Clover Health Investments Q3 2023 Earnings Call Transcript

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November 6, 2023

There are 6 speakers on the call.

Operator

And gentlemen, good afternoon, and welcome to the Clover Health Third Quarter 2023 Earnings Conference Call. At this time, all participants are in a listen only mode. A question and answer session will follow the prepared remarks. As a reminder, today's call is being recorded. I would now like to turn the call over to Ryan Schmidt, Investor Relations for Clover Health.

Operator

Please go ahead,

Speaker 1

Good afternoon, everyone. Joining me on our call today to discuss the company's Q3 results are Andrew Toye, Clover Health's Chief Executive Officer and Scott Leffler, the company's Chief Financial Officer. You can find today's press release and the accompanying supplemental slides in the Investor This webcast is being recorded and a replay will be available in the Investor Relations section of the I'd also like to caution you that we may make forward looking statements during today's call that are subject to risks and uncertainties, including expectations about future performance. Factors that may cause actual results to differ materially from expectations are detailed in our SEC filings, including in the Risk A reconciliation of those measures to GAAP measures can be found in the earnings materials available on our website. With that, I'll now turn the call over to Andrew.

Speaker 2

Thank you, Ryan, and thanks everyone for joining us. Our results that we've reported today continue to highlight our progress towards sustained profitability and the great value derived from Clover Assistant. We built upon our impressive first half of the year with our insurance segment once again delivering excellent results, driving strong overall company performance during the Q3. Our results represent another proof point in our strategic shift to prioritize profitability this year, which in turn has led us to once again improve upon our full year 2023 guidance ranges. We believe that our Q3 results coupled with our first half momentum further show our potential to achieve profitability next year on an adjusted EBITDA basis I'm without needing to raise additional capital.

Speaker 2

Before I dive in more into our Q3 results, I hope that everyone was able to tune into our Clover Assistant showcase last month, where we highlighted our cloud based AI powered We reported segment revenue of $301,000,000 during the Q3, representing an increase of 12% year over year. This segment continued its strong margin trajectory, delivering an MCR of 78.5%, a great improvement as compared to Q3 of 2020 I'm proud that our efforts this year to optimize our MA plant operations, grow revenue and blunt Medex growth continue to shine through in our results. We're constantly looking to optimize our capabilities and I expect our MA mature operations can truly support better care management within any MA population. As compared to other similar MA plans, our membership is more ethnically diverse and has a much higher percentage of members considered low income. Studies have shown that both low income and more diverse populations generally have a higher disease burden and also have difficulty accessing needed care.

Speaker 2

We believe that our ability to comprehensively support this population while delivering strong sustainable economics Demonstrates the power of our technology centric model. Now let's move on to the recent publication of STAR's performance for the measurement year 2022 cycle. While we received stronger scores in many areas on our STAR rating, We received an overall 3 star rating for measurement year 2022, which dictates reimbursement for payment year 2025. This result is obviously disappointing to us, but we do see this cycle as an outlier. We came very close to 3 point STARS for measurement year 2022, even with the significant increase in cut points and the significant number of STARS improvement efforts we deployed for measurement year 2023 Plus the increased predictability given to us through the new CMS STARZ guardrails gives us optimism about our ability to regain our 3.5 star rating in the near As an overall summary on Starz, we are disappointed in the 3 star rating, but see it as likely a 1 year event for 2025.

Speaker 2

For that year, we're committed to having strong financial momentum to mitigate its effects and we do not see it as a barrier to long term sustained profitability and we anticipate our STAAR performance improving in future measurement years. Shifting over to growth, Similar to 2023, we intend to measure ourselves in terms of increasing top line insurance revenue and we are targeting high single to low double digit insurance segment revenue growth in 2024. Expect us to continue to index on profitable growth through a combination of new member lives, Churn reduction and per member revenue initiatives. As our business continues to mature, we believe that this balanced approach is the right one to help us achieve our broader goal of reaching sustained profitability on an adjusted EBITDA basis next year. We'll obviously have more to talk about regarding our Annual enrollment performance and our next earnings.

