Clover Health Investments, Corp.

Ladies and gentlemen, good afternoon and welcome to the Clover Health first quarter 2023 earnings conference call. At this time, all participants are in a listen only mode. A question and answer session will follow the prepared remarks. At that time, if you wish to ask a question, please press star one on your telephone keypad. As a reminder, today's call is being recorded. I would now like to turn the call over to Ryan Schmidt Investor Relations for Clover Health. Please go ahead.

Good morning, everyone. Joining me on our call today to discuss the company's first quarter results are Andrew Toy, Clover Health's Chief Executive Officer, and Scott Leffler, the company's Chief Financial Officer. You can find today's press release and the accompanying supplemental slides in the Investor Events and Presentations section of our website at investors.cloverhealth.com. This webcast is being recorded, and a replay will be available in the investor relations section of the Clover Health website. I'd also like to caution you that we may make forward-looking statements during today's call that are subject to risks and uncertainties, including expectations about future performance. Factors that may cause actual results to differ materially from expectations are detailed in our SEC filings, including in the risk factors section of our most recent annual report on Form 10-K. Information about non-GAAP financial measures referenced including a reconciliation of those measures to gap measures, can be found in the earnings materials available on our website. With that, I'll now turn the call over to Andrew.

Thank you, Ryan, and thanks, everyone, for joining us today. We're very excited to be reporting our first quarter results, which mark an extremely strong start to the year and highlight the progress we're making towards our goals for 2023 and beyond. Starting with the headlines, we're excited to have delivered strong results in We performed very well on insurance revenue growth, which has increased year-over-year by approximately 14% in the first quarter. This revenue growth has also helped deliver favorable Q1 insurance MCR of 86.6% and will flow through to a strong projected full-year insurance MCR as well. And of course, all of this results in significant improvement in our adjusted EBITDA. This overall strong performance was driven by thoughtful plan optimization, significant enhancements to core operations, a focus on member retention, as well as the improvement in our star rating. We have been anticipating this step function change in our performance since we shifted to a profitability mindset, and I'm very pleased with how our team has executed. We also believe that our focus here has room for even more upside as the year progresses. We've aligned the organization to prioritize profitability, create shareholder and societal value, and continue to enhance our Clover Assistant technology platform. We've meaningfully improved MCR and have delivered Q1 gross profit on both our insurance and non-insurance lines of business. While not yet reflected in our Q1 performance, we've also recently announced important steps to drive operational efficiencies and thereby reduce SG&A. We believe that the combination of these effects demonstrates the power and sustainability of our model, and we see a path to achieving positive adjusted EBITDA in 2024. Speaking more on our insurance line of business, we're very pleased with our MCR of 86.6% as compared to MCR of 96.4% in Q1 of last year. This significant improvement was driven by stronger revenue performance due to the operational enhancements mentioned previously. We believe this progress is durable, and we expect to sustain insurance revenue growth as part of our focus on delivering both revenue growth and positive NCR performance. Our strategy of prioritizing our core markets has also generated a greater portion of returning members in our population mix than in years past, and has granted us better line of sight into our members' care needs. In the near term, this intentional focus on member retention is one of the key levers for our path to profitability, as it strongly affects MCR from both a revenue and a care management perspective. This, paired with our Clover home care progress, is a dynamic we're really excited about. We're also very excited about our recently announced partnership with UST HealthProof, an industry leader helping to service millions of members, allowing us to take advantage of their economies of scale and operational capabilities. Not only will this deliver significant savings in SG&A starting in 2024, but more importantly, as we grow, we now have access to scale and efficiencies which would be otherwise impossible for a plan our size. Finally, on the insurance segment, we want to call out that we anticipate the recent CMS changes around MA risk adjustment will have limited effect on Clover in 2024. We believe the changes were mainly targeting scenarios where providers with revenue-sharing network contracts were overusing certain codes. Our wide network model insulates us from exposure to these groups and types of contracts. We therefore feel good about the changes, support CMS's efforts to maintain Medicare program integrity, and believe that the 2024 effect on Clover will be modest. Moving on to our non-insurance line of business. we delivered an NCR of 96.1%. While this makes us cautiously optimistic, this number does include favorable prior period development, and it is still too early in the year to judge total program performance. This is due to the typical lag in receiving data from CMS, the same data lag which created variability in expectations throughout last year. That said, we remain optimistic about our strategy and expect this business to be accretive to gross profits this year. Beyond our two reportable segments, I'd also like to provide a quick update regarding Clover Home Care. Powered by Clover Assistant, we aim to afford our most vulnerable members the ability to receive comprehensive, personalized care directly in the comfort of their homes as often as necessary to support their needs. We see Clover Home Care as a step-function upgrade from the home health programs offered by other payers as our program delivers active care via physician-led pods that include nurse practitioners, medical assistants, licensed social workers, and patient care coordinators. Our data shows that approximately 8% of our members accounted for nearly 30% of total MA medical expenses in 2022. When we enroll these members in our home care program, in addition to high member satisfaction, we also see reduced near-term costs achieved through reduced hospitalization and post-acute care utilization. We believe Clover home care is already one of the largest direct-to-home practices in New Jersey, and powered by Clover Assistant, we're excited in our ability to scale this model to new markets and geographies in the future. Before handing the call over to Scott, I want to once again emphasize how excited I am that we have a clear roadmap to achieve our goals as an organization. This quarter's results, combined with our recent cost reduction initiatives, show great progress to accelerating our timeline to profitability. Now, I'll turn it over to Scott for a more detailed financial update.

