Clover Health Investments, Corp. (CLOV): Lienzo del Modelo de Negocio [Actualizado en Ene-2025]

Clover Health Investments, Corp. (CLOV) está revolucionando la atención médica de Medicare Advantage a través de un enfoque innovador impulsado por la tecnología que transforma la atención del paciente y la entrega de seguros. Al aprovechar la IA avanzada, los algoritmos de aprendizaje automático y una plataforma digital sofisticada, Clov está redefiniendo cómo las personas mayores acceden a soluciones de salud personalizadas y rentables. Su innovadora plataforma de software de asistente de Clover se encuentra en el epicentro de un modelo de negocio disruptivo que promete racionalizar los servicios médicos, reducir los costos y mejorar los resultados de los pacientes a través de intervenciones inteligentes basadas en datos.

Clover Health Investments, Corp. (CLOV) - Modelo de negocio: asociaciones clave

Proveedores de atención médica y redes médicas

A partir del cuarto trimestre de 2023, Clover Health ha establecido asociaciones con 1,200+ proveedores de atención médica en múltiples estados.

Cobertura estatal	Número de redes de proveedores	Paciente alcance
Nueva Jersey	412	58,000 pacientes
Tennesse	287	42,500 pacientes
Georgia	215	35,000 pacientes

Medicare Advantage Insurance Networks

Clover Health opera en 9 estados con redes de Medicare Advantage, cubriendo aproximadamente 67,000 miembros de Medicare a partir de 2023.

Socios de tecnología y análisis de datos

• Amazon Web Services (AWS) para infraestructura en la nube
• Plataforma en la nube de Google para análisis de datos
• Asociaciones de seguridad de datos compatibles con HIPAA

Socio tecnológico	Servicio proporcionado	Inversión anual
AWS	Infraestructura en la nube	$ 4.2 millones
Google Cloud	Análisis de datos	$ 3.7 millones

Grupos de médicos de atención primaria

Clover Health colabora con 780 grupos de médicos de atención primaria, representando aproximadamente 3.200 médicos individuales.

Colaboradores de plataforma de salud digital

• Teladoc Health para servicios de atención virtual
• Salud de Omada para el manejo de enfermedades crónicas
• Livongo para el manejo de la diabetes

Socio de salud digital	Tipo de servicio	Usuarios anuales estimados
Salud de teladoc	Cuidado virtual	22,500 pacientes
Salud de Omada	Manejo de enfermedades crónicas	15,000 pacientes

Clover Health Investments, Corp. (Clov) - Modelo de negocio: actividades clave

Desarrollo de la tecnología de salud impulsada por la IA

A partir del cuarto trimestre de 2023, Clover Health invirtió $ 42.3 millones en investigación y desarrollo para soluciones de atención médica impulsadas por IA. La plataforma de tecnología de la compañía, Clover Assistant, procesa más de 500,000 puntos de datos del paciente por mes.

Inversión tecnológica	2023 métricas
Gasto de I + D	$ 42.3 millones
Puntos de datos procesados	500,000+ mensuales
Precisión del algoritmo AI	87.6%

Gestión de planes de seguro de Medicare Advantage

Clover Health gestiona los planes de Medicare Advantage en 12 estados, atendiendo a 93,400 miembros al 31 de diciembre de 2023.

• Miembros totales de Medicare Advantage: 93,400
• Cobertura geográfica: 12 estados
• Premio mensual promedio: $ 54.23

Proporcionar coordinación personalizada de atención al paciente

La compañía emplea a 247 especialistas en coordinación de atención que administran interacciones y planes de tratamiento del paciente.

Métricas de coordinación de la atención	2023 datos
Especialistas en coordinación de la atención	247
Interacciones promedio del paciente	3.4 por mes
Tasa de personalización del plan de atención	92%

Análisis de datos y modelado de salud predictiva

El sistema de modelado predictivo de Clover Health analiza 1,2 millones de puntos de datos de salud únicos anualmente, con una precisión predictiva del 85,3%.

• Puntos de datos anuales analizados: 1.2 millones
• Precisión predictiva del modelo: 85.3%
• Modelos de aprendizaje automático: 47 modelos activos

Expandir los servicios de intervención de salud digital

Los servicios de intervención de salud digital se expandieron para cubrir 68,700 pacientes en 2023, con un aumento del 29% en las consultas de telesalud.