Speaker 2

For our non insurance segment, we reported a 3rd quarter MCR of 104.1% on revenue of $176,000,000 bringing the year to date performance to an NCR of 99.7%. Even though we are continuing to target a non insurance NCR below 100% for 2023, We continue to see challenges in the design of the program and therefore are committed to rightsizing our exposure to value based original Medicare. Consistent with that approach, we again expect a reduction in the number of participating physicians next year as we continue to evaluate this segment's performance. For the future of this segment, we very much believe in our ability to use Clover Assistant to help physicians go to value based care For non Clover MA plan patients with Medicare, we started this with ACO reach and original Medicare, but in the last couple of years, We have seen clear evidence that we have great strength in Medicare Advantage Total Risk Management. As such, while we will like We continue to closely manage our exposure to original Medicare.

Speaker 2

You will see us increase investment in Medicare Advantage within our non insurance segment. That is, we will look to enable physicians to use Clover Assistant across their entire MA panel for all MA plans and to be able to go to value based risk on those lives. We're incredibly excited by this adjustment to the non insurance strategy and With that, I'll now hand it to Scott for the more detailed financial update.

Speaker 1

Thanks, Andrew. I'll first cover the Q3 financial highlights and then review our improved outlook for full year 2023. Adjusted EBITDA significantly improved from a loss of $56,000,000 in Q3 of last year to an EBITDA loss of $5,000,000 in Q3 of this year, driven by strong insurance performance and a continued reduction in adjusted SG and A relative to the prior year period. For our insurance segment, MTR improved to 78.5% in Q3 From 86.3% in Q3 of last year, building on the strong momentum we delivered in the first half of this year. Our strong MCR performance was driven by revenue growth of 12% in Q3 to $301,000,000 And 15% growth year to date to $933,000,000 As we mentioned in the past, we have continued to see Favorable impacts from various operating initiatives all year and these initiatives resulted in modest amounts of TPD From earlier in 2023 impacting Q3.

Speaker 1

Our year to date NCR of 80.8% contains only minimal PPD and is a good representation of our underlying performance. During Q3, we experienced a similar medical cost trend to last quarter With PMPM Medex down 1% sequentially versus Q2, showing how our general medical expense trend is holding steady. We're always focused on initiatives to manage Medex through increasing impacts from Clover Assistant, improvements to M and A plan including optimization and planned product design, network, payment integrity capabilities and expansion of our clinical initiative. More specifically, our home care program continues to be a key lever contributing to the performance of the MA plan, where we're focused on delivering in home Primary care powered by CA to our highest need numbers to reduce costly hospitalization and post acute care utilization. We're increasingly enrolling higher risk new members into this program and are seeing lower inpatient admissions for participating members.

Speaker 1

We also benefited from being paid on 3.5 stars this year for our PPO plan similar to earlier quarters this year. Our non insurance segment revenue declined 70% versus the prior year period to $176,000,000 Primarily driven by the smaller group of participant providers at the start of this year. Our non insurance MCR in the 3rd quarter was 104.1% With a year to date FCR of 99.7 percent, this performance was relatively flat versus 104.2% for the Q3 of 2022. The deterioration from performance earlier in 2023 was largely driven by more conservative assumptions relating to benchmark views in determining To reiterate Andrew's earlier comments, we intend to improve the segment's performance with further reductions in our ACO REACH We believe this should reduce total participating physicians by approximately 40% beginning in 2024. I also wanted to provide an update regarding settlement on our 2022 performance for the non insurance segment.

Speaker 1

As a reminder, there is a significant lag between the time we book profits or losses under the program versus when that performance is settled in cash with CMS. We've received the final settlement report from CMS for the 2022 performance year and expect to settle it during Q4. We currently estimate the total settlement amount owed to CMS as being approximately $147,000,000 $52,000,000 of which accounts for a shared loss. The remainder of this settlement relates to repayment of working capital obligations. 3rd quarter adjusted SG and A improved to $68,000,000 a 6% reduction year over year from $73,000,000 in Q3 of 2022.

