JPM23, Day 3: Clover Health tees up busy day for insurtechs; Hinge Health stretches its reach into at-home care

Welcome to Day 3 of the annual J. P. Morgan Healthcare Conference. Here's your need to know during another soggy, busy day covering healthcare news in San Francisco.

We're expecting news from Bright Health Group, Clover Health, Oscar Health, GoodRx, Veradigm (formerly Allscripts) and many other companies today, so stay tuned.

Fierce Healthcare will be covering the day's biggest news as it happens. Check back here for updates, and catch Fierce Biotech's reporting here and Fierce Pharma's reporting here.

UPDATED: Wednesday, Jan. 11 at 3:44 p.m. ET

Wednesday afternoon is shaping up to be a busy one for insurtechs and ahead of its presentation today Clover Health released an update on its outlook for the year.

The company, which focuses much of its business in Medicare Advantage, said it expects membership in 2023 to be on par with membership as of Jan. 1, 2022, which means it likely shed thousands of people over the past year. Clover anticipated this outcome, the company said, as it intentionally priced its plans to drive toward its profitability goals rather than sheer membership growth.

In its non-insurance business, Clover Health has also slimmed the number of participating providers, with that same profitability target in mind, the company said.

Incoming CEO Andrew Toy said in a statement that the company expects favorable impact from its strategic shift over the course of 2023. Clover Health estimates insurance revenues of between $1.15 billion and $1.2 billion, up from its previous estimate of between $1 billion and $1.1 billion.

Clover Health also projects medical cost ratio of between 89% and 91%. — Paige Minemyer

UPDATED: Wednesday, Jan. 11 at 3:15 p.m. ET

Digital health company Hinge Health is rolling out a physical therapy house call service.

The service will start in Chicago, followed by a nationwide rollout, executives said.

The company, which launched in late 2014, offers a digital platform that uses wearable sensors and one-on-one health coaching to deliver in-home musculoskeletal therapy.

Hinge Health touts the service as the first fully integrated model for musculoskeletal (MSK) health that combines digital with in-person care. 

Many patients prefer complementing a digital experience with in-person visits. This is especially true for back, joint, or muscle pain, where in-person evaluations can substantially enhance downstream digital care. 

Hinge Health house calls will offer in-person physical therapy visits at home or the workplace with next-day, evening, and weekend appointments – avoiding delays, commutes, and missed work, executives said in a press release. The service also will offer physical and environmental assessments, hands-on therapy, and guided digital setup.

Patients also will work with a single provider for coordinated care as digital and in-person care will be seamlessly provided by Hinge Health’s care team.

As the market leader in MSK care, it’s incumbent on us to transform the member experience by challenging the status quo,” said Daniel Perez, co-founder and CEO, Hinge Health. “Integrating digital and in-person care is a leap forward in bridging care gaps and reimagining a healthcare model that works for everyone.” 

Hinge Health works with 1,250 enterprise customers and has access to 25 million members, executives said. The company also says four in five health plans and employers with a digital MSK solution partner with Hinge Health, including AutoZone, Land O’Lakes, L.L. Bean, Salesforce, Self-Insured Schools of California, Southern Company, State of New Jersey, US Foods and Verizon. — Heather Landi

UPDATED: Wednesday, Jan. 11 at 9:42 a.m. ET

Investors and JPM attendees got an opportunity to hear from Intermountain Healthcare's new leadership team as the 33-hospital heavyweight plots out its strategy to accelerate value-based care, including a new clinically integrated network it plans to launch with UCHealth in Colorado.

With the close of its merger last year with SCL Health, Intermountain Healthcare says it is now the eleventh-largest nonprofit system in the country. Transitioning from from a volume-based, fee-for-service healthcare operation to a value-based model is a key priority for Intermountain's executive team.

Before the merger with SCL Health, about half of Intermountain Healthcare's revenue was based on at-risk value-based care models, said Rob Allen, Intermountain Health's new chief executive officer.

"After the merger, because of the dynamics in SCL Health's markets, we're about 37% and growing. We don’t anticipate getting to where they are all with those contracts but we’d certainly like to see that grow continually higher because we think it creates a better alignment," said Allen.

He touted Intermountain Healthcare's recently announced partnership with UCHealth, Colorado's largest health system, as an example of the health system's initiatives to accelerate value-based care. 

The partnership will establish a new clinically integrated network in the state, bringing together 700 primary care doctors and "hundreds" of clinics and hospitals across Colorado. The partnership will also provide a new health insurance option to individuals with Medicare Advantage and/or individual ACA coverage in Colorado in 2024, pending regulatory approval, the systems said. Read more here. — Heather Landi