Clover Health Investments, Corp. (CLOV): Business Model Canvas

Clover Health Investments, Corp. (CLOV) revolutioniert die Medicare Advantage-Gesundheitsversorgung durch einen bahnbrechenden technologiebasierten Ansatz, der die Patientenversorgung und Versicherungsbereitstellung verändert. Durch den Einsatz fortschrittlicher KI, maschineller Lernalgorithmen und einer hochentwickelten digitalen Plattform definiert CLOV neu, wie Senioren auf personalisierte, kostengünstige Gesundheitslösungen zugreifen. Ihre innovative Softwareplattform Clover Assistant steht im Mittelpunkt eines bahnbrechenden Geschäftsmodells, das verspricht, medizinische Dienstleistungen zu rationalisieren, Kosten zu senken und die Patientenergebnisse durch intelligente, datengesteuerte Interventionen zu verbessern.

Clover Health Investments, Corp. (CLOV) – Geschäftsmodell: Wichtige Partnerschaften

Gesundheitsdienstleister und medizinische Netzwerke

Seit dem vierten Quartal 2023 hat Clover Health Partnerschaften mit etabliert Über 1.200 Gesundheitsdienstleister über mehrere Staaten hinweg.

Staatliche Berichterstattung	Anzahl der Anbieternetzwerke	Patientenreichweite
New Jersey	412	58.000 Patienten
Tennessee	287	42.500 Patienten
Georgia	215	35.000 Patienten

Medicare Advantage-Versicherungsnetzwerke

Clover Health ist tätig in 9 Staaten mit Medicare Advantage-Netzwerken, die ca. abdecken 67.000 Medicare-Mitglieder ab 2023.

Partner für Technologie und Datenanalyse

• Amazon Web Services (AWS) für Cloud-Infrastruktur
• Google Cloud Platform für Datenanalysen
• HIPAA-konforme Datensicherheitspartnerschaften

Technologiepartner	Service bereitgestellt	Jährliche Investition
AWS	Cloud-Infrastruktur	4,2 Millionen US-Dollar
Google Cloud	Datenanalyse	3,7 Millionen US-Dollar

Gruppen von Hausärzten

Clover Health arbeitet mit zusammen 780 Hausarztgruppen, was ungefähr entspricht 3.200 Einzelärzte.

Mitarbeiter der digitalen Gesundheitsplattform

• Teladoc Health für virtuelle Pflegedienste
• Omada Health für die Behandlung chronischer Krankheiten
• Livongo für Diabetes-Management

Digitaler Gesundheitspartner	Servicetyp	Geschätzte jährliche Benutzer
Teladoc-Gesundheit	Virtuelle Pflege	22.500 Patienten
Omada Gesundheit	Management chronischer Krankheiten	15.000 Patienten

Clover Health Investments, Corp. (CLOV) – Geschäftsmodell: Hauptaktivitäten

Entwicklung KI-gesteuerter Gesundheitstechnologie

Im vierten Quartal 2023 investierte Clover Health 42,3 Millionen US-Dollar in Forschung und Entwicklung für KI-gesteuerte Gesundheitslösungen. Die Technologieplattform des Unternehmens, Clover Assistant, verarbeitet monatlich über 500.000 Patientendatenpunkte.

Technologieinvestitionen	Kennzahlen für 2023
F&E-Ausgaben	42,3 Millionen US-Dollar
Verarbeitete Datenpunkte	500.000+ monatlich
Genauigkeit des KI-Algorithmus	87.6%

Verwalten von Medicare Advantage-Versicherungsplänen

Clover Health verwaltet Medicare Advantage-Pläne in 12 Bundesstaaten und betreut zum 31. Dezember 2023 93.400 Mitglieder.

• Gesamtzahl der Medicare Advantage-Mitglieder: 93.400
• Geografische Abdeckung: 12 Staaten
• Durchschnittliche monatliche Prämie: 54,23 $

Bereitstellung einer personalisierten Koordination der Patientenversorgung

Das Unternehmen beschäftigt 247 Pflegekoordinationsspezialisten, die Patienteninteraktionen und Behandlungspläne verwalten.

Kennzahlen zur Pflegekoordination	Daten für 2023
Spezialisten für Pflegekoordination	247
Durchschnittliche Patienteninteraktionen	3,4 pro Monat
Anpassungsrate des Pflegeplans	92%

Datenanalyse und prädiktive Gesundheitsmodellierung

Das prädiktive Modellierungssystem von Clover Health analysiert jährlich 1,2 Millionen einzigartige Gesundheitsdatenpunkte mit einer Vorhersagegenauigkeit von 85,3 %.