Speaker 1

We continue to see a favorable impact this quarter from some of the cost savings initiatives reported earlier this year. The UST Health Group transition is actively underway for many of our MA plan operations with most of the benefits still yet to be realized starting in 2024. That said, many of the mission critical work streams are already configured into the UST ecosystem. This includes operations related to claims, Member enrollment, welcome kits, call center and administrative functions to name a few. And we believe this sets us up for a successful changeover in 2024.

Speaker 1

We remain excited to take advantage of the economies of scale and operational efficiencies that we expect our partnership with USD Health Proof will capture and still expect to realize the full savings originally compensated from the initiative. Turning to the balance sheet, We finished the Q3 with restricted and unrestricted cash, cash equivalents and investments totaling $672,000,000 on a consolidated basis With $308,000,000 of the parent entity and unregulated subsidiary level. Our strong Q3 performance is another important step in the right direction I'm proud of the continued step change improvement in our insurance business this quarter, driving favorable adjusted EBITDA performance and giving us confidence that our results this year are sustainable. We believe that this positions us well to achieve profitability in 2024 for the full year on an adjusted EBITDA basis. I believe that we're progressing well on our mission to improve our financial performance so that we do not need any additional capital.

Speaker 1

Finally, I'll provide an update to our full year 2023 guidance. This guidance is reflective of a certain amount of conservatism in Q4 and consideration of typical seasonality risk in Q4. We are narrowing our revenue guidance for the insurance line of business to between 1,210,000,000 And $1,230,000,000 We are improving insurance MCR guidance to a range of 81% to 82%. We are maintaining our previous non insurance revenue guidance at a range of 750,000,000 To $800,000,000 and MCR of 98% to 100%. We are also improving our adjusted SG and A Between $310,000,000 $315,000,000 These changes resulted in improved adjusted EBITDA guidance Between negative $55,000,000 negative $80,000,000 In conclusion, we delivered another durable proof point this quarter On our path to profitability, we significantly improved adjusted EBITDA, continued momentum in our insurance results With strong insurance segment MCR and a further reduction in adjusted SG and A from our previous initiatives.

Speaker 1

I believe that our great execution this year coupled with our updated expectations for the full year should set us up Well, to achieve profitability goals in 2024. Our aim is to continue this momentum and accelerate growth for our business on the other side of Now let me turn the call back to Andrew for some closing comments.

Speaker 2

Thanks, Scott. As always, I'll close with some commentary on Clover Assistant. From our own MA plan to the future of the non insurance segment, What gives us great confidence in our strategy is that Clover Assistant is continually demonstrating that arming physicians with the right data helps them make the right decisions. And when they do that, the patient gets better outcomes and Medicare Advantage plans get better medical economics. We continue to derive great value from our technology with over 1,000 basis points of MCR improvement for returning members whose PCPs use Clipper Assistant as compared to those who do not.

Speaker 2

Last month, we published an in-depth analysis further highlighting CA's clinical efficacy, Showing how clinicians using our technology are diagnosing and managing diabetes earlier, resulting in improved patient outcomes. Diabetes is a very common disease in the Medicare population that unfortunately can result in many severe complications. That's why diabetes care has been an important focus of Clover Assistant from its inception. And in our diabetes research paper, We outlined how the use of CA is associated with earlier diagnosis, earlier treatment, a reduction in hypoglycemia and During our recent Clover Assistant showcase, We put on display the incredible impact and efficacy we see from our platform. We demonstrated how we're leveraging new advancements in AI and machine learning so that clinicians have the information they need to better care for their patients and how we're increasing accessibility to the platform through deep EHR integration.

Speaker 2

Most importantly, we shared in-depth analysis of how Clover Assistance is associated with earlier identification and management of chronic conditions to illustrate how we're improving patient care coordination through timely clinical insights. Lastly, and what's even more exciting than our current results Is the untapped potential of our platform going forward? We've shared in the past that we currently have over 100 machine learning models in active use alongside dozens of active or patent pending technologies and algorithms. We're constantly launching and testing new features as Klubra Systems is always learning and always improving. Our conviction in our technology is such that we have based our entire model upon it and we believe we are the only managed care organization whose entire focus is on managing Medicare risk through AI powered physician focused software.

