Clover Health: Open networks encourage patient choice, promote health equity

Although healthcare coverage is trending toward narrower networks, Medicare Advantage insurer Clover Health thinks patients deserve more choices, not less.

“We see our total addressable market as everyone on Medicare, and we don’t want to just draw circles around certain provider groups and say, well, we want people who live within five miles of this group and five miles of that group,” said Andrew Toy, president and chief technology officer of Clover Health, during the Fierce Health Payer Summit on Tuesday. “We say, how can we service everybody, no matter where they’re living, no matter which doctor they’re seeing.”

Clover Health lets patients see any provider participating in Medicare that accepts them, not just providers that have partnered with the company.

Toy said allowing patients to choose their providers is critical to health equity, especially as some patients may be more likely to trust a doctor in their community or of the same ethnicity, for example.


“When you start to break down that trust wall between them and their physician, they become less compliant, they become less open to hearing about care, and that’s not good for anyone,” he said.

Toy said people often choose Medicare over Medicare Advantage plans precisely because Medicare offers an open network. And in areas with low-income populations, especially rural areas, there are usually fewer doctors, forcing patients to travel beyond their communities to find specialists and maybe even further if the patient’s insurer offers a narrow network.

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“This is a huge part of why we believe in the open network strategy—to serve these people who are having difficulty accessing care otherwise,” he said.

Many healthcare companies, Toy said, choose to operate in smaller, “safer” markets. But he said that going for the bigger market is part of Clover Health’s mission to provide services to everyone on Medicare.

He knows the company has chosen to tackle a difficult problem. But, he said, it’s about “owning the risk.”