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 猫 aumentato a 3,5 Stelle. Oltre il 95% dei membri di Medicare Advantage di Clover 猫 assistito tramite i suoi piani PPO.
Il punteggio migliorato 猫 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 capacit脿 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 pi霉 alto consenta a Clover di reinvestire in benefici pi霉 competitivi, potenzialmente aumentando la crescita dei membri mantenendo la solidit脿 finanziaria e la qualit脿 delle cure.
Clover Health anunci贸 que los Centros de Servicios de Medicare y Medicaid (CMS) han AUMENTADO la calificaci贸n Star de sus planes PPO de Medicare Advantage a 4 Estrellas para 2025, afectando el a帽o de pago 2026. La calificaci贸n de su plan HMO MA tambi茅n aument贸 a 3.5 Estrellas. M谩s del 95% de los miembros de Medicare Advantage de Clover son atendidos a trav茅s de sus planes PPO.
La mejora en la calificaci贸n se debi贸 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 ex谩menes preventivos y gestionar diversos problemas de salud.
El CEO de Clover, Andrew Toy, enfatiz贸 el compromiso de la compa帽铆a de mejorar los resultados de atenci贸n m茅dica a trav茅s de tecnolog铆as como Clover Assistant. Se espera que la calificaci贸n Star m谩s alta permita a Clover reinvertir en beneficios m谩s competitivos, lo que podr铆a impulsar el crecimiento de miembros mientras se mantiene la solidez financiera y la calidad de la atenci贸n.
Clover Health電 氅旊敂旒鞏 氚 氅旊敂旒鞚措摐 靹滊箘鞀 靹柬劙(CMS)臧 2025雲勳潉 鞙勴暣 PPO 氅旊敂旒鞏 鞏措摐氚错嫲歆 頂岆灉鞚 鞀ろ儉 霌标笁鞚 4靹膘溂搿 歃濌皜鞁滌及雼り碃 氚滍憸頄堨姷雼堧嫟, 鞚措姅 2026雲 歆旮 鞐半弰鞐 鞓來枼鞚 氙胳供雼堧嫟. 須岇偓鞚 HMO MA 頂岆灉 霌标笁霃 3.5靹膘溂搿 歃濌皜頄堨姷雼堧嫟. Clover鞚 氅旊敂旒鞏 鞏措摐氚错嫲歆 須岇洂鞚 95% 鞚挫儊鞚 PPO 頂岆灉鞚 韱淀暣 鞝滉车霅╇媹雼.
臧滌劆霅 霌标笁鞚 鞎诫 欷靾, HEDIS 氚 CAHPS 歆響滌棎靹滌潣 霙办柎雮 靹标臣鞐 鞚橅暣 齑夓霅橃棃鞀惦媹雼. 韸鬼瀳, Clover電 鞓堧癌 瓴歆勳潉 鞝滉车頃橁碃 雼れ枒頃 瓯搓皶 氍胳牅毳 甏毽晿電 電ル牓鞚 旄§爼頃橂姅 HEDIS鞐愳劀 5靹 毵岇爯 欷 4.94毳 鞏混棃鞀惦媹雼.
Clover鞚 CEO鞚 Andrew Toy電 Clover Assistant鞕 臧欖潃 旮办垹鞚 韱淀暣 鞚橂 瓴瓣臣毳 臧滌劆頃橁碃鞛 頃橂姅 須岇偓鞚 鞚橃毳 臧曥“頄堨姷雼堧嫟. 雴掛潃 鞀ろ儉 霌标笁鞚 Clover臧 氤措嫟 瓴届焷霠 鞛堧姅 順滍儩鞐 鞛埇鞛愴暊 靾 鞛堧弰搿 頃 瓴冹溂搿 鞓堨儊霅橂┌, 鞚措姅 鞛爼鞝 臧曥爯瓿 旃橂 頀堨鞚 鞙犾頃橂┐靹 須岇洂 靹膘灔鞙茧 鞚挫柎歆 靾 鞛堨姷雼堧嫟.
Clover Health a annonc茅 que les Centres pour les services Medicare et Medicaid (CMS) ont augment茅 la note Star de ses plans PPO Medicare Advantage 脿 4 茅toiles pour 2025, ce qui affecte l'ann茅e de paiement 2026. La note du plan HMO MA de l'entreprise a 茅galement augment茅 脿 3,5 茅toiles. Plus de 95 % des membres de Clover en Medicare Advantage sont servis par ses plans PPO.
Cette am茅lioration de la note a 茅t茅 stimul茅e par des performances exceptionnelles en mati猫re d'Adh茅rence aux M茅dicaments, de HEDIS et de mesures CAHPS. Notamment, Clover a obtenu 4,94 sur 5 茅toiles en HEDIS, qui mesure la capacit茅 d'un plan 脿 fournir des d茅pistages pr茅ventifs et 脿 g茅rer divers probl猫mes de sant茅.