Speaker 2

We've made plenty of comments today demonstrating the strength of the Clipper model and our exciting progress on our push towards sustained profitability. I'm proud of all we've been able to accomplish 3 quarters into the year. And while we have one more quarter to go, I applaud the entire Clover team for the great momentum we've generated so far this year. With that, let's move on to Q and A.

Operator

Our first question comes from Jason Casola, Citi?

Speaker 3

Great. Thanks and good afternoon. I just had a quick clarification on CMS You said you have $157,000,000 that's due in the Q4, just making sure I heard that right. And then it sounds like you noted you wouldn't need to raise additional capital, but just given the implied 4th quarter EBITDA losses within guidance, the settlement dollars, can you just maybe help us or help Bridge your cash position over the next few quarters would be helpful. Thanks.

Speaker 1

Yes. This is Scott.

Speaker 4

I'll take that question. So yes, you heard that right. The that we're anticipating in Q4 was a total of $147,000,000 a little over $50,000,000 of that relates to our shared loss under the program And then the remainder is just related to the working capital dynamics into the program, where in connection with the settlement, you paid back a certain amount of Capital that was advancing the program. But in terms of a cash flow bridge, yes, I'll just kind of reiterate our expectation that we have For operating capital, certainly at least for 2023. And as I think we indicated, our objective is to reach profitability and cash flow positivity without needing any incremental capital in 2024 and future years.

Speaker 4

As far as a cash flow bridge, I mentioned We do we finished the quarter with $308,000,000 of cash and cash equivalents and investments at the parent entity and unregulated Level and so that settlement amount just due to CMS would come out from that. And then to the extent that we do continue to deliver any EBITDA loss in Q4 going forward would come out of that amount as well. Although obviously, we continue to look for opportunities To leverage the capital that we have remaining at the regulated entity level and that's kind of an organic flow that occurs over But in general, we are comfortable with our capital position now and again

Speaker 1

look to a strong twenty

Speaker 3

Paul, maybe just a follow-up. I wanted to ask about utilization trends in the quarter. Obviously, a strong result with the 78.5% MAMLR, But it looks like medical costs per member per month grew about 11% year over year. I know you're more than covering that with a 22% revenue PMPM. But Just curious on what you saw on the utilization front, if there's any caveats that are driving that year over year medical

Speaker 4

Yes. So I'll comment on that. 1st, at a high level, I'll tell you from a utilization standpoint. We're not seeing anything very different From what we've seen earlier in the year and as a reminder, when we reported Q1 and Q2, We are seeing fairly benign trends from a utilization standpoint. On the year over year increase in PMPM Medex that you're referencing It's distorted a little bit by something that happened last year where we had some favorable PPD effect in our medics in Q3 of last year, Which distorts the top a little bit.

Speaker 4

I think what's more representative and we try to anchor people last quarter and this quarter now Instead of any one quarter looking at our year to date performance as being more representative of the overall performance this year, especially Compared to last year,

Speaker 1

and so as we said in

Speaker 4

our prepared comments, we're running at about an 81% MCR on a year to date basis.

Operator

Our next question comes from John Penney, Canaccord Genuity.

Speaker 5

EBITDA ramp in 4th quarter, can you just possibly flush that out on what exactly you're expecting? I assume some increased utilization, but any additional color would be great. Thanks.

Speaker 4

Yes. So earlier this year, when we made updates to our guidance, we got similar questions around what was implied about 2nd half of the year. And the way we've been answering all year is that we continue to model our guidance with what we think appropriate conservatism in the remaining part of the year. Q4 in particular is due to seasonality risk. Often Q4 is one where you see elevated utilization level, historically due to flu season or more recently, of course, due to the risk of COVID, Any kind of increased COVID related utilization.

Speaker 4

And so the conservatism in that number is really driven by that exposure, but there's nothing Specifics that we're pointing to.

Speaker 5

Okay, great. And then one follow-up.

Speaker 2

Yes, this is Andrew. So, we're not giving any guidance right On the AEP, what we'll do is we'll obviously discuss it in a more fulsome way at the next earnings. But what I will do is reiterate Just like this year, we are looking to maintain growth in our insurance revenue. We discussed that during the remarks. And that will come from a combination of membership growth during the AEP, growth during the year of membership, reduction in churn and per member revenue initiatives.

