JPM23: As the year gets underway, here's what insurtechs have planned

SAN FRANCISCO—Insurtechs have proven to be one of the more volatile segments of the health insurance industry, and it's with that backdrop that executives at several companies took the stage the J.P. Morgan Healthcare Conference on Wednesday afternoon.

Clover Health, Alignment Healthcare, Bright Health Group and Oscar Health presented nearly back-to-back at the conference, setting expectations for 2023 and highlighting where they've seen success and where there's still work to be done.

Clover, Alignment and Bright primarily serve Medicare patients, while the bulk of Oscar's business is in Affordable Care Act (ACA) exchange plans.

Here's a look at the highlights from each company's presentation:

Clover Health points to home health as key focus

Clover Health CEO Andrew Toy, who stepped into the CEO role at the beginning of the year, said the company has built a framework around serving seniors with two major pillars: its tech stack, called Clover Assistant, and its core managed care portfolio.

Within the latter, Toy said that Clover is working steadily to build out its home care practice, which currently serves about 3,300 primary care patients. He said the segment has grown significantly for Clover in New Jersey and is designed to reach some of the insurer's most vulnerable members in their homes.

The model is designed around palliative and supportive care in the home and aims to prevent hospital readmissions as the clinicians provide in-home assessments following hospital discharge as well as follow-ups to address any issues that could arise following a hospital stay.

The program has a high net promoter score and has gotten positive feedback from members, according to the presentation. It's also been designed to integrate with Clover Assistant, feeding data and insights back to the care team.

"It's not quite home health, it's not quite hospital-at-home," Toy said. "It's more about when you are sick and you really can't go to the doctor, the doctor should come to you."

Alignment Healthcare points to stratification to manage high-cost members

As Alignment Healthcare's Medicare membership grows, the insurer is putting a focus on using risk stratification models to mitigate the costs associated with the highest acuity members.

During the company's JPM presentation, CEO John Kao noted that about 20% of Medicare beneficiaries account for 80% of the costs in the program. At Alignment, the division is starker: 26% of its membership accounts for 96% of costs, and the healthiest 74% account for just 4% of costs.

The insurer's technology platform, AVA, then stratifies members based on risk, and within the highest risk group identifies people who have chronic conditions and those who are on the cusp of developing those conditions. The pre-chronic cohort accounts for about 1% of the membership and 8% of costs.

The chronic population, meanwhile, accounts for 10% of the population and 73% of costs, according to the presentation. So the insurer's Care Anywhere team, which includes physicians and other clinicians, social workers, case managers, care coordinators and behavioral health coaches, reaches out proactively to these members to address their needs.

The average member visits their primary care doctor five times a year, while they interact with the Care Anywhere team 27 times in a year.

"The whole point of that is you curate the care delivery depending on the acuity level of the patients," Kao said.

Bright Health Group outlines growth strategy

Bright Health's financial woes have grabbed headlines, and CEO Mike Mikan outlined the company's trajectory to bounce back in its JPM session.

In the presentation, Mikan said Bright's focus from 2016 through 2022 was to establish proof of concept around its perspective on integrated care, laying the foundation for its fully aligned care model. The company aimed to spend its early years establishing the alignment necessary to both take on and manage risk and then validate that its model can improve performance and patient outcomes.

Beginning in 2023 and carrying through 2024, the insurer is aiming to maintain its scuttled ACA membership through its care services thanks to relationships with external payers. Mikan said that at present, 70% of the patients served in its clinic are people that were previously enrolled in its ACA plans.

Once the fully aligned care model is delivered, beginning in 2024 and beyond, the company plans to turn its eye to growth, Mikan said.

"As we enter 2023, we believe we have a strong foundation to grow profitably and serve consumers across the country," he said.

Oscar Health demonstrates campaign builder tool

Oscar Health announced in April 2021 that it would sell its technology stack +Oscar to other healthcare companies but has since pumped the breaks on that initiative amid implementation challenges.

The company's JPM presentation hinted at how the insurer could pursue making its tech available in the future. CEO Mario Schlosser offered the audience a look at its campaign builder tool, which is an internal platform the company sees promise in commercializing.

Schlosser said the tool allows providers to reach out to members in a personalized way. Oscar's tech allows a practice group, for example, to see which doctors are driving the fewest preventive visits and then proactively reach out to their patients.

It can be used to distinguish between patients who are healthier and those who have more chronic concerns and craft messaging, outreach and follow-up that fits their specific needs. The platform also has significant potential in value-based care, Schlosser said, as the company thinks about ways it can push for more value-based arrangements with its provider partners.

The campaign builder is "a really interesting one we haven't talked much about," he said.