SAN FRANCISCO—Medicare Advantage (MA) insurer Clover Health is leaning on strong performance in the annual enrollment period and financial growth to turbocharge the company in the coming months.
The insurtech presented at the J.P. Morgan Healthcare Conference on Thursday morning, and CEO Andrew Toy told investors that achieving earnings before interest, taxes, depreciation and amortization profitability is a key turning point on the company's broader goal of reaching net income profitability.
The company announced Wednesday in advance of the session that it is on track for full-year general accepted accounting principles profitability in 2026 for the first time. This is on the back of 53% year-over-year membership growth in the annual enrollment period and high quality scores under the star ratings.
Clover kicks off the year with about 153,000 members, with 97% of them enrolled in the insurer's central PPO plan, which has a No. 1 ranking nationally on core HEDIS quality measures.
"We’re feeling very good about the fact that while we’re improving the business, we’re also improving the outcomes and the clinical quality that we deliver to our members," Toy said.
Like its peer health plan Alignment Healthcare, Clover posts notable membership growth as the biggest MA players retreat from certain markets and face compounding cost and utilization pressures. Clover said it had greater than 95% member retention during the annual enrollment window, according to the announcement.
A key differentiator for Clover is its tech stack, and a growing focus for the company is making that platform available to other payers. The Clover Assistant is designed to support physicians and clinical teams in identifying and treating high-cost chronic conditions earlier, which drives down costs and improves outcomes for the patient.
Toy said the tech stack is powered by AI and features a suite of tools designed to support physicians, with the ultimate goal of bending the cost curve at a time when healthcare expenses are accelerating. It also requires thoughtful layering to ensure the platform improves interoperability, he said.
"It is not technology for technology's sake," Toy said.