Clover Health Investments, Corp. (CLOV): Business Model Canvas [Jan-2025 Mis à jour]

Clover Health Investments, Corp. (CLOV) révolutionne Medicare Advantage Healthcare grâce à une approche révolutionnaire axée sur la technologie qui transforme les soins aux patients et la prestation d'assurance. En tirant parti de l'IA avancée, des algorithmes d'apprentissage automatique et d'une plate-forme numérique sophistiquée, CLOV redéfinit la façon dont les personnes âgées accèdent à des solutions de santé personnalisées et rentables. Leur plate-forme logicielle innovante Clover Assistant se tient à l'épicentre d'un modèle commercial perturbateur qui promet de rationaliser les services médicaux, de réduire les coûts et d'améliorer les résultats pour les patients grâce à des interventions intelligentes basées sur les données.

Clover Health Investments, Corp. (CLOV) - Modèle commercial: partenariats clés

Fournisseurs de soins de santé et réseaux médicaux

Au quatrième trimestre 2023, Clover Health a établi des partenariats avec 1 200+ fournisseurs de soins de santé dans plusieurs états.

Couverture de l'État	Nombre de réseaux de fournisseurs	Patient à portée de patient
New Jersey	412	58 000 patients
Tennessee	287	42 500 patients
Georgia	215	35 000 patients

Réseaux d'assurance Medicare Advantage

Clover Health opère dans 9 États avec les réseaux Medicare Advantage, couvrant approximativement 67 000 membres de Medicare En 2023.

Partenaires de la technologie et de l'analyse des données

• Amazon Web Services (AWS) pour l'infrastructure cloud
• Plateforme Google Cloud pour l'analyse des données
• Partenariats de sécurité des données conformes aux HIPAA

Partenaire technologique	Service fourni	Investissement annuel
AWS	Infrastructure cloud	4,2 millions de dollars
Google Cloud	Analyse des données	3,7 millions de dollars

Groupes de médecins de soins primaires

Clover Health collabore avec 780 groupes de médecins de soins primaires, représentant approximativement 3 200 médecins individuels.

Collaborateurs de plate-forme de santé numérique

• Téladoc Health for Virtual Care Services
• Omada Health pour la gestion des maladies chroniques
• Livongo pour la gestion du diabète

Partenaire de santé numérique	Type de service	Utilisateurs annuels estimés
Santé Teladoc	Soins virtuels	22 500 patients
Omada Health	Gestion des maladies chroniques	15 000 patients

Clover Health Investments, Corp. (CLOV) - Modèle d'entreprise: activités clés

Développer une technologie de santé axée sur l'IA

Au quatrième trimestre 2023, Clover Health a investi 42,3 millions de dollars dans la recherche et le développement pour les solutions de soins de santé axées sur l'IA. La plateforme technologique de l'entreprise, Clover Assistant, traite plus de 500 000 points de données des patients par mois.

Investissement technologique	2023 métriques
Dépenses de R&D	42,3 millions de dollars
Points de données traités	Plus de 500 000 mois
Précision de l'algorithme AI	87.6%

Gérer les régimes d'assurance Medicare Advantage

Clover Health gère les plans de Medicare Advantage dans 12 États, desservant 93 400 membres au 31 décembre 2023.

• Membres de Medicare Advantage: 93 400
• Couverture géographique: 12 États
• Prime mensuelle moyenne: 54,23 $

Fournir une coordination personnalisée des soins aux patients

L'entreprise emploie 247 spécialistes de la coordination des soins qui gèrent les interactions des patients et les plans de traitement.

Métriques de coordination des soins	2023 données
Spécialistes de la coordination des soins	247
Interactions moyennes du patient	3,4 par mois
Taux de personnalisation du plan de soins	92%

Analyse des données et modélisation prédictive de la santé

Le système de modélisation prédictive de Clover Health analyse 1,2 million de points de données de santé uniques par an, avec une précision prédictive de 85,3%.

• Points de données annuels analysés: 1,2 million
• Précision du modèle prédictif: 85,3%
• Modèles d'apprentissage automatique: 47 modèles actifs

Expansion des services d'intervention de santé numérique

Les services d'intervention de la santé numérique se sont développés pour couvrir 68 700 patients en 2023, avec une augmentation de 29% des consultations de télésanté.