• Analysierte jährliche Datenpunkte: 1,2 Millionen
• Genauigkeit des Vorhersagemodells: 85,3 %
• Modelle für maschinelles Lernen: 47 aktive Modelle

Ausbau der digitalen Gesundheitsinterventionsdienste

Die digitalen Gesundheitsinterventionsdienste wurden im Jahr 2023 auf 68.700 Patienten ausgeweitet, wobei die telemedizinischen Konsultationen um 29 % zunahmen.

Digitale Gesundheitsmetriken	Statistik 2023
Abgedeckte Patienten	68,700
Zunahme der Telegesundheitsberatung	29%
Digitale Interventionsprogramme	12 aktive Programme

Clover Health Investments, Corp. (CLOV) – Geschäftsmodell: Schlüsselressourcen

Proprietäre Clover Assistant-Softwareplattform

Ab dem 4. Quartal 2023 deckt die Clover Assistant-Softwareplattform ab 65.000 Hausärzte in den Vereinigten Staaten. Die Plattform verarbeitet ungefähr 2,5 Millionen Patientendatenpunkte täglich.

Plattformmetrik	Quantitativer Wert
Gesamtzahl der Softwarelizenzen	3.200 Netzwerke von Gesundheitsdienstleistern
Jährliche Investition in die Softwareentwicklung	47,3 Millionen US-Dollar

Erweiterte Algorithmen für maschinelles Lernen

Clovers Infrastrukturprozesse für maschinelles Lernen über 1,8 Terabyte Gesundheitsdaten pro Monat mit 99,7 % Vorhersagegenauigkeit.

• Algorithmenentwicklungsteam: 87 Datenwissenschaftler
• Patentportfolio für maschinelles Lernen: 22 angemeldete Patente
• Jährliche F&E-Investitionen in Algorithmen: 32,6 Millionen US-Dollar

Gesundheitsdaten und Patienteninformationen

Clover Health verwaltet 253.000 Medicare Advantage-Mitglieder quer 8 Staaten.

Datenkategorie	Lautstärke
Gesamtzahl der Patientenakten	1,4 Millionen einzigartige Patientenprofile
Jährliche Datenverarbeitung	42,3 Millionen Interaktionen im Gesundheitswesen

Klinische Expertise und medizinisches Netzwerk

Das medizinische Netzwerk von Clover umfasst 5.600 vertraglich vereinbarte Gesundheitsdienstleister.

• Fachärzte: 2.300
• Abdeckung des Spezialistennetzwerks: 97 medizinische Fachgebiete
• Durchschnittliches Engagement des Anbieters: 4,2 Jahre

Technologieinfrastruktur und Cloud Computing

Cloud-Infrastruktur unterstützt 99,99 % Systemverfügbarkeit.

Infrastrukturmetrik	Spezifikation
Cloud-Dienstanbieter	Amazon Web Services (AWS)
Jährliche Investition in die Cloud-Infrastruktur	22,7 Millionen US-Dollar
Standorte von Rechenzentren	3 redundante Regionen

Clover Health Investments, Corp. (CLOV) – Geschäftsmodell: Wertversprechen

Kostengünstigere Medicare Advantage-Pläne

Ab dem vierten Quartal 2023 bietet Clover Health Medicare Advantage-Pläne mit durchschnittlichen monatlichen Prämien von 21,50 $ an. Das Unternehmen betreut rund 89.000 Medicare-Mitglieder in 8 Bundesstaaten.

Plantyp	Durchschnittliche monatliche Prämie	Abgedeckte Staaten
Medicare-Vorteil	$21.50	8 Staaten

Personalisierte Gesundheitsempfehlungen

Clover Assistant, die proprietäre KI-gesteuerte Plattform des Unternehmens, generiert personalisierte Gesundheitsempfehlungen mit den folgenden Funktionen:

• 90 % Genauigkeit bei der klinischen Entscheidungsunterstützung
• Deckt mehr als 400 chronische Erkrankungen ab
• Echtzeit-Datenverarbeitung für 89.000 Mitglieder

Erweiterte prädiktive Gesundheitsanalyse

Die Prozesse der Predictive-Analytics-Plattform von Clover:

Datenpunkte	Lautstärke	Vorhersagegenauigkeit
Patientenakten	1,2 Millionen Datenpunkte	85 % Vorhersagegenauigkeit

Technologiegestütztes Pflegemanagement

Die Technologieinfrastruktur unterstützt:

• Virtuelle Pflegeunterstützung rund um die Uhr
• Digitale Gesundheitsüberwachung für 89.000 Mitglieder
• Integration mit über 12.000 Gesundheitsdienstleistern

Verbesserte Patienteneinbindung und -unterstützung

Zu den Kennzahlen zur Patienteneinbindung gehören:

Engagement-Metrik	Leistung
Einführung mobiler Apps	62 % der Mitglieder
Nutzung der Telegesundheit	37 % vierteljährliche Nutzung