Thanks, Andrew. I'll first touch on this quarter's financial highlights and then review our updated outlook for full year 2023. The first quarter of 2023 was highlighted by another period of significant MCR and gross profit improvement for both lines of business, strong insurance revenue growth, and the rollout of operating efficiencies that will result in meaningful SG&A savings once implemented. Starting with our insurance segment, MCR improved to 86.6% this quarter from 96.4% in Q1 of last year. Our year-over-year improvement of nearly 1,000 basis points was driven by continued operational enhancements, including improved performance from Clover Assistant, more efficient managed care activities, a favorable mix of new versus returning members, a balanced and sustainable plan design, and an improved star rating for our flagship PPO plan. Revenue for the insurance line of business grew 14% to $317 million in the first quarter, and we continue to focus on insurance revenue growth. This quarter, non-insurance revenue decreased to $206 million, primarily driven by our strategy to focus on a narrower group of participant providers. We recently received an updated view of our aligned beneficiary count from CMS, which came in slightly below our initial estimate. This slightly lower beneficiary count will have a minor impact on our revenue for the year, though this revenue effect may potentially be offset by other program factors as CMS finalizes them. Our non-insurance segment MCR in the first quarter was 96.1%, which compares favorably to MCR of 99.8% in the prior year period. As mentioned by Andrew, this result does include some favorable prior period development, but we remain optimistic about overall improvements in 2023. I also note that because ACO REACH relies on retrospective benchmarks, we'll likely be exposed to meaningful upside or downside prior period risks as final benchmarks are published by CMS for the 2022 plan year. This prior period exposure is embedded in the program framework for all participants. We expect to have more to share when we report our second quarter results. First quarter adjusted SG&A was $86 million, a minimal increase over Q1 of 2022. The increase was driven by the rollout of our new rewards and incentives program, but partly offset by savings in other areas. Reducing adjusted SG&A remains a key focus for the company as we push towards profitability. We've made statements on the last several earnings calls about efficiency opportunities throughout the organization. Recently, we announced a business transformation initiative to realize some of these opportunities, while also maintaining our own capabilities and investments with our true differentiator, Clover Assistance. This transformation includes a reduction in force and the movement of select non-core elements of our insurance operations to USC HealthProof's integrated technology platform. As previously announced, we expect a net annualized savings of approximately $30 million starting in 2024 from our combined initiatives. We will also be recording restructuring charges of between $7 million and $9 million in the first half of 2023. These charges will be adjustment items in our non-GAAP adjusted SCNA and EBITDA. The outperformance of both lines of business drove significant adjusted EBITDA improvement from a loss of $71 million in Q1 of last year to a loss of $30 million in Q1 of this year. We finished the first quarter with restricted and unrestricted cash, cash equivalents and investments totaling $635 million on a consolidated basis and $331 million at the parent entity and unregulated subsidiary level. Similar to what happened in Q3 of last year, we received both the March and April MA payments from CMS during the month of March. This resulted in an unusual working capital effect, temporarily elevating Q1 cash by about $108 million at both the regulated entity level and on a consolidated basis. This effect will normalize in Q2. Our focus on improving MCRs and generating gross profit for both business segments along with initiatives to achieve operational efficiencies and SG&A savings, will help to protect our liquidity position. I'll reiterate what we've said during prior earnings calls, which is that we consider our current liquidity to be sufficient to meet our 2023 operating needs. We also have a strong and unlevered balance sheet, which provides flexibility to pursue opportunistic financing. Having said that, our aim is to insulate ourselves from capital markets by accelerating our path to profitability. Finally, I'll provide an overview of our full year 2023 guidance, which we have updated in some areas based on strong Q1 results. We are increasing our revenue guidance for the insurance line of business to between $1.18 billion and $1.23 billion. We are also improving insurance MCR guidance to a range of 87% to 89%. We are maintaining our previous non-insurance revenue guidance at a range of $750 million to $800 million, an MCR of between 98% and 100%. These metrics cannot yet be updated due to the previously mentioned lag on data and key benchmarks under the program. As mentioned, we will not realize the full effect of our recently announced transformation and cost savings initiative until 2024. So while we remain focused here, we are maintaining our previously issued guidance for adjusted SG&A of between $315 million and $325 million. Finally, these changes result in an improved adjusted EBITDA guidance of between negative $125 million and negative $175 million. I'd like to close by emphasizing that we view this quarter as a strong first proof point that the areas of strategic emphasis we have been talking about since last year are already paying off in 2023. We look forward to sharing more updates on our progress towards profitability in the coming quarters. With that, I'll turn the call back to Andrew for some final comments.