Métriques de santé numérique	2023 statistiques
Patients couverts	68,700
Augmentation de la consultation de la télésanté	29%
Programmes d'intervention numérique	12 programmes actifs

Clover Health Investments, Corp. (CLOV) - Modèle d'entreprise: Ressources clés

Plateforme logicielle assistante de trèfle propriétaire

Depuis le quatrième trimestre 2023, les couvertures de plate-forme logicielle assistant Clover 65 000 médecins de soins primaires Aux États-Unis. La plate-forme traite approximativement 2,5 millions de points de données du patient tous les jours.

Métrique de la plate-forme	Valeur quantitative
Licences logicielles totales	3 200 réseaux de prestataires de soins de santé
Investissement annuel de développement de logiciels	47,3 millions de dollars

Algorithmes avancés d'apprentissage automatique

Processus d'infrastructure d'apprentissage automatique de Clover plus de 1,8 téraoctets de données de santé par mois avec 99,7% de précision prédictive.

• Équipe de développement d'algorithmes: 87 scientifiques des données
• Portfolio des brevets d'apprentissage automatique: 22 brevets enregistrés
• Investissement annuel de R&D dans les algorithmes: 32,6 millions de dollars

Données sur les soins de santé et informations sur les patients

Clover Health gère 253 000 membres de Medicare Advantage à travers 8 États.

Catégorie de données	Volume
Dossiers totaux des patients	1,4 million de profils de patients uniques
Traitement annuel des données	42,3 millions d'interactions de soins de santé

Expertise clinique et réseau médical

Le réseau médical de Clover comprend 5 600 fournisseurs de soins de santé sous contrat.

• Physiciens certifiés au conseil: 2 300
• Couverture du réseau spécialisé: 97 Spécialités médicales
• Engagement moyen des fournisseurs: 4,2 ans

Infrastructure technologique et cloud computing

Prise en charge des infrastructures cloud 99,99% de disponibilité du système.

Métrique d'infrastructure	Spécification
Fournisseur de services cloud	Amazon Web Services (AWS)
Investissement annuel sur les infrastructures cloud	22,7 millions de dollars
Emplacements du centre de données	3 régions redondantes

Clover Health Investments, Corp. (CLOV) - Modèle d'entreprise: propositions de valeur

Plans avantage de Medicare à moindre coût

Depuis le quatrième trimestre 2023, Clover Health propose des plans Medicare Advantage avec des primes mensuelles moyennes de 21,50 $. La société dessert environ 89 000 membres de Medicare dans 8 États.

Type de plan	Prime mensuelle moyenne	États couverts
Avantage Medicare	$21.50	8 États

Recommandations de soins de santé personnalisés

Clover Assistant, la plate-forme propriétaire de l'IA de la société, génère des recommandations de soins de santé personnalisées avec les capacités suivantes:

• Précision de 90% dans l'apparence de la décision clinique
• Couvre plus de 400 conditions chroniques
• Traitement des données en temps réel pour 89 000 membres

Analyse de santé prédictive avancée

Processus de plate-forme d'analyse prédictive de Clover:

Points de données	Volume	Précision prédictive
Dossiers de santé des patients	1,2 million de points de données	85% de précision prédictive

Gestion des soins comparés à la technologie

Soutien de l'infrastructure technologique:

• Support de soins virtuels 24/7
• Surveillance de la santé numérique pour 89 000 membres
• Intégration avec plus de 12 000 fournisseurs de soins de santé

Engagement et soutien améliorés aux patients

Les mesures d'engagement des patients comprennent:

Métrique de l'engagement	Performance
Adoption d'applications mobiles	62% des membres
Utilisation de la télésanté	37% d'utilisation trimestrielle

Clover Health Investments, Corp. (CLOV) - Modèle d'entreprise: relations avec les clients

Plates-formes de libre-service numériques

Clover Health propose une plate-forme numérique avec les mesures clés suivantes:

Fonctionnalité de plate-forme	Statistiques d'utilisation
Utilisateurs d'applications mobiles	87 000 utilisateurs actifs au troisième trimestre 2023
Portail de patients en ligne	64% des membres de Medicare Advantage activement engagés
Suivi de la santé numérique	42% des membres utilisent des caractéristiques de surveillance de la santé continue

