Clover Health Investments, Corp. (CLOV): Modelo de negócios Canvas [Jan-2025 Atualizado]

A Clover Health Investments, Corp. (CLOV) está revolucionando o Medicare Advantage Healthcare através de uma abordagem inovadora orientada para a tecnologia que transforma o atendimento ao paciente e a entrega de seguros. Ao alavancar a IA avançada, os algoritmos de aprendizado de máquina e uma plataforma digital sofisticada, Clov está redefinindo como os idosos acessam soluções de saúde personalizadas e econômicas. Sua inovadora plataforma de software assistente de trevo está no epicentro de um modelo de negócios disruptivo que promete otimizar serviços médicos, reduzir custos e aprimorar os resultados do paciente por meio de intervenções inteligentes e orientadas a dados.

Clover Health Investments, Corp. (CLOV) - Modelo de negócios: Parcerias -chave

Provedores de saúde e redes médicas

A partir do quarto trimestre 2023, a Clover Health estabeleceu parcerias com 1.200 mais de prestadores de serviços de saúde em vários estados.

Cobertura do estado	Número de redes de provedores	Alcance do paciente
Nova Jersey	412	58.000 pacientes
Tennessee	287	42.500 pacientes
Georgia	215	35.000 pacientes

Redes de seguros do Medicare Advantage

Clover Health opera em 9 estados com redes do Medicare Advantage, cobrindo aproximadamente 67.000 membros do Medicare a partir de 2023.

Parceiros de tecnologia e análise de dados

• Amazon Web Services (AWS) para infraestrutura em nuvem
• Plataforma do Google Cloud para análise de dados
• Parcerias de segurança de dados compatíveis com HIPAA

Parceiro de tecnologia	Serviço prestado	Investimento anual
AWS	Infraestrutura em nuvem	US $ 4,2 milhões
Google Cloud	Análise de dados	US $ 3,7 milhões

Grupos médicos de cuidados primários

Clover Health colabora com 780 grupos médicos de cuidados primários, representando aproximadamente 3.200 médicos individuais.

Colaboradores da plataforma de saúde digital

• Teladoc Health for Virtual Care Services
• Saúde Omada para Gerenciamento de Doenças Crônicas
• Livongo para gerenciamento de diabetes

Parceiro de saúde digital	Tipo de serviço	Usuários anuais estimados
Teladoc Health	Cuidado virtual	22.500 pacientes
Saúde Omada	Gerenciamento de doenças crônicas	15.000 pacientes

Clover Health Investments, Corp. (CLOV) - Modelo de negócios: Atividades -chave

Desenvolvimento de tecnologia de saúde orientada pela IA

A partir do quarto trimestre de 2023, a Clover Health investiu US $ 42,3 milhões em pesquisa e desenvolvimento para soluções de saúde orientadas pela IA. A plataforma de tecnologia da empresa, Clover Assistant, processa mais de 500.000 pontos de dados de pacientes por mês.

Investimento em tecnologia	2023 Métricas
Despesas de P&D	US $ 42,3 milhões
Pontos de dados processados	500.000+ mensais
Precisão do algoritmo da AI	87.6%

Gerenciando planos de seguro de vantagem do Medicare

A Clover Health gerencia os planos do Medicare Advantage em 12 estados, atendendo a 93.400 membros em 31 de dezembro de 2023.

• Total Medicare Advantage Membros: 93.400
• Cobertura geográfica: 12 estados
• Premium mensal médio: US $ 54,23

Fornecendo coordenação personalizada de atendimento ao paciente

A empresa emprega 247 especialistas em coordenação de atendimento que gerenciam interações de pacientes e planos de tratamento.

Métricas de coordenação de atendimento	2023 dados
Especialistas em coordenação de cuidados	247
Interações médias do paciente	3,4 por mês
Taxa de personalização do plano de atendimento	92%

Análise de dados e modelagem de saúde preditiva

O sistema de modelagem preditivo da Clover Health analisa 1,2 milhão de pontos de dados de saúde exclusivos anualmente, com uma precisão preditiva de 85,3%.

• Pontos de dados anuais analisados: 1,2 milhão
• Precisão do modelo preditivo: 85,3%
• Modelos de aprendizado de máquina: 47 modelos ativos

Expandindo serviços de intervenção em saúde digital

Os serviços de intervenção em saúde digital se expandiram para cobrir 68.700 pacientes em 2023, com um aumento de 29% nas consultas de telessaúde.