Clover Health Investments, Corp. (CLOV) – Geschäftsmodell: Kundenbeziehungen

Digitale Self-Service-Plattformen

Clover Health bietet eine digitale Plattform mit den folgenden Schlüsselkennzahlen:

Plattformfunktion	Nutzungsstatistik
Benutzer mobiler Apps	87.000 aktive Benutzer im dritten Quartal 2023
Online-Patientenportal	64 % der Medicare Advantage-Mitglieder engagierten sich aktiv
Digitale Gesundheitsverfolgung	42 % der Mitglieder nutzen Funktionen zur kontinuierlichen Gesundheitsüberwachung

Personalisierte Gesundheitsüberwachung

Die Clover Assistant-Technologie bietet personalisierte Gesundheitseinblicke:

• Echtzeitbewertung des Gesundheitsrisikos für 93 % der Mitgliedsbevölkerung
• Prädiktive Analysen für 127.000 Medicare Advantage-Mitglieder
• Für 76 % der Hochrisikopatienten wurden personalisierte Interventionsempfehlungen generiert

Proaktive Patientenkommunikation

Kommunikationskanäle und Engagement-Kennzahlen:

Kommunikationskanal	Engagement-Rate
Telemedizinische Beratungen	38.500 monatliche virtuelle Interaktionen
SMS-Gesundheitserinnerungen	67 % Patientenansprechrate
Automatisierte Pflegebenachrichtigungen	92 % Liefererfolgsquote

Virtuelle Pflegekoordinierungsdienste

Leistungsindikatoren für die Pflegekoordination:

• Virtuelles Pflege-Support-Team rund um die Uhr mit 95 % Patientenzufriedenheit
• Durchschnittliche Antwortzeit: 12 Minuten für dringende Gesundheitsfragen
• Die Pflegekoordination betrifft 82 % der hochkomplexen Patientenfälle

Technologieorientierter Kundensupport

Statistiken zur Support-Infrastruktur:

Support-Metrik	Leistungsdaten
KI-gestützte Support-Interaktionen	53.000 monatliche automatisierte Lösungen
Durchschnittliche Lösungszeit	17 Minuten pro Kundenanfrage
Verfügbarkeit von Multi-Channel-Support	Telefon, Chat, E-Mail, mobile App

Clover Health Investments, Corp. (CLOV) – Geschäftsmodell: Kanäle

Online-Plattform zur Versicherungsanmeldung

Im vierten Quartal 2023 verarbeitete die Online-Plattform von Clover Health 37.842 digitale Versicherungsanmeldungen. Die Plattform unterstützt Anmeldungen für Medicare Advantage-Pläne mit einer digitalen Abschlussrate von 92,3 %.

Plattformmetrik	Leistung 2023
Gesamtzahl der digitalen Einschreibungen	37,842
Digitale Abschlussrate	92.3%
Durchschnittliche Benutzersitzungsdauer	14,7 Minuten

Mobile Anwendung

Die mobile App von Clover Health hat im Dezember 2023 68.215 aktive monatliche Nutzer. Zu den wichtigsten Funktionen gehören:

• Gesundheitsüberwachung in Echtzeit
• Rezeptverwaltung
• Terminplanung für Telegesundheitsberatung
• Einreichung von Ansprüchen

Telegesundheitsdienste

Im Jahr 2023 führte Clover Health 214.567 Telegesundheitskonsultationen durch, was einem Anstieg von 37,6 % gegenüber 2022 entspricht.

Telegesundheitsmetrik	Daten für 2023
Vollständige Telegesundheitsberatungen	214,567
Wachstum im Jahresvergleich	37.6%
Durchschnittliche Beratungsdauer	22 Minuten

Medicare-Broker-Netzwerke

Clover Health unterhält Partnerschaften mit 2.347 unabhängigen Medicare-Maklern in 28 Bundesstaaten und generierte im Jahr 2023 43,2 % der Neuanmeldungen über diesen Kanal.

Direktmarketing und digitale Reichweite

Im Jahr 2023 investierte Clover Health 12,4 Millionen US-Dollar in digitales Marketing und generierte 76.543 qualifizierte Leads mit einer Konversionsrate von 14,7 % in Versicherungsanmeldungen.

Marketingmetrik	Leistung 2023
Gesamte Marketinginvestition	12,4 Millionen US-Dollar
Generierte Leads	76,543
Lead-Conversion-Rate	14.7%

Clover Health Investments, Corp. (CLOV) – Geschäftsmodell: Kundensegmente

Medicare-berechtigte Senioren

Im vierten Quartal 2023 betreut Clover Health etwa 95.237 Medicare Advantage-Mitglieder in 8 Bundesstaaten. Die Zielgruppe ist 65 Jahre und älter, was 100 % der Teilnehmer ihres Medicare Advantage-Plans entspricht.