Surveillance de la santé personnalisée

Clover Assistant Technology fournit des informations sur la santé personnalisées:

• Évaluation des risques pour la santé en temps réel pour 93% de la population membre
• Analyse prédictive couvrant 127 000 membres de Medicare Advantage
• Recommandations d'intervention personnalisées générées pour 76% des patients à haut risque

Communication proactive du patient

Canaux de communication et mesures d'engagement:

Canal de communication	Taux d'engagement
Consultations de télésanté	38 500 interactions virtuelles mensuelles
Rappels de santé SMS	Taux de réponse de 67%
Notifications de soins automatisées	Taux de réussite de la livraison à 92%

Services de coordination des soins virtuels

Indicateurs de performance de coordination des soins:

• Équipe de soutien aux soins virtuels 24/7 avec une satisfaction à 95% des patients
• Temps de réponse moyen: 12 minutes pour les requêtes de santé urgentes
• La coordination des soins touche 82% des cas de patients à haute complexité

Support client axé sur la technologie

Soutenir les statistiques des infrastructures:

Métrique de soutien	Données de performance
Interactions de support alimentées par l'IA	53 000 résolutions automatisées mensuelles
Temps de résolution moyen	17 minutes par demande client
Disponibilité du support multicanal	Téléphone, chat, e-mail, application mobile

Clover Health Investments, Corp. (CLOV) - Modèle d'entreprise: canaux

Plateforme d'inscription d'assurance en ligne

Au quatrième trimestre 2023, la plate-forme en ligne de Clover Health a traité 37 842 inscriptions d'assurance numérique. La plate-forme prend en charge les inscriptions du plan Medicare Advantage avec un taux d'achèvement numérique de 92,3%.

Métrique de la plate-forme	Performance de 2023
Inscriptions numériques totales	37,842
Taux d'achèvement numérique	92.3%
Durée moyenne de la session utilisateur	14,7 minutes

Application mobile

L'application mobile de Clover Health compte 68 215 utilisateurs mensuels actifs en décembre 2023. Les caractéristiques clés incluent:

• Suivi de santé en temps réel
• Gestion des ordonnances
• Planification des consultations en télésanté
• Rédaction des réclamations

Services de télésanté

En 2023, Clover Health a effectué 214 567 consultations de télésanté, ce qui représente une augmentation de 37,6% par rapport à 2022.

Métrique de la télésanté	2023 données
Consultations totales de télésanté	214,567
Croissance d'une année à l'autre	37.6%
Durée de consultation moyenne	22 minutes

Réseaux de courtiers Medicare

Clover Health maintient des partenariats avec 2 347 courtiers d'assurance-maladie indépendants dans 28 États, générant 43,2% des nouvelles inscriptions via ce canal en 2023.

Marketing direct et sensibilisation numérique

En 2023, Clover Health a investi 12,4 millions de dollars dans le marketing numérique, générant 76 543 prospects qualifiés avec un taux de conversion de 14,7% en inscriptions en assurance.

Métrique marketing	Performance de 2023
Investissement marketing total	12,4 millions de dollars
Lead généré	76,543
Taux de conversion de plomb	14.7%

Clover Health Investments, Corp. (CLOV) - Modèle d'entreprise: segments de clients

Seniors éligibles à l'assurance-maladie

Depuis le quatrième trimestre 2023, Clover Health dessert environ 95 237 membres de Medicare Advantage dans 8 États. La démographie de l'âge cible est de 65 ans et plus, représentant 100% de leurs participants à Medicare Advantage Plan.

Groupe d'âge	Nombre de membres	Pourcentage
65-74 ans	57,142	60%
75-84 ans	28,571	30%
85 ans et plus	9,524	10%

Consommateurs de soins de santé à faible revenu

Clover Health cible les personnes âgées à faible revenu, 68% de leurs membres se qualifiant pour l'admissibilité à double Medicare et Medicaid en 2023.

• Revenu moyen des ménages des membres: 24 500 $ par an
• Revenu médian des ménages des zones de service: 38 200 $

Individus souffrant de problèmes de santé chroniques

La gestion des conditions chroniques est un objectif de base, 72% des membres de la santé de Clover ont plusieurs affections chroniques.