Thanks, Scott. Before we take questions, I'd like to quickly discuss our Clover assistance progress. As a reminder, Clover Assistant's differentiated ability is to change the timeline of care through helping physicians with the early identification and management of chronic disease. We continue to see a significant MCR benefit from physicians using Clover Assistant. In the past, we've shared the 1,000 basis point MCR differential for returning members whose PCPs use Clover Assistant as compared to members whose PCPs do not. We've continued to see this, and actually, our data shows the differential is often materially higher. This is due to our constant focus on making Clover Assistant the leading platform in helping physicians identify and manage disease earlier. In addition, we've recently seen a significant improvement in the world of healthcare interoperability, and this increased access to data, combined with recent improvements in AI technologies, make us very excited about progress on the Clover Assistant front. With that, let's move on to Q&A.

Thank you, sir. We will be taking questions first from Clover's research analysts. At this time, if you wish to ask a question, please press star 1 on your telephone keypad. You may remove yourself from the queue by pressing star 2. In the interest of time, we ask that you please limit yourself to one question and one quick follow-up. And we'll pause for a moment to allow questions to queue. Our first question will come from Jonathan Young with Credit Suisse. Your line is open.

Okay, thanks for the good question. I just wanted to ask on the improved MOR there. What did you kind of see in the quarter? Did the COVID headwinds really abate a lot? How was the mix of inpatient utilization versus outpatient, et cetera? Thanks.

Yeah, sure. So we definitely saw, thanks for the question. So the COVID environment we're seeing as relatively stabilized, I think at this point, we're not expecting to see anything materially happening according to our data. And I think that even from compared to a year ago, we're definitely seeing that things have stabilized. Nothing really strongly to note on the COVID front.

Okay. But I guess just in terms of general core utilization, are you seeing a bounce back with seniors going back to see their PCPs? Are you seeing more inpatient volume at all? Is that a little bit less than it would normally be in your mind?

Yeah, so I don't think we're not seeing any suppressed utilization, definitely. We're seeing that sort of like going back, I think, on trend with the numbers looking a little bit like what we would see prior to COVID. And so I think that on trend is what we'd say, controlling for the fact that COVID came in between 2019 and now, that we're seeing approximately what we would expect to see. So I don't think we're seeing extra utilization. I don't think we're seeing suppressed utilization either.

Okay, good. And then just my second question is, on USP, I guess, is the reason for the initiatives not yielding anything in 23 is more a contract timeline? Or, I guess, how come we wouldn't see any benefit in 23 at this time? Or is it more logistical? Thanks.