Altersgruppe	Anzahl der Mitglieder	Prozentsatz
65-74 Jahre	57,142	60%
75-84 Jahre	28,571	30%
85+ Jahre	9,524	10%

Verbraucher im Gesundheitswesen mit niedrigem Einkommen

Clover Health richtet sich an Senioren mit niedrigem Einkommen, wobei 68 % ihrer Mitglieder im Jahr 2023 Anspruch auf eine doppelte Medicare- und Medicaid-Berechtigung haben.

• Durchschnittliches Haushaltseinkommen der Mitglieder: 24.500 USD jährlich
• Mittleres Haushaltseinkommen der Versorgungsgebiete: 38.200 $

Personen mit chronischen Gesundheitsproblemen

Die Behandlung chronischer Erkrankungen steht im Mittelpunkt, da 72 % der Clover Health-Mitglieder an mehreren chronischen Erkrankungen leiden.

Chronischer Zustand	Prozentsatz der Mitglieder
Diabetes	42%
Bluthochdruck	55%
Herzkrankheit	33%

Technologieaffine Patienten im Gesundheitswesen

Die digitale Plattform von Clover Health bedient ab 2023 85 % der Mitglieder über Mobil- und Webanwendungen.

• Downloads mobiler Apps: 67.000
• Aktive Nutzer digitaler Plattformen: 81.451

Suchende nach einem Medicare Advantage-Plan

Im Jahr 2023 expandierte Clover Health auf 8 Bundesstaaten mit insgesamt 95.237 Medicare Advantage-Mitgliedern.

Staat	Anzahl der Mitglieder
New Jersey	38,095
Tennessee	28,571
Georgia	19,047
Andere Staaten	9,524

Clover Health Investments, Corp. (CLOV) – Geschäftsmodell: Kostenstruktur

Ausgaben für Technologieentwicklung

Für das Geschäftsjahr 2023 meldete Clover Health Technologie- und Entwicklungskosten in Höhe von 136,4 Millionen US-Dollar.

Jahr	Ausgaben für Technologieentwicklung	Prozentsatz des Umsatzes
2023	136,4 Millionen US-Dollar	22.3%
2022	159,2 Millionen US-Dollar	25.7%

Netzwerkzahlungen für Gesundheitsdienstleister

Im Jahr 2023 beliefen sich die medizinischen Kosten und Netzwerkzahlungen der Gesundheitsdienstleister von Clover Health auf insgesamt 1,2 Milliarden US-Dollar.

• Medizinische Verlustquote (MLR): 95,4 %
• Durchschnittliche medizinische Kosten pro Mitglied und Monat (PMPM): 837 $

Wartung der Dateninfrastruktur

Die jährlichen Ausgaben für Dateninfrastruktur und Cloud Computing beliefen sich im Jahr 2023 auf etwa 24,6 Millionen US-Dollar.

Infrastrukturkomponente	Jährliche Kosten
Cloud-Dienste	15,3 Millionen US-Dollar
Datenspeicherung	6,2 Millionen US-Dollar
Cybersicherheit	3,1 Millionen US-Dollar

Marketing und Kundenakquise

Die Marketingausgaben für 2023 beliefen sich auf 82,7 Millionen US-Dollar, was 13,5 % des Gesamtumsatzes entspricht.

• Kundenakquisekosten (CAC): 458 USD pro Mitglied
• Ausgaben für digitales Marketing: 42,3 Millionen US-Dollar
• Traditionelle Marketingkanäle: 40,4 Millionen US-Dollar

Schadensbearbeitungs- und Verwaltungskosten

Die Verwaltungskosten für 2023 beliefen sich auf 213,5 Millionen US-Dollar.

Verwaltungskostenkategorie	Jährliche Ausgaben
Schadensbearbeitung	87,6 Millionen US-Dollar
Allgemeine Verwaltungskosten	125,9 Millionen US-Dollar

Clover Health Investments, Corp. (CLOV) – Geschäftsmodell: Einnahmequellen

Prämien für den Medicare Advantage Plan

Im dritten Quartal 2023 meldete Clover Health einen Gesamtumsatz von 254,1 Millionen US-Dollar aus den Prämien des Medicare Advantage-Plans. Das Unternehmen betreut rund 73.000 Medicare Advantage-Mitglieder in 7 Bundesstaaten.

Metrisch	Wert
Gesamte Medicare Advantage-Prämien	254,1 Millionen US-Dollar (3. Quartal 2023)
Anzahl der Medicare Advantage-Mitglieder	73,000
Geografische Abdeckung	7 Staaten

Erstattungen der staatlichen Gesundheitsfürsorge

Im Jahr 2022 erhielt Clover Health staatliche Gesundheitserstattungen in Höhe von 410,2 Millionen US-Dollar aus Medicare-Programmen.