Condition chronique	Pourcentage de membres
Diabète	42%
Hypertension	55%
Maladie cardiaque	33%

Patiens de santé avertis de la technologie

La plate-forme numérique de Clover Health dessert 85% des membres via des applications mobiles et Web à partir de 2023.

• Téléchargements d'applications mobiles: 67 000
• Utilisateurs de plate-forme numérique actifs: 81 451

Demandeurs de plan medicare avantage

En 2023, Clover Health s'est étendu à 8 États avec 95 237 membres totaux de Medicare Advantage.

État	Nombre de membres
New Jersey	38,095
Tennessee	28,571
Georgia	19,047
Autres États	9,524

Clover Health Investments, Corp. (CLOV) - Modèle d'entreprise: Structure des coûts

Dépenses de développement technologique

Pour l'exercice 2023, Clover Health a déclaré des frais de technologie et de développement de 136,4 millions de dollars.

Année	Dépenses de développement technologique	Pourcentage de revenus
2023	136,4 millions de dollars	22.3%
2022	159,2 millions de dollars	25.7%

Paiements de réseau de prestataires de soins de santé

En 2023, les paiements de réseau médical et de soins de santé de Clover Health ont totalisé 1,2 milliard de dollars.

• Ratio de perte médicale (MLR): 95,4%
• Coûts médicaux moyens par membre par mois (PMPM): 837 $

Maintenance d'infrastructure de données

Les frais d'infrastructure de données annuels et de cloud computing pour 2023 étaient d'environ 24,6 millions de dollars.

Composant d'infrastructure	Coût annuel
Services cloud	15,3 millions de dollars
Stockage de données	6,2 millions de dollars
Cybersécurité	3,1 millions de dollars

Marketing et acquisition de clients

Les dépenses de marketing pour 2023 étaient de 82,7 millions de dollars, ce qui représente 13,5% des revenus totaux.

• Coût d'acquisition du client (CAC): 458 $ par membre
• Dépenses en marketing numérique: 42,3 millions de dollars
• Canaux de marketing traditionnels: 40,4 millions de dollars

Réclamations Traitement et frais administratifs

Les dépenses administratives pour 2023 s'élevaient à 213,5 millions de dollars.

Catégorie de coût administratif	Dépenses annuelles
Traitement des réclamations	87,6 millions de dollars
Frais administratifs généraux	125,9 millions de dollars

Clover Health Investments, Corp. (CLOV) - Modèle d'entreprise: Strots de revenus

Medicare Advantage Plan Primiums

Au troisième rang 2023, Clover Health a déclaré 254,1 millions de dollars de revenus totaux des primes du plan Medicare Advantage. La société dessert environ 73 000 membres de Medicare Advantage dans 7 États.

Métrique	Valeur
Primes totales de Medicare Advantage	254,1 millions de dollars (T3 2023)
Nombre de membres de Medicare Advantage	73,000
Couverture géographique	7 États

Remboursements du gouvernement

En 2022, Clover Health a reçu 410,2 millions de dollars de remboursements gouvernementaux de santé des programmes Medicare.

• Paiements d'ajustement des risques Medicare: 87,5 millions de dollars
• Remboursements de rémunération Medicare pour le service: 122,7 millions de dollars
• Paiements du programme d'épargne partagé Medicare: 53,9 millions de dollars

Licence et partenariats technologiques

Clover Assistant Technology Licensing a généré environ 12,3 millions de dollars de revenus en 2022.

Type de partenariat	Revenu
Licence de technologie	12,3 millions de dollars
Partenariats de la technologie des soins de santé	5,6 millions de dollars

Services d'analyse de données

Les services d'analyse de données de Clover Health ont généré 8,7 millions de dollars de revenus en 2022.

Paiements d'incitation aux soins basés sur la valeur

Les paiements d'incitation aux soins fondés sur la valeur ont totalisé 45,6 millions de dollars en 2022, représentant une source de revenus clé pour la société.

Type d'incitation	Paiements totaux
Bonus de performance de qualité	28,3 millions de dollars
Incitations à l'économie des coûts	17,3 millions de dollars

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.