Yeah. Hey, Jonathan. This is Scott. So, really, that's just a function of implementation timeline. You know, these back office and related non-core operations that we are moving over to USD are fairly complex operations in the transition. in a manner that ensures mitigating any potential risk to the plan operations. And so that being the case, we really target largely an early 2024 implementation timeline for the majority of the workstreams that we're moving over. Thanks.

Thank you. As a reminder, that is star 1 to ask a question. And our next question will come from Richard Close with Canaccord Genuity. Your line is open.

Hi, this is John Petty on for Richard. Thanks for the question. So with the Clover home care, you said it's like it's like, is it all in New Jersey at this point? And it's for 2023 for the foreseeable future. Is it like expected to stay in New Jersey? And where exactly would be any type of expansion plans for that?

Yeah, thanks, Jonathan. So with Clover Home Care, as a reminder, we're really excited about that particular initiative, and it is mainly serving in our New Jersey markets right now, which is where we launched the program. We've matured it there. We're excited by the results that we see. So we have plans and thoughts about how we might bring it to other markets. Certainly, it's a core part of our care management service. It uses Clover assistance. and so we want to have that operating in any market in which we have a strong material presence but right now it does operate mainly in new jersey like i said in my remarks we believe it's one of the largest home care focus practices in new jersey we have plans to bring it to other markets that we haven't formally announced anything there yet okay great thanks um

And then also just on MAMCR, is there any type of cadence, quarter to quarter, that you guys can call out or anything when we're thinking about modeling?

Regarding seasonality, basically? Yes.

Okay.

Yeah, so, you know, we would typically expect to see slightly elevated MCR levels in Q1, but more pronounced in Q4 with kind of a flatter level of performance in the middle part of the year.

Okay, great. Thank you.

Thank you. And as a reminder, that is star one to ask a question. All right, there are no further questions in the queue at this time. I would now like to turn the call back over to Andrew Toy for any additional or closing remarks.

Sure. So thanks for the question so far. I'd like to end the call with just some thoughts on why I'm incredibly excited about the moment we're at within the healthcare industry and our ability at Clover to use our technology to power an incredible acceleration in physician capabilities. As a reminder, I've been involved with some of the most transformative moments of the last few decades, moments where technology has really created a step function change in the capabilities of human beings. The previous company I founded helped deliver the mobile revolution, a revolution that has allowed almost every person to have access to supercomputing capability pretty much at all times. Next, at Google, I spent time focused on bringing the capability of the cloud to businesses all around the world to provide a level of real-time data interconnectedness that we've never really had before. And the final piece of this puzzle has always been my work around artificial intelligence and machine learning, incredible capabilities that I truly believe will be powerfully additive to the capabilities of all of us as human beings. These experiences are intersecting, and I truly believe that the time is now for the realization of these benefits in healthcare. At Clover, we built Clover Assistant to be literally that, an assistant to physicians to give them superpowers and let them access the power of cloud data, telemedicine, machine learning, AI, all at once. And as a technologist, I knew that the key to this would be to make sure we get our platform implemented and used every day by actual real-world physicians on a wide network that has many different kinds of user personas. And in the slow-moving world of healthcare technology, this is no small feat. So I'm proud of what we've achieved. I've always said that the one thing that makes my colleagues in the tech world jealous is the amount of usage that we have on Clover Assistant every single day, something that none of them really have access to. At Clover, we're providing real doctors real insights, and we can see what they engage with more and what they engage with less. And this usage lets us tune, tweak, and accelerate our product and AI and ML capabilities in a way that I really believe is truly transformational. So the goal of Clover has always been to not just climb the obvious local maxima, but to move the capabilities of physicians onto a different part of the curve entirely. It's not about a better laptop. It's about a supercomputer phone. It's not about a better data center. It's about existing entirely on the cloud. And it's not about just simply building academic AI models, but about making sure that they're built to be useful to real-world physicians. every day. It's taken significant investment and time to create this platform, but now we're at the exciting stage where we can realize the benefits of all of our capabilities. So I really see this first quarter, this strong quarter of results, is us aligning Clover business capabilities behind this transformative vision, the same vision we've had for the last few years. I'm excited about the additional progress we'll deliver this year, of course, but I'm also incredibly excited to be part of this critical moment in time for our entire society. Thank you all again for being part of the journey with us.

Thank you, ladies and gentlemen. This concludes today's Clover Health's first quarter 2023 earnings call-in webcast. You may disconnect your line at this time and have a...