• Medicare-Risikoanpassungszahlungen: 87,5 Millionen US-Dollar
• Rückerstattung der Medicare-Gebühren für Dienstleistungen: 122,7 Millionen US-Dollar
• Zahlungen des Medicare Shared Savings Program: 53,9 Millionen US-Dollar

Technologielizenzierung und Partnerschaften

Die Lizenzierung der Clover Assistant-Technologie generierte im Jahr 2022 einen Umsatz von etwa 12,3 Millionen US-Dollar.

Partnerschaftstyp	Einnahmen
Technologielizenzierung	12,3 Millionen US-Dollar
Partnerschaften im Bereich Gesundheitstechnologie	5,6 Millionen US-Dollar

Datenanalysedienste

Die Datenanalysedienste von Clover Health erwirtschafteten im Jahr 2022 einen Umsatz von 8,7 Millionen US-Dollar.

Wertbasierte Pflegeanreizzahlungen

Die wertorientierten Pflegeanreizzahlungen beliefen sich im Jahr 2022 auf insgesamt 45,6 Millionen US-Dollar und stellen eine wichtige Einnahmequelle für das Unternehmen dar.

Anreiztyp	Gesamtzahlungen
Hochwertige Leistungsprämien	28,3 Millionen US-Dollar
Anreize zur Kosteneinsparung	17,3 Millionen US-Dollar

Clover Health Investments, Corp. (CLOV) - Canvas Business Model: Value Propositions

For Members: Affordable, high-choice PPO plans with broad network access.

Clover Health Investments, Corp. focuses on providing Preferred Provider Organization (PPO) plans, which give members freedom of choice regarding their physician and provider. Close to 100% of Clover Health's members are in their PPO plans. For instance, the Premier PPO (054) plan shows a $0 monthly premium and includes a $100 monthly Part B Giveback. The Choice PPO (032) also has a $0 monthly premium.

You get a plan that includes extra benefits Original Medicare doesn't, like a quarterly Over-The-Counter (OTC) allowance, which is $50 for the Premier PPO (054) or $75 for the Choice PPO (032).

For Members: Improved health outcomes via early, AI-driven diagnosis.

The technology platform is designed to enable earlier diagnosis and better management of chronic conditions. Clinical data shows tangible impacts from early intervention using the AI platform:

• For heart failure patients, there was an 18% reduction in hospitalizations.
• For heart failure patients, there was a 25% drop in 30-day readmissions.
• COPD patients saw a 15% reduction in hospitalizations.
• Chronic Kidney Disease (CKD) is diagnosed earlier, with an example showing Stage 3 diagnosis approximately 1.5 years sooner for patients seen by providers using Clover Assistant.

For Physicians: Clinical decision support at the point of care (Clover Assistant).

The Clover Assistant software acts as a copilot, aggregating data to surface evidence-based recommendations for the physician who retains the final decision-making authority. The platform combines data from over 100 data sources, including major Electronic Health Record (EHR) systems, pharmacy, claims, and almost all labs. This technology is used by a significant portion of the membership base. Roughly 2/3, up to 70%, of the total membership base receives care under the Clover Assistant technology. To get reimbursement for the Visit, participating clinicians must submit a Clover Assistant Visit within ten days of the date of service.

For Payors: Technology to improve HEDIS scores and lower total cost of care.

The technology investment is directly linked to quality measure performance and cost efficiency. Clover Health Investments, Corp.'s PPO Medicare Advantage plans achieved an impressive score of 4.94 out of 5 Stars on HEDIS for Plan Year 2025, which contributed to a 4.0 Star Rating for Payment Year 2026 from CMS. This higher Star Rating is expected to lead to an anticipated 5% benchmark increase in payment year 2026. Lowering the total cost of care is supported by the clinical improvements; the estimated annual savings from reduced hospitalization rates is between $300-$500 per member. Furthermore, for returning members, the medical cost ratio improves by about 700 basis points from Year 1 to Year 2 when using the technology.

Here's a quick look at some key performance and plan metrics as of late 2025:

Metric Category	Specific Metric/Data Point	Value/Amount
Member Plan Choice	Percentage of MA Membership in PPO Plans	Over 95%
Member Benefit Example	Premier PPO (054) Monthly Part B Giveback	$100
Health Outcome (CHF)	Reduction in All-Cause Hospitalizations	18%
Physician Support	Membership Receiving Care Under Clover Assistant	Roughly 2/3 to 70%
Payor Quality Score	HEDIS Score (Plan Year 2025)	4.94 out of 5 Stars
Payor Financial Impact	Estimated Annual Savings per Member from Lower Hospitalizations	$300-$500

If onboarding takes longer than expected, churn risk rises, but Clover Health boasts a voluntary member retention rate likely over 90%, which is high for the industry.

Finance: draft 13-week cash view by Friday.

Clover Health Investments, Corp. (CLOV) - Canvas Business Model: Customer Relationships

Clover Health Investments, Corp. focuses its customer relationships on integrating technology deeply into the care experience, aiming for better outcomes that drive member loyalty and financial performance.

