Publicly traded medical training 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 alternative payment model (APM) for physicians in value-based arrangements that requires assuming financial risks for Medicare beneficiaries while committing to promoting health equity, stakeholder feedback and expertise of the participants. To better support care delivery and patient coordination in underserved communities, each model participant must design and implement a comprehensive health equity plan that identifies their underserved communities and establishes initiatives to measurably reduce health disparities within of its 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 meet all of its obligations under the ACO REACH Program for the 2023 performance year.
Clover Assistant, the Franklin, Tennessee-based company’s software platform, is designed to aggregate patient data from across the healthcare ecosystem to support clinical decision making and improve health outcomes through early identification and management of chronic diseases.
“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 allowing us to rapidly increase the number of physicians with the that we work. directly,” Andrew Toy, CEO of Clover Health, said in a statement. “And while we were successful in those objectives, 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 much greater and faster progress 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 developing that business and continuing to invest in Clover Assistant as part of its path to profitability.