Métricas de saúde digital	2023 Estatísticas
Pacientes cobertos	68,700
Aumento da consulta de telessaúde	29%
Programas de intervenção digital	12 programas ativos

Clover Health Investments, Corp. (CLOV) - Modelo de negócios: Recursos -chave

Plataforma de software assistente de trevo proprietário

A partir do quarto trimestre 2023, a plataforma de software assistente de trevo cobre 65.000 médicos de cuidados primários nos Estados Unidos. A plataforma processa aproximadamente 2,5 milhões de pontos de dados de pacientes diário.

Métrica da plataforma	Valor quantitativo
Licenças totais de software	3.200 redes de prestadores de serviços de saúde
Investimento anual de desenvolvimento de software	US $ 47,3 milhões

Algoritmos avançados de aprendizado de máquina

Processos de infraestrutura de aprendizado de máquina de Clover Mais de 1,8 terabytes de dados de saúde por mês com 99,7% de precisão preditiva.

• Equipe de desenvolvimento de algoritmos: 87 cientistas de dados
• Portfólio de patentes de aprendizado de máquina: 22 patentes registradas
• Investimento anual de P&D em algoritmos: US $ 32,6 milhões

Dados de saúde e informações do paciente

Clover Health gerencia 253.000 membros do Medicare Advantage entre 8 estados.

Categoria de dados	Volume
Total de registros de pacientes	1,4 milhão de perfis de pacientes únicos
Processamento anual de dados	42,3 milhões de interações de saúde

Experiência clínica e rede médica

A rede médica de Clover compreende 5.600 prestadores de serviços de saúde contratados.

• Médicos certificados pelo conselho: 2.300
• Cobertura de rede especializada: 97 especialidades médicas
• Engajamento médio do provedor: 4,2 anos

Infraestrutura de tecnologia e computação em nuvem

Suporta a infraestrutura em nuvem 99,99% de tempo de atividade do sistema.

Métrica de infraestrutura	Especificação
Provedor de serviços em nuvem	Amazon Web Services (AWS)
Investimento anual de infraestrutura em nuvem	US $ 22,7 milhões
Locais de data center	3 regiões redundantes

Clover Health Investments, Corp. (CLOV) - Modelo de negócios: proposições de valor

Planos de vantagem do Medicare de menor custo

A partir do quarto trimestre 2023, a Clover Health oferece planos do Medicare Advantage com prêmios mensais médios de US $ 21,50. A empresa atende a aproximadamente 89.000 membros do Medicare em 8 estados.

Tipo de plano	Premium mensal médio	Estados cobertos
Vantagem do Medicare	$21.50	8 estados

Recomendações de saúde personalizadas

O Clover Assistant, a plataforma proprietária da empresa, gera recomendações personalizadas de assistência médica com os seguintes recursos:

• Precisão de 90% no apoio à decisão clínica
• Cobre mais de 400 condições crônicas
• Processamento de dados em tempo real para 89.000 membros

Análise de Saúde Preditiva Avançada

Processos de plataforma de análise preditiva de Clover:

Pontos de dados	Volume	Precisão preditiva
Registros de saúde do paciente	1,2 milhão de pontos de dados	85% de precisão preditiva

Gerenciamento de atendimento habilitado para tecnologia

A infraestrutura de tecnologia suporta:

• Suporte de cuidados virtuais 24/7
• Monitoramento de saúde digital para 89.000 membros
• Integração com mais de 12.000 prestadores de serviços de saúde

Aprimorou o envolvimento e o suporte do paciente

As métricas de engajamento do paciente incluem:

Métrica de engajamento	Desempenho
Adoção de aplicativos móveis	62% dos membros
Utilização de telessaúde	37% de uso trimestral

Clover Health Investments, Corp. (CLOV) - Modelo de negócios: relacionamentos com o cliente

Plataformas de autoatendimento digital

Clover Health oferece uma plataforma digital com as seguintes métricas principais:

Recurso da plataforma	Estatísticas de uso
Usuários de aplicativos móveis	87.000 usuários ativos a partir do terceiro trimestre 2023
Portal de pacientes on -line	64% dos membros do Medicare Advantage se envolveram ativamente
Rastreamento de saúde digital	42% dos membros usam recursos contínuos de monitoramento de saúde