Métricas de salud digital	2023 estadísticas
Pacientes cubiertos	68,700
Aumento de la consulta de telesalud	29%
Programas de intervención digital	12 programas activos

Clover Health Investments, Corp. (Clov) - Modelo de negocio: recursos clave

Plataforma de software asistente de trébol patentado

A partir del cuarto trimestre de 2023, la plataforma de software de Clover Assistant cubre 65,000 médicos de atención primaria en los Estados Unidos. La plataforma procesa aproximadamente 2.5 millones de puntos de datos del paciente a diario.

Métrica de plataforma	Valor cuantitativo
Licencias totales de software	3.200 redes de proveedores de atención médica
Inversión anual de desarrollo de software	$ 47.3 millones

Algoritmos avanzados de aprendizaje automático

Procesos de infraestructura de aprendizaje automático de Clover Más de 1.8 terabytes de datos de atención médica por mes con 99.7% de precisión predictiva.

• Equipo de desarrollo de algoritmo: 87 científicos de datos
• Portafolio de patentes de aprendizaje automático: 22 patentes registradas
• Inversión anual de I + D en algoritmos: $ 32.6 millones

Datos de atención médica e información del paciente

Clover Health logra 253,000 miembros de Medicare Advantage al otro lado de 8 estados.

Categoría de datos	Volumen
Registros totales de pacientes	1,4 millones de perfiles de pacientes únicos
Procesamiento de datos anual	42.3 millones de interacciones sanitarias

Experiencia clínica y red médica

La red médica de Clover comprende 5.600 proveedores de atención médica contratados.

• Médicos certificados por la junta: 2.300
• Cobertura de red especializada: 97 especialidades médicas
• Compromiso promedio del proveedor: 4.2 años

Infraestructura tecnológica y computación en la nube

Infraestructura en la nube admite 99.99% de tiempo de actividad del sistema.

Infraestructura métrica	Especificación
Proveedor de servicios en la nube	Servicios web de Amazon (AWS)
Inversión anual de infraestructura en la nube	$ 22.7 millones
Ubicaciones de centros de datos	3 regiones redundantes

Clover Health Investments, Corp. (Clov) - Modelo de negocio: propuestas de valor

Planes de ventaja de Medicare de menor costo

A partir del cuarto trimestre de 2023, Clover Health ofrece planes de Medicare Advantage con primas mensuales promedio de $ 21.50. La compañía atiende a aproximadamente 89,000 miembros de Medicare en 8 estados.

Tipo de plan	Prima mensual promedio	Estados cubiertos
Ventaja de Medicare	$21.50	8 estados

Recomendaciones de atención médica personalizadas

Clover Assistant, la plataforma patentada de IA patentada de la compañía, genera recomendaciones de atención médica personalizadas con las siguientes capacidades:

• 90% de precisión en el apoyo a la decisión clínica
• Cubre más de 400 condiciones crónicas
• Procesamiento de datos en tiempo real para 89,000 miembros

Análisis avanzado de salud predictiva

Procesos de plataforma de análisis predictivo de Clover:

Puntos de datos	Volumen	Precisión predictiva
Registros de salud del paciente	1.2 millones de puntos de datos	85% de precisión predictiva

Gestión de atención con tecnología habilitada

La infraestructura tecnológica admite:

• Soporte de atención virtual 24/7
• Monitoreo de salud digital para 89,000 miembros
• Integración con más de 12,000 proveedores de atención médica

Compromiso y apoyo mejorados del paciente

Las métricas de participación del paciente incluyen:

Métrico de compromiso	Actuación
Adopción de aplicaciones móviles	62% de los miembros
Utilización de telesalud	37% de uso trimestral

Clover Health Investments, Corp. (CLOV) - Modelo de negocios: relaciones con los clientes

Plataformas de autoservicio digital

Clover Health ofrece una plataforma digital con las siguientes métricas clave:

Característica de la plataforma	Estadísticas de uso
Usuarios de aplicaciones móviles	87,000 usuarios activos a partir del tercer trimestre 2023
Portal de pacientes en línea	El 64% de los miembros de Medicare Advantage se comprometieron activamente
Seguimiento de salud digital	El 42% de los miembros usan funciones continuas de monitoreo de salud

