Sequoia Capital, the early backer of companies like Google and Amazon, said Wednesday that it is putting $35 million into a upstart health insurance company, Clover Health.
Clover is trying to use data analysis and preventative care to improve healthcare for seniors and to give customers who use private versions of Medicare a cheaper option. The company’s technology is supposed to recognize when patients need medical treatment and then intervene in their care to save money for both the patient and the insurance company.
Clover’s insurance falls under Medicare Advantage, a federal program for people 65 and older who have certain disabilities that lets private insurance companies administer their coverage. The government subsidizes the premium and pays all the claims administered by the private insurance companies.
Clover’s investors are hoping that the company can upend a segment of the huge $220 billion health insurance market . But it is a huge challenge because insurance giants like United Healthcare (UNH) already dominate and have huge resources to fend off small rivals.
Clover says that its algorithms and software identify the patients most at-risk of hospitalization or costly treatments. It then may send nurse practitioners to visit those patients’ homes and coordinate necessary tests that may be missing in their medical files. The company also analyzes lab data to identify patients who are in danger of serious illness like diabetes. The goal is to counsel them before they require costly treatments.
Helping patients avoid hospitalization saves Clover Health an average of $10,000 per visit.
Currently, Clover, founded in 2012, operates in only nine New Jersey counties. But it claims to have made great strides in a short amount of time and with a limited number of customers. In the first half of the year, Clover said its members had nearly 50% fewer hospital admissions and 34% fewer hospital readmissions than the average group of Medicare patients in the New Jersey areas it serves. In the past two months, the company has doubled its number of customers to 15,000 senior citizens in New Jersey.
Clover says it will be using the new funding to expand beyond New Jersey. The company previously raised $100 million in debt and equity funding from early Uber backer-First Round Capital and Athyrium Capital Management, both of which contributed to the most recent round of Series B funding.
Clover Health isn’t the only startup trying to tackle health insurance. Oscar Health also wants to provide a better health insurance with the help of data and technology. But Clover differs from Oscar Health in that it purely focuses on the Medicare Advantage market, whereas Oscar provides coverage for a broader demographic.
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