Medicare Advantage insurer Clover Health believes its AI assistant platform has positioned the company toward success next year.
Just months after its first quarterly net profit, Clover posted a net loss of $8.8 million. That is a 73.8% year-over-year improvement from last year’s third quarter results, when the company lost $33.6 million.
But Clover is uniquely positioned for next year for membership growth and market share expansion, executives said during an earnings call.
In markets where Clover doesn’t offer an MA plan, subsidiary Counterpart Health’s proprietary AI will be deployed.
“Clover’s plans have almost no traditional value-based contracts or delegated risk,” said CEO Andrew Toy. “Instead what we focus on is having physicians use Clover Assistant, which acts as a GPS for physicians to better manage MA, total cost of care and quality.”
The company will spend in areas to support the annual enrollment period and in research and development to improve member outcome, said CFO Peter Kuipers.
Toy and Kuipers also highlighted the company’s strong star ratings and HEDIS performance measure results. The company will receive a 5% quality bonus to benchmark rates for payment year 2026.
Since star ratings were released, the company has fielded more interest in Counterpart from potential clients.
“Not only do we offer strong performance, but what others find particularly compelling is that we specialize in improving the performance of wide network, fee-for-service independent physicians,” Toy added. “Most managed care entities have no real solution for this component of the care ecosystem.”
Clover’s results largely fell inline with analyst expectations. Its earnings per share for the quarter is -0.03 and total revenue is $331 million.
The company is slightly improving its full-year guidance. Insurance medical cost ratio is expected to end between 76% and 77%. Adjusted EBITDA will be at least $55 million, raising the floor initially anticipated.
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