Clover Health PPO Medicare Advantage Plans Earn 4 Star Rating for 2025
Clover Health announced that the Centers for Medicare and Medicaid Services (CMS) has increased the Star rating of its PPO Medicare Advantage plans to 4 Stars for 2025, affecting payment year 2026. The company's HMO MA plan rating also increased to 3.5 Stars. Over 95% of Clover's Medicare Advantage membership is served through its PPO plans.
The improved rating was driven by exceptional performance in Medication Adherence, HEDIS, and CAHPS measures. Notably, Clover earned a 4.94 out of 5 Stars on HEDIS, which measures a plan's ability to deliver preventative screenings and manage various health issues.
Clover's CEO, Andrew Toy, emphasized the company's commitment to improving healthcare outcomes through technology like Clover Assistant. The higher Star rating is expected to allow Clover to reinvest in more competitive benefits, potentially driving membership growth while maintaining financial strength and care quality.
Clover Health ha annunciato che i Centri per i Servizi Medicare e Medicaid (CMS) hanno aumentato il punteggio Star dei suoi piani PPO Medicare Advantage a 4 Stelle per il 2025, influenzando l'anno di pagamento 2026. Anche il punteggio del piano HMO MA della compagnia è aumentato a 3,5 Stelle. Oltre il 95% dei membri di Medicare Advantage di Clover è assistito tramite i suoi piani PPO.
Il punteggio migliorato è stato guidato da prestazioni eccezionali nei parametri di Adesione ai Farmaci, HEDIS e CAHPS. In particolare, Clover ha ottenuto un punteggio di 4.94 su 5 Stelle su HEDIS, che misura la capacità di un piano di fornire screening preventivi e gestire vari problemi di salute.
Il CEO di Clover, Andrew Toy, ha sottolineato l'impegno della compagnia nel migliorare i risultati sanitari attraverso tecnologie come Clover Assistant. Si prevede che il punteggio Star più alto consenta a Clover di reinvestire in benefici più competitivi, potenzialmente aumentando la crescita dei membri mantenendo la solidità finanziaria e la qualità delle cure.
Clover Health anunció que los Centros de Servicios de Medicare y Medicaid (CMS) han AUMENTADO la calificación Star de sus planes PPO de Medicare Advantage a 4 Estrellas para 2025, afectando el año de pago 2026. La calificación de su plan HMO MA también aumentó a 3.5 Estrellas. Más del 95% de los miembros de Medicare Advantage de Clover son atendidos a través de sus planes PPO.
La mejora en la calificación se debió a rendimiento excepcional en Adherencia a Medicamentos, HEDIS y medidas CAHPS. En particular, Clover obtuvo un 4.94 de 5 Estrellas en HEDIS, que mide la capacidad de un plan para ofrecer exámenes preventivos y gestionar diversos problemas de salud.
El CEO de Clover, Andrew Toy, enfatizó el compromiso de la compañía de mejorar los resultados de atención médica a través de tecnologías como Clover Assistant. Se espera que la calificación Star más alta permita a Clover reinvertir en beneficios más competitivos, lo que podría impulsar el crecimiento de miembros mientras se mantiene la solidez financiera y la calidad de la atención.
Clover Health는 메디케어 및 메디케이드 서비스 센터(CMS)가 2025년을 위해 PPO 메디케어 어드밴티지 플랜의 스타 등급을 4성으로 증가시켰다고 발표했습니다, 이는 2026년 지급 연도에 영향을 미칩니다. 회사의 HMO MA 플랜 등급도 3.5성으로 증가했습니다. Clover의 메디케어 어드밴티지 회원의 95% 이상이 PPO 플랜을 통해 제공됩니다.
개선된 등급은 약물 준수, HEDIS 및 CAHPS 지표에서의 뛰어난 성과에 의해 촉진되었습니다. 특히, Clover는 예방 검진을 제공하고 다양한 건강 문제를 관리하는 능력을 측정하는 HEDIS에서 5성 만점 중 4.94를 얻었습니다.
Clover의 CEO인 Andrew Toy는 Clover Assistant와 같은 기술을 통해 의료 결과를 개선하고자 하는 회사의 의지를 강조했습니다. 높은 스타 등급은 Clover가 보다 경쟁력 있는 혜택에 재투자할 수 있도록 할 것으로 예상되며, 이는 재정적 강점과 치료 품질을 유지하면서 회원 성장으로 이어질 수 있습니다.
Clover Health a annoncé que les Centres pour les services Medicare et Medicaid (CMS) ont augmenté la note Star de ses plans PPO Medicare Advantage à 4 étoiles pour 2025, ce qui affecte l'année de paiement 2026. La note du plan HMO MA de l'entreprise a également augmenté à 3,5 étoiles. Plus de 95 % des membres de Clover en Medicare Advantage sont servis par ses plans PPO.
