Clover Health to Exit ACO REACH Program

Dec. 6, 2023
Physician enablement company says it has ‘not seen a clear line to profitability in this business’

Publicly traded physician enablement company Clover Health (NASDAQ: CLOV) says it will exit the ACO REACH program at the end of the 2023 performance year, citing a lack of profitability. 

ACO REACH is an advanced alternate payment model (APM) for physicians in value-based arrangements that requires assuming financial risk for Medicare beneficiaries while committing to advancing health equity, stakeholder feedback and participant experience. To better support care delivery and coordination for patients in underserved communities, each model participant must design and implement a comprehensive health equity plan that identifies its underserved communities and establishes initiatives to measurably reduce health disparities within their beneficiary populations. 

In addition to notifying CMS, the company said written notification will also be sent to all participating physicians in accordance with CMS requirements. Clover said the decision will have no impact on its ACO REACH beneficiaries, and Clover will continue to fulfill all of its obligations under the ACO REACH Program for the 2023 performance year.

The Franklin, Tenn.-based company’s software platform, Clover Assistant is designed to aggregate patient data from across the healthcare ecosystem to support clinical decision-making and improve health outcomes through the early identification and management of chronic disease.

“When we entered the ACO REACH business in 2021, we felt that expanding our platform to Original Medicare would have a number of benefits, including increasing the number of lives under Clover Assistant management and enabling us to rapidly increase the number of physicians we worked with directly,” said Andrew Toy, Clover Health’s CEO, in a statement. “And, while we were successful in those goals, we have not seen a clear line to profitability in this business and it has also become quite clear that, over the same period of time, we have made far greater and swifter strides on our path to profitability in our Medicare Advantage insurance business.”

Toy added that Clover remains excited about the success of its Medicare Advantage insurance business in 2023 and intends to focus its resources on building that business and continuing to invest in Clover Assistant as part of its path to profitability. 

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