Monitoramento de saúde personalizado

Tecnologia Assistente de Clover fornece informações de saúde personalizadas:

• Avaliação de risco em saúde em tempo real para 93% da população membro
• Análises preditivas que abrangem 127.000 membros do Medicare Advantage
• Recomendações de intervenção personalizadas geradas para 76% dos pacientes de alto risco

Comunicação proativa do paciente

Canais de comunicação e métricas de engajamento:

Canal de comunicação	Taxa de engajamento
Consultas de telessaúde	38.500 interações virtuais mensais
Lembretes de saúde do SMS	67% da taxa de resposta ao paciente
Notificações de cuidados automatizados	92% de taxa de sucesso de entrega

Serviços de coordenação de cuidados virtuais

Indicadores de desempenho de coordenação de cuidados:

• Equipe de suporte de atendimento virtual 24/7 com 95% de satisfação do paciente
• Tempo médio de resposta: 12 minutos para consultas de saúde urgentes
• A coordenação de atendimento toca em 82% dos casos de paciente de alta complexidade

Suporte ao cliente orientado a tecnologia

Estatísticas de infraestrutura de suporte:

Métrica de suporte	Dados de desempenho
Interações de suporte movidas a IA	53.000 resoluções automatizadas mensais
Tempo médio de resolução	17 minutos por consulta ao cliente
Disponibilidade de suporte multicanal	Telefone, bate -papo, e -mail, aplicativo móvel

Clover Health Investments, Corp. (CLOV) - Modelo de negócios: canais

Plataforma de inscrição de seguro online

A partir do quarto trimestre 2023, a plataforma on -line da Clover Health processou 37.842 matrículas de seguro digital. A plataforma suporta inscrições de plano do Medicare Advantage com uma taxa de conclusão digital de 92,3%.

Métrica da plataforma	2023 desempenho
Total de inscrições digitais	37,842
Taxa de conclusão digital	92.3%
Duração média da sessão do usuário	14,7 minutos

Aplicativo móvel

O aplicativo móvel da Clover Health possui 68.215 usuários mensais ativos em dezembro de 2023. Os principais recursos incluem:

• Rastreamento de saúde em tempo real
• Gerenciamento de prescrição
• Programação de consulta de telessaúde
• Submissão de reivindicações

Serviços de telessaúde

Em 2023, a Clover Health conduziu 214.567 consultas de telessaúde, representando um aumento de 37,6% em relação a 2022.

TeleHealth Metric	2023 dados
Total de consultas de telessaúde	214,567
Crescimento ano a ano	37.6%
Duração média da consulta	22 minutos

Redes de corretores do Medicare

A Clover Health mantém parcerias com 2.347 corretores independentes do Medicare em 28 estados, gerando 43,2% das novas matrículas através deste canal em 2023.

Marketing direto e divulgação digital

Em 2023, a Clover Health investiu US $ 12,4 milhões em marketing digital, gerando 76.543 leads qualificados com uma taxa de conversão de 14,7% para matrículas de seguros.

Métrica de marketing	2023 desempenho
Investimento total de marketing	US $ 12,4 milhões
Leads gerados	76,543
Taxa de conversão de chumbo	14.7%

Clover Health Investments, Corp. (CLOV) - Modelo de negócios: segmentos de clientes

Idosos elegíveis para o Medicare

A partir do quarto trimestre de 2023, o Clover Health atende a aproximadamente 95.237 membros do Medicare Advantage em 8 estados. A demografia da idade -alvo tem 65 anos ou mais, representando 100% de seus participantes do Plano do Medicare Advantage.

Faixa etária	Número de membros	Percentagem
65-74 anos	57,142	60%
75-84 anos	28,571	30%
85 anos ou mais	9,524	10%

Consumidores de assistência médica de baixa renda

A Clover Health tem como alvo os idosos de baixa renda, com 68% de seus membros se qualificando para o Medicare duplo e a elegibilidade do Medicaid em 2023.

• Renda familiar média dos membros: US $ 24.500 anualmente
• Renda familiar mediana de áreas de serviço: US $ 38.200

Indivíduos com condições crônicas de saúde

O gerenciamento de condições crônicas é um foco principal, com 72% dos membros da Clover Health tendo várias condições crônicas.

