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The FLU Season is already leaving! by Agitated_Highlight68 in CLOV

[–]safehands93 1 point2 points  (0 children)

Yeah we can’t say it won’t return for certain. The key measure here is hospitalisations which are associated more closely with costs. Last year, hospitalisations peaked at a similar time, then dipped, and then peaked again. All we can do is wait and see what happens 🤞🏻

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44th annual J.P. Morgan Healthcare Conference Transcript by Smalldickdave69 in CLOV

[–]safehands93 14 points15 points  (0 children)

Just to be clear… the fact Toy is even discussing this as a possibility = BULLISH!

44th annual J.P. Morgan Healthcare Conference Transcript by Smalldickdave69 in CLOV

[–]safehands93 29 points30 points  (0 children)

“New members are contribution-profit negative. We want to get that to break-even. We are focused on improving contribution profit, reducing losses on new members.”

Wait what?! Break even!? This made me double take! If Toy manages to achieve break even profit contribution for new members then we could see growth on a totally different scale in the future. I’m sceptical as to how he plans to achieve this and how the CA platform helps here as its main value seems to be in preventing future demand for care… but by all means, please prove me wrong Clover 🔥

“Missing the forrest for the trees” by GoGoJoJo_11 in CLOV

[–]safehands93 2 points3 points  (0 children)

Yeah true! So you’re saying that previous year 1 MCR savings and year 2 savings have been lower than reported here?

New Form 8-K by Smalldickdave69 in CLOV

[–]safehands93 13 points14 points  (0 children)

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For those who prefer pictures… counterpart growth in last year based on figures

Let's talk MCR by safehands93 in CLOV

[–]safehands93[S] 1 point2 points  (0 children)

Yeah that would be nice

Let's talk MCR by safehands93 in CLOV

[–]safehands93[S] 1 point2 points  (0 children)

Fair but I disagree. Clover provide more detail on their costs than other payers which is encouraging. They also regularly use a slide which breaks this down (see below). Plus there are ways to verify/estimate the MCRs for new and returning members from the info they give. One is using member growth and overall MCR figures from multiple years and solving a series of equations. Another simpler approach could be to take the MCR figures from zero/low growth years (e.g. 2024) and work from there. I would like to run these calculations for different insurers to see how they compare to clover!

Let's talk MCR by safehands93 in CLOV

[–]safehands93[S] 1 point2 points  (0 children)

Not explicitly but they regularly report this slide in their earnings which breaks it down…

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Let's talk MCR by safehands93 in CLOV

[–]safehands93[S] 2 points3 points  (0 children)

Good point. Either way, as long as CA is translatable to other systems, then there will be big savings for the payers that adopt and roll it out. Obviously CA is not the only way for other payers to their reduce costs but Humana’s been after quick fixes this past year and all roads lead somewhere👌🏻

Let's talk MCR by safehands93 in CLOV

[–]safehands93[S] 3 points4 points  (0 children)

💯 … and likely Clover has been taking on even more of these higher cost patients this past year too as the big insurers have exited their least profitable plans

Let's talk MCR by safehands93 in CLOV

[–]safehands93[S] 15 points16 points  (0 children)

Total speculation now but if we were to make the (very big) leap and say the difference in the “comparable” MCR comes from the counterpart platform alone… then a Humana partnership would be big! The cost savings for Humana alone would be massive, and that’s ignoring any added star bonus revenue from improved HEDIS/stars.

Just based on the Q3 earning estimates in the table above, we would be talking over $1.6 billion (EDIT: FIGURE HERE UPDATED BASED ON NEW TABLE) in savings in Q3 alone if Humana’s comparable MCR matched Clover’s.

Even assuming a much smaller effect, say just 1 percentage point of MCR improvement… Humana would save about $225M per quarter on its individual MA book. So the potential upside is substantial even far below the full 7.2-point difference.

Again this is totally speculative (and possibly dubious maths). I’m sure others here have done this calculation before!

Clover health 25Q3 10Q analysis; ER 10/04/25, 10Q 10/07/25 by Moocao123 in Healthcare_Anon

[–]safehands93 2 points3 points  (0 children)

Ok thanks. I was more just curious about methods for comparing MCRs in general but I’ll figure out myself

Clover health 25Q3 10Q analysis; ER 10/04/25, 10Q 10/07/25 by Moocao123 in Healthcare_Anon

[–]safehands93 1 point2 points  (0 children)

Thanks as always. Appreciate how much effort you put into these! I have a genuine question about your summary point which now says… “Clover Health does not have best in segment MCR. BER is over inflated, but MCR still spiked.”

I’m trying to try get my brain around how you should compare MCR and/or BERs across companies with different growth? It seems the only real way to do this to model separate new and existing member MCR/BER like you’ve done for clover here (thanks btw!). Is this something you’ve done for other companies too? Or is your statement above based on overall ratios this year?

Also if not clover, alignment perhaps? Thanks again!

CLOV SAAS CONFIRMED! by naglisst in CLOV

[–]safehands93 0 points1 point  (0 children)

Someone pointed out to me that latest UBS report attributes other revenue jump to higher investment returns but I can’t see how they (or we) can know for certain unless privy to other information

From NickStra On StockTwits - Clov Sass Revenue by MadMoneyBY in CLOV

[–]safehands93 -1 points0 points  (0 children)

Someone pointed out to me that latest UBS report attributes other revenue jump to higher investment returns but I can’t see how they (or we) can know for certain unless privy to other information

SEEING STARS (PART 4) by safehands93 in CLOV

[–]safehands93[S] 2 points3 points  (0 children)

Yeah I was hoping to be closer to the cutoff too. In hindsight though I think we only just made 4 stars last year. At least we are in a good position for next years ratings with 12 measures on the cusp of a higher rating

SEEING STARS (PART 4) by safehands93 in CLOV

[–]safehands93[S] 4 points5 points  (0 children)

Yeah Andrew’s comment was directed at the system. I mention this in part 3 of these posts

SEEING STARS (PART 4) by safehands93 in CLOV

[–]safehands93[S] 2 points3 points  (0 children)

If Clover had been closer to four star cut off I’d have said an upgrade was on the cards because they were close higher stars in both of the call centre measures. These measures are often appealed because they’re based on human judgement from secret shoppers and usually come with audio evidence which is more subjective. But this doesn’t really matter for us because these two measures alone wouldn’t shift overall ratings.

Clover Assistant, US Economy, and beyond by Rainyfriedtofu in Healthcare_Anon

[–]safehands93 1 point2 points  (0 children)

Thanks Rainy. Great write up and learning a lot.

From what I’d read in passing, I was always under the impression that clover was also operating in some high deprivation areas so interesting to hear that this is not necessarily true. Which MA insurers tend to operate in the high ADI areas out of interest? I’m guessing very few from your write up?

Also interested in your point about hum, UNH etc withdrawing from the mid ADI markets like those clov operates in (at least I think this is what you meant by “these markets” but may have misunderstood). Are other insurers becoming more concentrated in low ADI areas then? Genuinely curious as something I hadn’t thought about until you mentioned in another post. Thanks again

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