Le PDG de Clover, Andrew Toy, a soulign茅 l'engagement de l'entreprise envers l'am茅lioration des r茅sultats de sant茅 gr芒ce 脿 des technologies comme Clover Assistant. La note Star plus 茅lev茅e devrait permettre 脿 Clover de r茅investir dans des avantages plus comp茅titifs, ce qui pourrait favoriser la croissance des membres tout en maintenant la solidit茅 financi猫re et la qualit茅 des soins.
Clover Health hat angek眉ndigt, dass die Zentren f眉r Medicare und Medicaid-Dienste (CMS) die Star-Bewertung seiner PPO Medicare Advantage-Pl盲ne f眉r 2025 auf 4 Sterne erh枚ht haben, was sich auf das Zahlungsjahr 2026 auswirkt. Auch die Bewertung des HMO MA-Plans des Unternehmens wurde auf 3,5 Sterne erh枚ht. 脺ber 95 % der Mitglieder von Clover's Medicare Advantage werden durch seine PPO-Pl盲ne betreut.
Die verbesserte Bewertung wurde durch au脽ergew枚hnliche Leistungen bei der Medikationsadh盲renz, HEDIS und CAHPS-Ma脽nahmen vorangetrieben. Besonders bemerkenswert ist, dass Clover bei HEDIS, das die F盲higkeit eines Plans zur Bereitstellung von pr盲ventiven 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 h枚here Star-Bewertung wird voraussichtlich es Clover erm枚glichen, in wettbewerbsf盲higere Vorteile reinvestieren zu k枚nnen, was m枚glicherweise das Mitgliederwachstum f枚rdert und gleichzeitig die finanzielle St盲rke und die Qualit盲t der Pflege erh盲lt.
- 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) (鈥淐lover,鈥 鈥淐lover Health鈥 or the 鈥淐ompany鈥), today announced that the Centers for Medicare and Medicaid Services (鈥淐MS鈥) has increased the Star rating of its PPO Medicare Advantage (鈥淢A鈥) plans to 4 Stars for 2025, which will affect payment year 2026. Additionally, CMS increased the rating of Clover鈥檚 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鈥檚 overall Star rating was driven by the Company鈥檚 exceptional performance across a number of measures including Medication Adherence, the Healthcare Effectiveness Data and Information Set (鈥淗EDIS鈥), and Consumer Assessment of Healthcare Providers and Systems (鈥淐AHPS鈥). Clover earned an impressive 4.94 out of 5 Stars on HEDIS in particular, which is a set of performance measures quantifying a plan鈥檚 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,鈥 said Andrew Toy, CEO of Clover Health. 鈥淥ur investment in quality far exceeds industry standards, as demonstrated by our exceptional HEDIS score. By leveraging the power of Clover Assistant technology, we鈥檙e 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鈥檝e been able to accomplish with this year鈥檚 Star ratings is a manifestation of the foundational improvements we鈥檝e 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.鈥
To learn more about Clover Health and its Medicare Advantage plans visit . For providers, health systems and plans interested in learning about how they can use Clover鈥檚 proprietary technology stack to succeed in value based care, visit .
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鈥檚 impact on , as well as the earlier identification and management of and .
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鈥檚 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 鈥渕ay,鈥 鈥渨ill,鈥 鈥渟hould,鈥 鈥渆xpects,鈥 鈥減lans,鈥 鈥渁nticipates,鈥 鈥済oing to,鈥 鈥渃an,鈥 鈥渃ould,鈥 鈥渟hould,鈥 鈥渨ould,鈥 鈥渋ntends,鈥 鈥渢arget,鈥 鈥減rojects,鈥 鈥渃ontemplates,鈥 鈥渂elieves,鈥 鈥渆stimates,鈥 鈥減redicts,鈥 鈥減otential,鈥 鈥渙utlook,鈥 鈥渇orecast,鈥 鈥済uidance,鈥 鈥渙bjective,鈥 鈥減lan,鈥 鈥渟eek,鈥 鈥済row,鈥 鈥渢arget,鈥 鈥渋f,鈥 鈥渃ontinue鈥 or the negative of these words or other similar terms or expressions that concern Clover Health鈥檚 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鈥檚 2025 Star rating of 4 for Clover Health鈥檚 PPO MA plans, as well as our expectations related to Clover Health鈥檚 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鈥檚 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鈥檚 most recent Annual Report on Form 10-K, filed with the Securities and Exchange Commission (the 鈥淪EC鈥) 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?
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