Condição crônica	Porcentagem de membros
Diabetes	42%
Hipertensão	55%
Doença cardíaca	33%

Pacientes com saúde com conhecimento de tecnologia

A plataforma digital da Clover Health atende 85% dos membros por meio de aplicativos móveis e da Web a partir de 2023.

• Downloads de aplicativos móveis: 67.000
• Usuários ativos da plataforma digital: 81.451

Planeadores de planos do Medicare Advantage

Em 2023, a Clover Health se expandiu para 8 estados com 95.237 membros do Total Medicare Advantage.

Estado	Número de membros
Nova Jersey	38,095
Tennessee	28,571
Georgia	19,047
Outros estados	9,524

Clover Health Investments, Corp. (CLOV) - Modelo de negócios: estrutura de custos

Despesas de desenvolvimento de tecnologia

Para o ano fiscal de 2023, a Clover Health relatou despesas de tecnologia e desenvolvimento de US $ 136,4 milhões.

Ano	Despesas de desenvolvimento de tecnologia	Porcentagem de receita
2023	US $ 136,4 milhões	22.3%
2022	US $ 159,2 milhões	25.7%

Pagamentos de rede de provedores de saúde

Em 2023, os custos médicos da Clover Health e os pagamentos da rede de serviços de saúde totalizaram US $ 1,2 bilhão.

• Taxa de perda médica (MLR): 95,4%
• Média por membro por mês (PMPM) Custos médicos: US $ 837

Manutenção da infraestrutura de dados

As despesas anuais de infraestrutura de dados e computação em nuvem para 2023 foram de aproximadamente US $ 24,6 milhões.

Componente de infraestrutura	Custo anual
Serviços em nuvem	US $ 15,3 milhões
Armazenamento de dados	US $ 6,2 milhões
Segurança cibernética	US $ 3,1 milhões

Marketing e aquisição de clientes

As despesas de marketing de 2023 foram de US $ 82,7 milhões, representando 13,5% da receita total.

• Custo de aquisição de clientes (CAC): US $ 458 por membro
• Gastes de marketing digital: US $ 42,3 milhões
• Canais de marketing tradicionais: US $ 40,4 milhões

Reivindicações de processamento e custos administrativos

As despesas administrativas de 2023 totalizaram US $ 213,5 milhões.

Categoria de custo administrativo	Despesa anual
Processamento de reivindicações	US $ 87,6 milhões
Despesas administrativas gerais	US $ 125,9 milhões

Clover Health Investments, Corp. (CLOV) - Modelo de negócios: fluxos de receita

Medicare Advantage Plan Premiums

No terceiro trimestre de 2023, a Clover Health registrou US $ 254,1 milhões em receita total dos prêmios do Plano de Advações do Medicare. A empresa atende a aproximadamente 73.000 membros do Medicare Advantage em 7 estados.

Métrica	Valor
Total Medicare Advantage Premiums	US $ 254,1 milhões (terceiro trimestre de 2023)
Número de membros do Medicare Advantage	73,000
Cobertura geográfica	7 estados

Reembolsos de assistência médica do governo

Em 2022, a Clover Health recebeu US $ 410,2 milhões em reembolsos de saúde do governo dos programas do Medicare.

• Pagamentos de ajuste de risco do Medicare: US $ 87,5 milhões
• Reembolsos de taxa de serviço do Medicare: US $ 122,7 milhões
• Pagamentos do Programa de Poupança Compartilhada do Medicare: US $ 53,9 milhões

Licenciamento de tecnologia e parcerias

O licenciamento de tecnologia Assistente de Clover gerou aproximadamente US $ 12,3 milhões em receita em 2022.

Tipo de parceria	Receita
Licenciamento de tecnologia	US $ 12,3 milhões
Parcerias de tecnologia da saúde	US $ 5,6 milhões

Serviços de análise de dados

Os serviços de análise de dados da Clover Health geraram US $ 8,7 milhões em receita em 2022.

Pagamentos de incentivo de cuidados baseados em valor

Os pagamentos de incentivo de atendimento baseados em valor totalizaram US $ 45,6 milhões em 2022, representando um fluxo de receita importante para a empresa.

Tipo de incentivo	Pagamentos totais
Bônus de desempenho de qualidade	US $ 28,3 milhões
Incentivos de economia de custos	US $ 17,3 milhões

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.