Speaker 2

So we are very focused on growing that insurance revenue in that single digit to low double digit range as well as maintaining highly profitable growth and that's where our attention is focused.

Operator

Our next question comes from Jason Kaczorla, Citi.

Speaker 3

Great. Thanks for letting me back in the queue. I just wanted to go, your commentary around reducing exposure in the non insurance business. Maybe can you just give us more color on the decision To reduce for the 2nd time in 2 years, I think last year, you shifted towards working with higher performing physicians to help offset on the profitability front. But It sounds like even in that context, you're still looking to get smaller there.

Speaker 3

I guess just any more color around that decision? And then can you remind us That business has a relatively small SG and A load, correct, as you think about reducing membership there?

Speaker 2

Yes. So a couple of different points there. Thanks, Jason. Number 1, I would just make sure that I'm we're clear in our remarks. The non insurance segment, which is where we do not play a role as an insurer, remains interesting to us.

Speaker 2

The remarks that we made earlier today are specifically to do with the original Medicare, the ACO reach component of the non insurance business. And so what I discussed was the fact that the original Medicare area, we continue to reduce our exposure over there and to look to that we right size that business. While we are very excited about the possibility and our capability of increasing our exposure on the Medicare I just want to make sure that I clarify that particular point. Your last question, yes, we said before that it's a relatively smaller part of our SG and A load, which makes Because of the nature of that particular program. And the last thing that I'll say there is that I think that what we're looking for in terms of partnerships and in terms of And in terms of how applying Clover Assistant is places where we can help providers move their entire book of Medicare risk Medicare booked towards risk including MA and that's part of our rightsizing of this program is introducing that MA side of the program versus looking at just original Medicare.

Speaker 2

So as we look at the future of the non insurance segment, that's where you should expect us to go.

Speaker 3

Okay, got it. Thanks. Very, very helpful. Maybe just one last follow-up here. Just on that MA side, In terms of offering the non transfer for the MA side of the Fed, can you remind us, do you have any lives there now?

Speaker 3

Would that be kind of I'm just trying to get a sense of where you're at there now. I thought that

Speaker 2

Yes, yes, really fair question. So in terms of whether we have any of that right now, what we haven't actually shared the sizing of that particular program The majority of it is in that original Medicare program, that's for sure. But we definitely see opportunities there. We've been approached. We've had discussions.

Speaker 2

And so while we haven't shared exactly where we are with that program and we're sharing today that we're very excited about where we can go with that. We haven't actually given any of the numbers in terms of like how many lives we

Operator

This concludes the Q and A portion of today's conference. I would now like to turn the call back over to Andrew Toy for any additional and closing remarks.

Speaker 2

Great. Thanks everyone for all of your questions. So I hope that our Q3 and year to date results really give everyone another durable proof point highlighting our ability to drive great results this year. And thank you all again for joining us on this exciting journey.

Operator

This concludes today's

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Key Takeaways

  • Q3 results showed continued progress toward profitability with insurance segment revenue of $301 million (up 12% year-over-year), an MCR of 78.5%, and an adjusted EBITDA loss narrowed to $5 million from $56 million.
  • Management raised full-year 2023 guidance, narrowing insurance revenue to $1.21–1.23 billion, improving insurance MCR to 81–82%, maintaining non-insurance revenue of $750–800 million, and tightening SG&A to $310–315 million, with adjusted EBITDA now expected between –$55 million and –$80 million.
  • The company received an overall 3-star STAR rating for measurement year 2022 (payment year 2025) but views this as a one-year outlier and expects to regain a 3.5-star rating under new CMS guardrails.
  • The non-insurance segment generated $176 million in Q3 revenue with an MCR of 104.1%, and the company plans to reduce ACO REACH physician participation by ~40% in 2024 while shifting emphasis to Medicare Advantage risk management using Clover Assistant.
  • Clover Assistant, the AI-powered care management platform, continues to drive over 1,000 basis points of MCR improvement for returning members and demonstrates early chronic disease detection (e.g., diabetes), underpinning the company’s tech-centric model.
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Earnings Conference Call
Clover Health Investments Q3 2023
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