Cette amélioration de la note a été stimulée par des performances exceptionnelles en matière d'Adhérence aux Médicaments, de HEDIS et de mesures CAHPS. Notamment, Clover a obtenu 4,94 sur 5 étoiles en HEDIS, qui mesure la capacité d'un plan à fournir des dépistages préventifs et à gérer divers problèmes de santé.
Le PDG de Clover, Andrew Toy, a souligné l'engagement de l'entreprise envers l'amélioration des résultats de santé grâce à des technologies comme Clover Assistant. La note Star plus élevée devrait permettre à Clover de réinvestir dans des avantages plus compétitifs, ce qui pourrait favoriser la croissance des membres tout en maintenant la solidité financière et la qualité des soins.
Clover Health hat angekündigt, dass die Zentren für Medicare und Medicaid-Dienste (CMS) die Star-Bewertung seiner PPO Medicare Advantage-Pläne für 2025 auf 4 Sterne erhöht haben, was sich auf das Zahlungsjahr 2026 auswirkt. Auch die Bewertung des HMO MA-Plans des Unternehmens wurde auf 3,5 Sterne erhöht. Über 95 % der Mitglieder von Clover's Medicare Advantage werden durch seine PPO-Pläne betreut.
Die verbesserte Bewertung wurde durch außergewöhnliche Leistungen bei der Medikationsadhärenz, HEDIS und CAHPS-Maßnahmen vorangetrieben. Besonders bemerkenswert ist, dass Clover bei HEDIS, das die Fähigkeit eines Plans zur Bereitstellung von präventiven Screenings und zur Verwaltung verschiedener Gesundheitsprobleme misst, 4,94 von 5 Sternen erzielt hat.
Der CEO von Clover, Andrew Toy, betonte das Engagement des Unternehmens, die Gesundheits Ergebnisse durch Technologien wie Clover Assistant zu verbessern. Die höhere Star-Bewertung wird voraussichtlich es Clover ermöglichen, in wettbewerbsfähigere Vorteile reinvestieren zu können, was möglicherweise das Mitgliederwachstum fördert und gleichzeitig die finanzielle Stärke und die Qualität der Pflege erhält.
- Increased Star rating to 4 Stars for PPO Medicare Advantage plans
- Exceptional performance in Medication Adherence, HEDIS (4.94 out of 5 Stars), and CAHPS measures
- Higher Star rating enables reinvestment in more competitive benefits
- Potential for increased membership growth
- None.
Insights
The 4-star rating for Clover Health's PPO Medicare Advantage plans is a significant achievement, potentially impacting both short-term and long-term performance. This improved rating allows for increased reimbursements from CMS, which could translate to more competitive benefits and potentially drive membership growth.
The exceptional HEDIS score of
However, investors should note that while over
The improved Star ratings have significant financial implications for Clover Health. Higher ratings typically lead to increased reimbursements from CMS, potentially boosting revenue. This could allow Clover to offer more competitive benefits, potentially driving membership growth and market share expansion.
Investors should consider the potential for improved margins and profitability. The ability to reinvest in benefits without compromising financial strength suggests efficient operations. However, it's important to monitor how this translates into actual financial performance in upcoming quarters.
With a market cap of
Overall Star rating performance increase was driven by exceptional performance on healthcare quality measures, Medication Adherence and Member Experience
FRANKLIN, Tenn., Oct. 10, 2024 (GLOBE NEWSWIRE) -- Clover Health Investments, Corp. (Nasdaq: CLOV) (“Clover,” “Clover Health” or the “Company”), today announced that the Centers for Medicare and Medicaid Services (“CMS”) has increased the Star rating of its PPO Medicare Advantage (“MA”) plans to 4 Stars for 2025, which will affect payment year 2026. Additionally, CMS increased the rating of Clover’s HMO MA plan to 3.5 Stars. Currently, over
Each year CMS rates every plan on its healthcare quality and drug plan, and issues a Star rating on a scale of 1 to 5 Stars. For this measurement year, Clover’s overall Star rating was driven by the Company’s exceptional performance across a number of measures including Medication Adherence, the Healthcare Effectiveness Data and Information Set (“HEDIS”), and Consumer Assessment of Healthcare Providers and Systems (“CAHPS”). Clover earned an impressive 4.94 out of 5 Stars on HEDIS in particular, which is a set of performance measures quantifying a plan’s ability to deliver preventative screenings and comprehensively manage a range of health issues including diabetes, cancer, and heart disease.