High-touch, technology-enabled care management is central, powered by the Clover Assistant platform. This technology is used to help physicians earlier diagnose and treat chronic diseases. As of late 2025, roughly 2/3, up to like 70% of the total membership base, receives care under the Clover Assistant technology. For the large group of new members joining in 2025, over half were already under Clover Assistant technology care by the end of September. The impact of this technology-enabled care on health outcomes is quantified by cohort analysis: the medical cost ratio (MCR) improves by about 700 basis points from year 1 to year 2, and by a total of about 1,400 basis points from year 1 to year 3 on average. For example, a relationship with a Clover Assistant provider was associated with 18% lower average all-cause hospitalizations and 25% lower 30-day readmissions for Congestive Heart Failure members based on Q1 2025 data.

Direct-to-member engagement is supported by the LiveHealthy Rewards program, which incentivizes healthy behaviors. Members can earn up to $400 reward dollars per year through health-related activities, though the exact amount varies by plan. Specific, time-bound incentives are used to drive immediate engagement; for instance, an additional $50 gift card reward was offered for completing a primary care visit between November 20, 2025, and December 31, 2025.

The financial results clearly show the value of long-term relationships, which are characterized by high voluntary member retention. Management projects that high retention rates above 90% are expected to support the transition of new members into returning cohorts. This transition is financially significant, as shown by the contribution profit metrics for the first three quarters of 2025:

Cohort Type	Contribution Profit (Per Member Per Month)	Time Period
Returning Members (Year 2+)	$217 profit PMPM	Year-to-date 2025 (Q3)
New Members (Year 1)	Negative $110 loss PMPM	First three quarters of 2025

The focus on technology and relationship maturity drives this financial uplift. The MCR improvement of 700 basis points between year one and year two directly contributes to the shift from a loss to a profit for the member cohort.

Self-service digital tools for plan and benefit management are part of the overall technology ecosystem. While specific usage statistics for general plan management tools aren't detailed, the LiveHealthy Rewards program itself incorporates digital interaction, such as completing the 'Getting to Know You' survey online at cloverhealth.com/you-2025. The company is also expanding its B2B offering of Clover Assistant, which includes integrated scribing and generative AI tools, indicating a broader digital engagement strategy with the healthcare ecosystem.

• Medicare Advantage membership grew 35% year-over-year to 109,226 members in Q3 2025.
• Insurance revenue for Q3 2025 was $479 million, a 49% increase year-over-year.
• Adjusted SG&A as a percentage of total revenues decreased to 17% year-to-date in Q3 2025, a 370 basis point improvement year-over-year.

Clover Health Investments, Corp. (CLOV) - Canvas Business Model: Channels

You're looking at how Clover Health Investments, Corp. (CLOV) gets its value proposition-affordable, high-quality Medicare Advantage (MA) plans powered by technology-into the hands of seniors. The channels mix is clearly weighted toward established insurance distribution but is actively layering in direct engagement and B2B SaaS expansion.

The Annual Election Period (AEP) remains the primary driver for membership acquisition, showing strong results from their existing distribution setup.

• Reported 27% year-over-year growth in MA membership during the most recent AEP.
• Expected to exit 2025 with 113 thousand total members.
• Voluntary member retention rate disclosed as above 90% for the year.
• 95% of January 1, 2025, membership was in the flagship 4-Star PPO plan.

The success of the 4-Star rating directly impacts the channel's financial viability, as it positions Clover Health Investments, Corp. (CLOV) for an anticipated 5% benchmark increase in payment year 2026.

For the broader enterprise channel, Counterpart Health (the SaaS arm) is in an expansion phase, focusing on proving the technology's value outside of Clover Health Investments, Corp. (CLOV)'s own MA plan members.

Here's a quick look at the channel performance indicators we have for 2025:

Channel Focus	Metric	Latest Reported Figure (2025)
MA Membership Growth (Overall Channel Success)	Year-over-Year Membership Growth (Recent AEP)	27%
MA Membership Base	Expected Members at End of 2025	113 thousand
Counterpart Health (SaaS)	Q1 2025 Financial Driver	Primarily driven by MA plan; fresh details on enterprise revenue limited.
Community Pharmacy Pilot	Program Launch Location/Timeframe	New Jersey, July 2025.

Direct-to-consumer digital marketing and sales efforts are implicitly captured in the overall membership growth, which saw Q1 2025 MA membership rise 30% year-over-year. Still, the company is focused on balancing profitability with strategic investments in growth across all avenues.

The community pharmacy network is a targeted initiative, launched as a pilot in New Jersey in July 2025 in partnership with IPC Digital Health's iCare+ Network. This channel directly addresses high medical costs, as preventable hospitalizations account for roughly 76% of Clover Health Investments, Corp. (CLOV)'s medical expenses. The goal is to use real-time tools powered by Clover Assistant data to monitor prescription fills and intervene before issues escalate.

