a little bit more on on that yeah exactly we believe we're less impacted

Peter Kuipers, CFO

it because of our model, because we have the Clover system platform. We have the medical data. We have the medical interactions and counter-based. So not after the fact. It's our data right there, if you will. So we believe we're much less impacted than others.

Operator

Have you given an update on the percentage of your members that are in a panel with a physician that's using the Clover assistant technology? I can't remember if you've updated that in a while. Of the total population? Yeah, of the total members.

Peter Kuipers, CFO

Around 70% of our total member group is covered by physicians using the software. Yeah, okay. Around that number. So, again, we're scaling that with 53% new members this year. We're aiming to keep that percentage at that same level. Which is exceptional, but it's also very achievable if you think about where the growth actually occurred, what I talked about earlier, growth actually was in the areas that we wanted the growth where we already have PCP practices using the software. So in many cases, it's simply just the same physician practice, the same physician, just among his or her members in the population in his or her panel, there's more Clover members.

Operator

CMS in the technical notice back in November, I was just thinking about this, you know this better than I, when they proposed the potential elimination of 12 measures and star ratings and those measures a lot of the plans do very well on and when we analyzed it for a number of them, it certainly is kind of a headway. How do you look at the potential for that change and what that might mean for your overall raw STARS score?

Peter Kuipers, CFO

Yeah, so from a STARS perspective, we've always believed and we believe that STARS should mostly be focused on clinical outcomes. So, we talked earlier about the HEDIS quality scores. We're the strongest in the nation there. So, we believe, you know, overall, that's a direction that we support. It would be beneficial for just our STARS ratings. But I think more importantly, we care about our members. who care about the health of our members, and health outcomes.

Operator

I think it's well known that there's, you know, you've got a STARS lawsuit. I'm not asking you to comment on details of that, but just in terms of the process, is there any update on the progression of how that case is moving through the court system? It is no. There's no update. No update. Okay. Strike. Miss. Okay. We'll see if there's any questions in the audience at this point. Peter, anything I haven't asked that you want to share, make sure that investors are dialed I think you covered it all.

Peter Kuipers, CFO

Again, we're excited. Not all.

Operator

Almost all. Try to hit on some of the highlights. Well, good. We can just wrap it up there. Thank you very much. Good to see you man.