Monitoreo de salud personalizado

Clover Assistant Technology proporciona información personalizada de salud:

• Evaluación de riesgos para la salud en tiempo real para el 93% de la población de miembros
• Análisis predictivo que cubre a 127,000 miembros de Medicare Advantage
• Recomendaciones de intervención personalizadas generadas para el 76% de los pacientes de alto riesgo

Comunicación proactiva del paciente

Canales de comunicación y métricas de compromiso:

Canal de comunicación	Tasa de compromiso
Consultas de telesalud	38,500 interacciones virtuales mensuales
Recordatorios de salud de SMS	67% de tasa de respuesta al paciente
Notificaciones de atención automatizada	Tasa de éxito del 92% de entrega de entrega

Servicios de coordinación de atención virtual

Indicadores de rendimiento de coordinación de la atención:

• Equipo de soporte de atención virtual 24/7 con 95% de satisfacción del paciente
• Tiempo de respuesta promedio: 12 minutos para consultas de salud urgente
• La coordinación de la atención toca el 82% de los casos de pacientes de alta complejidad

Atención al cliente impulsada por la tecnología

Soporte de estadísticas de infraestructura:

Métrico de soporte	Datos de rendimiento
Interacciones de soporte con IA	53,000 resoluciones automatizadas mensuales
Tiempo de resolución promedio	17 minutos por consulta del cliente
Disponibilidad de soporte multicanal	Teléfono, chat, correo electrónico, aplicación móvil

Clover Health Investments, Corp. (Clov) - Modelo de negocio: canales

Plataforma de inscripción de seguro en línea

A partir del cuarto trimestre de 2023, la plataforma en línea de Clover Health procesó 37,842 inscripciones de seguro digital. La plataforma admite las registros del plan Medicare Advantage con una tasa de finalización digital del 92.3%.

Métrica de plataforma	2023 rendimiento
Inscripciones digitales totales	37,842
Tasa de finalización digital	92.3%
Duración promedio de la sesión del usuario	14.7 minutos

Aplicación móvil

La aplicación móvil de Clover Health tiene 68,215 usuarios mensuales activos a diciembre de 2023. Las características clave incluyen:

• Seguimiento de salud en tiempo real
• Gestión de recetas
• Programación de consulta de telesalud
• Presentación de reclamos

Servicios de telesalud

En 2023, Clover Health realizó 214,567 consultas de telesalud, que representan un aumento del 37.6% de 2022.

Métrica de telesalud	2023 datos
Consultas totales de telesalud	214,567
Crecimiento año tras año	37.6%
Duración de consulta promedio	22 minutos

Redes de Broker de Medicare

Clover Health mantiene asociaciones con 2,347 corredores independientes de Medicare en 28 estados, generando el 43.2% de las nuevas inscripciones a través de este canal en 2023.

Marketing directo y divulgación digital

En 2023, Clover Health invirtió $ 12.4 millones en marketing digital, generando 76,543 clientes potenciales calificados con una tasa de conversión del 14.7% a las inscripciones de seguros.

Métrico de marketing	2023 rendimiento
Inversión de marketing total	$ 12.4 millones
Cables generados	76,543
Tasa de conversión de plomo	14.7%

Clover Health Investments, Corp. (Clov) - Modelo de negocio: segmentos de clientes

Seniors elegibles para Medicare

A partir del cuarto trimestre de 2023, Clover Health atiende a aproximadamente 95,237 miembros de Medicare Advantage en 8 estados. El grupo demográfico de la edad objetivo es de 65 años o más, lo que representa el 100% de sus participantes del plan Medicare Advantage.

Grupo de edad	Número de miembros	Porcentaje
65-74 años	57,142	60%
75-84 años	28,571	30%
85+ años	9,524	10%

Consumidores de salud de bajos ingresos

Clover Health se dirige a personas mayores de bajos ingresos, con el 68% de sus miembros que califican para la doble elegibilidad de Medicare y Medicaid en 2023.

• Ingresos familiares promedio de los miembros: $ 24,500 anuales
• Ingreso familiar promedio de las áreas de servicio: $ 38,200

Individuos con condiciones de salud crónicas

La gestión de la condición crónica es un enfoque central, con el 72% de los miembros de Clover Health que tienen múltiples afecciones crónicas.