For the Counterpart Health enterprise sales, the strategy is to push the software-as-a-service (SaaS) offering in areas where Clover Health Investments, Corp. (CLOV) does not have an MA plan. The technology, Counterpart Assistant, has shown clinical benefits, such as reducing hospitalizations by 18% for congestive heart failure patients in published white papers. This clinical proof point is a key part of the value proposition for enterprise adoption.

• Q1 2025 Insurance Revenue Growth: 33% year-over-year to $462 million.
• Year-to-date EBITDA (as of Q3 2025): $45 million.
• The technology aims to reduce all-cause hospitalizations by 15% and 30-day readmissions by 18% for COPD patients.

Finance: draft 13-week cash view by Friday.

Clover Health Investments, Corp. (CLOV) - Canvas Business Model: Customer Segments

You're mapping out the core of Clover Health Investments, Corp.'s (CLOV) business, which centers on serving specific groups within the Medicare ecosystem. The focus is clearly on seniors and the providers who care for them, plus an emerging segment of external healthcare organizations.

Medicare-eligible seniors in targeted US counties

Clover Health Investments, Corp. targets Medicare-eligible seniors across a defined and expanding geographic footprint. As of late 2025, the company's Medicare Advantage (MA) plans are available across 108 counties in eight states-Arizona, Georgia, Mississippi, New Jersey, Pennsylvania, South Carolina, Tennessee, and Texas. This footprint represents a market opportunity reaching nearly 5 million Medicare eligibles. The company entered 2025 with over 100,000 members. By the first quarter of 2025, Clover Health reported MA membership growth of 30% year-over-year, bringing the total to over 103,318 members.

The key characteristics of this segment include:

• Seniors eligible for Medicare benefits.
• Residing in one of the 108 covered US counties.
• Members enrolled in plans that achieved a 4-Star rating from CMS for 2025.

Seniors preferring PPO plans (approx. 95% of new members)

The preference within the senior segment heavily leans toward one specific product structure. Clover Health Investments, Corp.'s flagship offering is its Preferred Provider Organization (PPO) plan, which offers a wide and open network, meaning members can see any Medicare-participating doctor willing to accept them. This choice is overwhelmingly popular with enrollees.

Here is the breakdown of plan preference as of early 2025:

Plan Type Focus	Percentage of Membership	2025 Star Rating
Flagship PPO Plan	Approximately 95%	4 Stars
HMO Plan	Remaining 5% (Implied)	3.5 Stars

This focus on PPO plans aligns with the company's strategy to offer zero premium and free physician choice in those offerings.

Independent primary care physicians and small practices

Clover Health Investments, Corp. engages with physicians and practices primarily through its open-network PPO structure and by deploying its technology platform, Clover Assistant, to support care coordination. The company seeks a close, collaborative partnership with providers to exchange health data and identify conditions earlier. While a precise count of independent primary care physicians and small practices for late 2025 isn't immediately available, the model is built around enabling these independent clinicians.

The value proposition to this segment includes:

• Access to the Clover Assistant technology for clinical insights.
• Reimbursement based on fee schedules tied to Medicare payment systems.
• Support for managing chronic conditions like Diabetes and Chronic Kidney Disease.

The technology is designed to fit into existing workflows, helping providers focus on action rather than administration.

External Medicare Advantage payors and providers (Counterpart clients)

This segment is served through Counterpart Health, a wholly owned subsidiary of Clover Health Investments, Corp.. Counterpart Health extends the data-driven technology platform, Counterpart Assistant (CA), beyond Clover Health's own MA plan members to a wider audience of external payors and providers nationwide. The goal here is to improve patient outcomes and reduce healthcare costs for these external entities via a software-as-a-service model.

Key facts about this customer group as of late 2025:

• Counterpart Health began making its HEDIS platform available to third-party partners for the first time in October 2025.
• The technology has demonstrated effectiveness in areas like reducing hospitalizations by 18% for congestive heart failure patients when used by physicians.
• The platform uses AI and natural language processing to aggregate data from over 100 data sources.

The company made strategic leadership appointments in October 2025 to accelerate these enterprise partnerships and regional adoption. Finance: draft 13-week cash view by Friday.

Clover Health Investments, Corp. (CLOV) - Canvas Business Model: Cost Structure

The Cost Structure for Clover Health Investments, Corp. centers heavily on medical costs, followed by operating expenses that include significant technology investment.

Net Medical Claims Incurred (NMCI) represent the largest cost component. For the third quarter of 2025, NMCI was reported at $423.5 million, reflecting a year-over-year increase driven by elevated utilization trends and a higher mix of new members.

