Clever Care nabs $41M to scale up Medicare Advantage plans integrating Eastern and Western medicine

Clever Care Health Plan launched in 2020 with the aim of offering a holistic Medicare Advantage (MA) program for the growing number of beneficiaries interested in benefits that encompass Western clinical medicine and Eastern wellness benefits such as acupuncture. 

Myong Lee, a healthcare executive with more than a decade in managed care and health plan operations, recognized the lack of culturally-sensitive MA plans for certain populations.

"Both of my parents are immigrants and they're both on Medicare Advantage health plans. They don't speak much English, if any. I just saw how challenging it was for them to access care," he said in an interview. "When they lived in New Jersey, there was literally one Korean-speaking primary care provider in their county, forget about specialists. On top of that, the materials that they would get from their MA plan were in English and my sister always had to be a part of it because she's fluent in Korean and she's a nurse. She always had to support that because the plans use translators but it just didn't work. The translations are hard enough, especially when you get into healthcare terminology and then the benefits themselves."

When the Centers for Medicare and Medicaid Services expanded the type of supplemental benefits MA plans can offer, Lee saw an opportunity to launch a Medicare Advantage health plan that could serve this underserved population.

"The focus was on this Asian population who, maybe they speak some English but their preference is to be able to speak their own language, to be able to receive the materials in their language, to be able to see their providers who understand their culture, as well as create supplemental benefits that really speak to them," said Lee, co-founder and now CEO of Clever Care Health Plan.

"My parents never have never been to a gym in their life," he quipped. "That's not what they do."

Since the company's launch in 2020, Clever Care has offered a unique, holistic approach for beneficiaries interested in comprehensive medical, and supplemental benefits, including dental, hearing, vision, and Eastern benefits.

Clever Care’s location in Southern California in the heart of the San Gabriel Valley’s Asian community gives it easy access to a large market for those seeking coverage for Asian medicines and medical techniques.

"We offer things like acupuncture, herbal medicine, cupping and Tai Chi classes. We also have multiple community centers in specific neighborhoods in Southern California like Koreatown in downtown L.A., Little Saigon in Orange County as well as San Gabriel Valley, which is primarily Chinese and Taiwanese," he said. "The motivation was just seeing the challenges my own parents had and the challenges that other friends; parents had in accessing care because Medicare Advantage is primarily done in English. I felt like there would be an opportunity to be able to provide better support.

Because of its differentiated value proposition, Clever Care Health Plan has grown its membership to over 11,000 members. Clever Care’s network has grown to include more than 15,000 medical providers, more than 600 contracted acupuncturists and 58 hospitals, mostly in Southern California.

The company banked a $41 million series C funding found to fuel its continued growth and to expand into new markets. GV, formerly Google Ventures, led the round. New investor Point32Health also backed the round along with existing investors Norwest Venture Partners, Health Velocity Capital, Prudential Ventures, Brighton Health Partners, Windham Venture Partners, Figure 8 Investments and AV8. 

Clever Care takes a new approach to holistic healthcare and the company has a deep understanding of the communities they are serving, said Ben Robbins, general partner at GV. The VC firm saw an opportunity to invest in an MA-focused company that provides better healthcare experiences for underserved patient populations, he noted.

'I've been impressed watching the Clever Care team create this health plan specifically focused on Asian communities, typically a population of people that are generally underserved by the MA market. There's a host of offerings that they're offering that seem to be able to better serve this population than what is possible through a large insurer."

While larger health plans cover services like acupuncture, Clever Care can build a high-quality network and practitioners and reimburse at higher rates and also offer services in members' native language, Robbins noted.

Robbins added, "They're incredibly scrappy. They know these communities super well and offer services that are custom-built around them. They can get into the deep nuanced Eastern medical benefits that are particularly attractive for Korean or Vietnamese populations. Clever Care offers this high degree of customized services, customized supplemental benefits and a customized network of primary care physicians that are also culturally informed."

Lee said Clever Care Health Plan aims to use the fresh capital to continue its growth and outreach in advance of the 2024 annual enrollment period. The company also plans to expand its network of independent physicians and clinicians and enter new markets.

"We have been looking into the Northern California market. We're still in the process of talking to providers and trying to get the right contracts in place for us to be able to go there but that is an area that we are looking at."

Lee is confident that Clever Care can succeed in a competitive Medicare Advantage market with its unique approach to holistic care.

"We came out with 500 members during COVID which was challenging, to now where we're over 11,200 members. We've seen significant growth over the last two years. I think this is really a testament to the fact that we are providing great service, not just to the members but also to all our key stakeholders, including our providers and our agency partners and brokers. A number of our agents, they're bilingual too, so we not only support our members with the language and cultural sensitivity and the materials, but we do the same thing for all of our key stakeholders because it's not something that most insurance companies do."

He added, "Having that focus, being able to provide that level of service, being able to provide the type of benefits and providing the right provider network to the members, it's really all those things that are driving interest in the health plan."

In November, the company inked a partnership with Allied Pacific IPA, one of the largest provider networks in Southern California, serving over 350,000 patients in the greater San Gabriel Valley area. The company announced partnerships with Alpha Care Medical Group serving Inland Empire communities and Accountable Health Care IPA, which serves the greater Long Beach area of Los Angeles County and Downtown Los Angeles.

Despite the marcoecnomomic environment and the downturn in health tech investment, Lee says the company's focus on growing a. Medicare Advantage platform has shielded it from some of the current turbulence in the funding market. 

"We do have technology investments that we've made but they have been really focused more on enabling, as an example, automating language translations. We are more focused on being a core Medicare Advantage Health plan focused on an underserved population. I'm not building a technology company. That combined with the significant growth that we've seen in Southern California, which is a challenging market, but the fact that we've been able to get the type of growth that we've seen over the last few years, I think those are the core reasons why we've seen so much interest from top tier investors like GV," he said.

Most large Medicare Advantage plans focus on the broader, English-speaking population, according to Lee, based on his experience working at other MA plans.

"Typically these plans are integrated, they provide multiple products beyond Medicare to offer commercial plans and leverage their existing networks. They're obviously aware that there are all these other cultures and languages and ethnicities, but they are really focused on growing within their core populations. It's challenging for a large incumbent to be able to pivot and try to deeply understand the nuances between all these different filters," Lee said.

"As an example, the herbal medicines that are Korean population uses are very distinctly different from our Chinese population versus our Vietnamese population versus our Filipino," he added. "The way you approach these populations from a care management perspective and how you talk to a male or female member are also very distinctly different by ethnicity because of the cultural differences. These are the type of things that we're really understanding and then implementing into our CRM [customer relationship management] system as well as training our staff who are bilingual and speak the language and those are very significant nuances that differentiate what we're doing."

Looking ahead, Lee sees opportunities to serve other senior populations with its unique holistic approach.

"As we continue to build out our technology platform as well as our capabilities in terms of automating the back office functions. I do think at some point we'll be able to further expand. Right now, we're making sure that we focus on our core membership to make sure that we truly get this right first and understand what appeals to them about Clever Care before we expand further," he noted.