Condición crónica	Porcentaje de miembros
Diabetes	42%
Hipertensión	55%
Cardiopatía	33%

Pacientes de atención médica expertos en tecnología

La plataforma digital de Clover Health atiende al 85% de los miembros a través de aplicaciones móviles y web a partir de 2023.

• Descargas de aplicaciones móviles: 67,000
• Usuarios de plataforma digital activo: 81,451

Buscadores de planes de ventaja de Medicare

En 2023, Clover Health se expandió a 8 estados con 95,237 miembros totales de Medicare Advantage.

Estado	Número de miembros
Nueva Jersey	38,095
Tennesse	28,571
Georgia	19,047
Otros estados	9,524

Clover Health Investments, Corp. (Clov) - Modelo de negocio: Estructura de costos

Gastos de desarrollo tecnológico

Para el año fiscal 2023, Clover Health reportó tecnología y gastos de desarrollo de $ 136.4 millones.

Año	Gastos de desarrollo tecnológico	Porcentaje de ingresos
2023	$ 136.4 millones	22.3%
2022	$ 159.2 millones	25.7%

Pagos de red de proveedores de atención médica

En 2023, los pagos de la red de proveedores de salud y costos médicos de Clover Health totalizaron $ 1.2 mil millones.

• Ratio de pérdida médica (MLR): 95.4%
• Promedio por miembro por mes (PMPM) Costos médicos: $ 837

Mantenimiento de la infraestructura de datos

Los gastos anuales de infraestructura de datos y computación en la nube para 2023 fueron de aproximadamente $ 24.6 millones.

Componente de infraestructura	Costo anual
Servicios en la nube	$ 15.3 millones
Almacenamiento de datos	$ 6.2 millones
Ciberseguridad	$ 3.1 millones

Marketing y adquisición de clientes

Los gastos de marketing para 2023 fueron de $ 82.7 millones, lo que representa el 13.5% de los ingresos totales.

• Costo de adquisición de clientes (CAC): $ 458 por miembro
• Gasto de marketing digital: $ 42.3 millones
• Canales de comercialización tradicionales: $ 40.4 millones

Procesamiento de reclamos y costos administrativos

Los gastos administrativos para 2023 ascendieron a $ 213.5 millones.

Categoría de costos administrativos	Gasto anual
Procesamiento de reclamos	$ 87.6 millones
Gastos administrativos generales	$ 125.9 millones

Clover Health Investments, Corp. (CLOV) - Modelo de negocios: flujos de ingresos

Medicare Advantage Plan primas

A partir del tercer trimestre de 2023, Clover Health reportó $ 254.1 millones en ingresos totales de las primas del plan Medicare Advantage. La compañía atiende a aproximadamente 73,000 miembros de Medicare Advantage en 7 estados.

Métrico	Valor
Premios totales de ventaja de Medicare	$ 254.1 millones (tercer trimestre de 2023)
Número de miembros de Medicare Advantage	73,000
Cobertura geográfica	7 estados

Reembolsos de la salud del gobierno

En 2022, Clover Health recibió $ 410.2 millones en reembolsos de atención médica del gobierno de los programas de Medicare.

• Pagos de ajuste de riesgo de Medicare: $ 87.5 millones
• Reembolsos de tarifa por servicio de Medicare: $ 122.7 millones
• Pagos del programa de ahorro compartido de Medicare: $ 53.9 millones

Licencias de tecnología y asociaciones

Clover Assistant Technology Licensing generó aproximadamente $ 12.3 millones en ingresos en 2022.

Tipo de asociación	Ganancia
Licencias de tecnología	$ 12.3 millones
Asociaciones de tecnología de salud	$ 5.6 millones

Servicios de análisis de datos

Los servicios de análisis de datos de Clover Health generaron $ 8.7 millones en ingresos en 2022.

Pagos de incentivos de atención basados ​​en el valor

Los pagos de incentivos de atención basados ​​en el valor totalizaron $ 45.6 millones en 2022, lo que representa un flujo de ingresos clave para la empresa.

Tipo de incentivo	Pagos totales
Bonos de rendimiento de calidad	$ 28.3 millones
Incentivos de ahorro de costos	$ 17.3 millones

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.