"At Clover Health, our mission is centered around improving healthcare outcomes for our members, and our 4-Star CMS rating reaffirms our commitment to this goal,” said Andrew Toy, CEO of Clover Health. “Our investment in quality far exceeds industry standards, as demonstrated by our exceptional HEDIS score. By leveraging the power of Clover Assistant technology, we’re empowering physicians with real-time insights that directly enhance the quality of care through better preventive services and care coordination. We will continue prioritizing these efforts to drive impactful, long-term health improvements for our members."
"What we’ve been able to accomplish with this year’s Star ratings is a manifestation of the foundational improvements we’ve built over the last several years," said Jamie Reynoso, CEO of Medicare Advantage, Clover Health. "With a higher Star rating, we are able to further reinvest in more competitive benefits, which we believe will deliver greater value to our members while fueling continued membership growth. This milestone allows us to scale our impact to more people on Medicare without compromising our financial strength or commitment to care quality.”
To learn more about Clover Health and its Medicare Advantage plans visit www.cloverhealth.com. For providers, health systems and plans interested in learning about how they can use Clover’s proprietary technology stack to succeed in value based care, visit www.counterparthealth.com.
Federal Contracting Disclaimer: Clover Health is a Preferred Provider Organization (PPO) and a Health Maintenance Organization (HMO) with a Medicare contract. Enrollment in Clover Health depends on contract renewal.
The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document.
About Clover Health:
Clover Health (Nasdaq: CLOV) is a physician enablement technology company committed to bringing access to great healthcare to everyone on Medicare. This includes a health equity-based focus on seniors who have historically lacked access to affordable, high-quality healthcare. Our strategy is powered by our software platform, Clover Assistant, which is designed to aggregate patient data from across the healthcare ecosystem to support clinical decision-making and improve health outcomes through the early identification and management of chronic disease. For our members, we provide PPO and HMO Medicare Advantage plans in several states, with a differentiated focus on our flagship wide-network, high-choice PPO plans. For healthcare providers outside Clover Health's Medicare Advantage plan, we aim to extend the benefits of our data-driven technology platform to a wider audience via our subsidiary, Counterpart Health, and to enable enhanced patient outcomes and reduced healthcare costs on a nationwide scale. Clover Health has published data demonstrating the technology’s impact on Medication Adherence, as well as the earlier identification and management of Diabetes and Chronic Kidney Disease.
Forward-Looking Statements:
Please note that this press release contains forward-looking statements within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended. Forward-looking statements include statements regarding future events and Clover Health’s future results of operations, financial position, business strategy and future plans. Forward-looking statements are not guarantees of future performance, and you are cautioned not to place undue reliance on such statements. In some cases, you can identify forward looking statements because they contain words such as “may,” “will,” “should,” “expects,” “plans,” “anticipates,” “going to,” “can,” “could,” “should,” “would,” “intends,” “target,” “projects,” “contemplates,” “believes,” “estimates,” “predicts,” “potential,” “outlook,” “forecast,” “guidance,” “objective,” “plan,” “seek,” “grow,” “target,” “if,” “continue” or the negative of these words or other similar terms or expressions that concern Clover Health’s expectations, strategy, priorities, plans or intentions. Forward-looking statements in this press release include, but are not limited to, the anticipated benefits associated with CMS’s 2025 Star rating of 4 for Clover Health’s PPO MA plans, as well as our expectations related to Clover Health’s profitability, liquidity, future performance, future operations and future results. These statements are subject to known and unknown risks, uncertainties and other factors that may cause Clover Health’s actual results, levels of activity, performance or achievements to differ materially from results expressed or implied in this press release. Additional information concerning these and other risk factors is contained in Clover Health’s most recent Annual Report on Form 10-K, filed with the Securities and Exchange Commission (the “SEC”) on March 14, 2024, and in our subsequent filings with the SEC, in each case where relevant, including the Risk Factors sections therein, and in its other filings with the SEC. The forward-looking statements included in this press release are made as of the date hereof. Except as required by law, Clover Health undertakes no obligation to update any of these forward-looking statements after the date of this press release or to conform these statements to actual results or revised expectations.
Press Contact:
Andrew Still-Baxter
press@cloverhealth.com
Investor Relations Contact:
Ryan Schmidt
investors@cloverhealth.com
FAQ
What is Clover Health's new Star rating for its PPO Medicare Advantage plans in 2025?
How did Clover Health (CLOV) perform in the HEDIS measure?
What percentage of Clover Health's Medicare Advantage membership is served through PPO plans?
How might the increased Star rating impact Clover Health's (CLOV) business?