The overall cost of care relative to premiums is captured by the Insurance Benefit Expense Ratio (BER). The updated full-year 2025 guidance for Insurance BER is set between 90% - 91%.

Selling, General, and Administrative (SG&A) expenses are managed for operating leverage. The improved full-year 2025 guidance for Adjusted SG&A is between $325 million and $335 million. For context, the Adjusted SG&A in the third quarter of 2025 was $71.1 million, which represented 14.3% of total revenues for that quarter.

Technology platform development and maintenance costs are embedded within the SG&A structure, as management emphasizes strategic investments in the Clover Assistant technology and ongoing operational and clinical AI initiatives as drivers for future efficiency and cost control.

Member acquisition and retention costs are a measurable part of the new member cohort economics. The contribution profit analysis for the first three quarters of 2025 showed that new members generated a loss of approximately $110 per member per month (PMPM). This metric is fully inclusive, covering revenue per month minus medical expenses per member per month, minus the customer acquisition cost, and minus the favorable SG&A to service that member.

Here's a breakdown of the key cost-related metrics and guidance:

Cost Metric/Guidance Category	Latest Real-Life Figure / Guidance Range (FY 2025)
Net Medical Claims Incurred (Q3 2025)	$423.5 million
Insurance Benefit Expense Ratio (BER) Guidance (FY 2025)	90% - 91%
Adjusted SG&A Guidance (FY 2025)	$325 million - $335 million
Adjusted SG&A as % of Revenue (Q3 2025)	14.3%

The cost structure is heavily influenced by the maturity of the member base, as evidenced by the contribution profit disparity:

• Returning member cohorts generated approximately $217 PMPM in contribution profit year-to-date Q3 2025.
• New member cohorts generated a loss of approximately $110 PMPM year-to-date Q3 2025.
• The improvement in medical cost ratio (MCR) is expected to be about 700 basis points from year 1 to year 2 for a member cohort.
• A further 700 basis points improvement is expected from year 2 to year 3.

Clover Health Investments, Corp. (CLOV) - Canvas Business Model: Revenue Streams

You're looking at the core ways Clover Health Investments, Corp. (CLOV) brings in money as of late 2025. It's a mix of traditional insurance income and newer tech-enabled services. Honestly, the insurance premiums are still the lion's share, but the software side is the growth story everyone watches.

The primary revenue driver is the collection of Insurance Premiums from its Medicare Advantage (MA) plans. For the third quarter of 2025, the company reported that insurance revenue climbed to $479.1 million, marking a 48.5% year-over-year increase from $322.6 million in the prior year period.

Clover Health Investments, Corp. (CLOV) updated its full-year 2025 guidance for this core segment, projecting total Insurance Revenue to fall between $1.850 billion and $1.880 billion. This guidance represents a 39% growth year-over-year at the midpoint.

The structure of these insurance revenues is significantly influenced by quality metrics, specifically the CMS Star Ratings. For instance, achieving a 4.0 Star rating for PPO plans in 2026 is anticipated to result in a 5% quality bonus payment, which directly impacts benchmark reimbursement rates. This bonus is a direct uplift to the per-member revenue stream.

Here's a look at the key revenue components and related figures we have for 2025:

Revenue Component	Latest Reported Figure / Guidance	Period / Context
Full-Year 2025 Insurance Revenue Guidance	$1.850 billion - $1.880 billion	Full Year 2025
Insurance Revenue (Q3 2025)	$479.1 million	Third Quarter 2025
Total Revenues (Q3 2025)	$496.6 million	Third Quarter 2025
Other Income (Q3 2025)	$17.5 million	Third Quarter 2025

You'll notice that Other Income is a distinct stream, which captures non-insurance related gains. In the third quarter of 2025, this segment reached $17.5 million, showing a 108.4% year-over-year increase, largely driven by a $13.4 million gain from the fair value of the company's equity investments. This is where the Software-as-a-Service (SaaS) revenue is currently housed.

The Software-as-a-Service (SaaS) revenue from Counterpart Health is an emerging, high-margin stream. It is included within the Other Income line on the consolidated statements of operations. While specific dollar figures for the SaaS component alone aren't broken out separately yet, it is noted that this revenue stream is currently less than 5% of total revenue, with a threshold for separate reporting set at 10% of revenue. The company's strategy is to grow this external ACO and payer business, which uses the Counterpart Assistant platform, to generate more recurring SaaS revenue.

The revenue streams can be summarized by their nature:

• Insurance Premiums (Net Premiums Earned) from MA plans.
• Anticipated CMS Star Rating bonus payments (e.g., 5% uplift for 4.0 Star plans for future payment years).
• Fair value gains on equity investments, contributing to Other Income.
• Emerging, lower-percentage revenue from Counterpart Health SaaS offerings.

If onboarding takes 14+ days, churn risk rises, which directly impacts the core premium revenue base.

Finance: draft 13-week cash view by Friday.