Latest / Becker’s Payer Issues Podcast / Dr. Damanjeet Chaubey, Vice President of Clinical Affairs at Clover Health

Transcript

Dr. Damanjeet Chaubey, Vice President of Clinical Affairs at Clover Health · Becker’s Payer Issues Podcast

0:00
Evernorth brings the power of wonder and relentless
0:02
innovation to create world class pharmacy, care, and
0:05
benefit solutions.
0:07
Barriers to care can lead to gaps in
0:08
care, which can drive up the total cost
0:10
of care. Our capabilities work seamlessly together to
0:13
create innovative pharmacy care and benefit solutions for
0:17
today and tomorrow.
0:18
Our connected health services make the treatment, prediction,
0:21
and prevention of health care's most complex conditions
0:24
easier and more accessible as we drive organizations
0:27
and people forward.
0:28
This is Haley Recker with the Becker's Payer
0:31
Podcast, and we are recording live at the
0:33
Becker's third annual spring payer issues roundtable.
0:36
Today, I am thrilled to be joined by
0:38
doctor Damanjeet Chaabi, who is the vice president
0:41
of clinical affairs at Clover Health.
0:44
Thank you so much, doctor, for joining me
0:46
today. Can you go ahead and introduce yourself
0:49
and a little bit about your background?
0:51
Sure.
0:52
So happy to be here.
0:54
I'm Damanjeet
0:55
Chaubey, vice president of clinical affairs at Clover
0:59
Health, trained as an internal medicine and palliative
1:02
care.
1:03
I continue to practice medicine,
1:06
and have few decades of health care experience
1:09
in a variety of, physician leadership positions
1:13
on both on the health care system side
1:16
and now with Clover Health.
1:18
Really, what I'm passionate about is everything that
1:22
solves
1:23
for
1:24
how to deliver the best
1:26
quality of care to our Medicare beneficiaries.
1:29
I'm happy to be at Becker's,
1:31
share my experiences,
1:34
and learn from my esteemed colleagues.
1:37
Well, thank you so much for that brief
1:39
introduction. I'm really excited to get into our
1:41
discussion today. To kick things off, balancing affordability
1:44
and quality is a constant challenge for health
1:47
plans. How is your organization
1:49
innovating to manage the cost of care while
1:51
maintaining or improving member outcomes?
1:54
So that's a that's a great question. And,
1:58
we at Clover
2:00
have been very successful
2:02
in managing this challenge,
2:04
affordability
2:05
and quality,
2:06
because our approach
2:08
is really unique,
2:10
in the sense that
2:11
our approach in managing the health of our
2:13
members
2:14
is unique and differentiated
2:16
from traditional MA,
2:18
approaches.
2:19
Firstly,
2:21
we are a tech centric model
2:23
focused on improving clinical care
2:26
outcomes via software,
2:28
which is our Clover Assistant platform.
2:30
So our approach is clinical. It is physician
2:33
enablement
2:35
via AI powered technology
2:37
through our Clover Assistant platform. And it's just
2:40
not focusing, you know, just on basic
2:43
insurance tech process.
2:44
So this is a very, you know, different
2:46
process.
2:47
Next, I think our care strategy.
2:50
It is rooted
2:52
in early disease identification,
2:55
management,
2:56
and care treatment by our clinicians
2:58
who use global assistant technology.
3:01
It's more of a proactive process
3:03
rather than a delayed or a reactive
3:06
typical health care process.
3:08
Thirdly, I feel that our network construct
3:11
is a wide open PPO plan, which is
3:14
unique.
3:15
We are not focused on risk delegation,
3:18
and most importantly,
3:20
we believe strongly
3:21
in providing
3:23
longitudinal
3:24
home based care
3:26
for our most at risk population
3:28
by physicians
3:29
who are using our Clover Assistant
3:32
power technology.
3:33
We are not just focused on one time
3:35
visits. We believe in longitudinal
3:37
care management
3:38
for our members.
3:40
And because of all these reasons,
3:42
I think, for our year today, 02/2024,
3:47
performance,
3:48
we've been able to achieve industry standard
3:51
leading MCR of 7075.6%
3:55
and an insurance
3:56
benefit expense ratio
3:58
of about 80.6%
4:00
in 2024.
4:01
We have also grown at the same time.
4:04
However, in a measured pace,
4:06
continuously innovating,
4:08
achieving profitability
4:10
in 2022,
4:11
and with a steady growth in our membership
4:14
in 2025.
4:15
So we are very, very excited about our
4:17
future,
4:18
you know, kind of, like, implementing
4:21
our,
4:22
unique approach to managing Medicare.
4:25
Well, I'd love to go a little bit
4:27
deeper into quality of care. You know, the
4:29
regulatory landscape is always changing.
4:32
So what best practices or tools does your
4:34
organization rely on to keep quality of care
4:36
at the forefront?
4:37
Again,
4:38
you know, I think, what I would like
4:41
to say to answer that question
4:43
is that the answer is
4:46
a tech centric clinical
4:48
delivery model of care and a benefit design
4:51
of an open network.
4:53
So we wanna engage with all stakeholders,
4:56
including patients and our providers,
4:59
and we believe
5:01
strongly
5:02
that consumers
5:03
prefer PPO plans
5:05
that allow them to see physicians
5:08
that they have existing relationships
5:10
with. What's unique about Clover
5:12
is that 90 of our membership is in
5:15
a PPO plan with a 3.5
5:17
star rating for 2025
5:19
and a four star rating for 2026.
5:22
Clover Health also has been rated,
5:26
4.94,
5:27
but really a five star on HEDIS measures
5:31
for star rating year 2025.
5:33
So that speaks about quality.
5:35
And I think it's so important that we
5:38
think about
5:39
we wanna meet the members where they are,
5:41
that we need for them to see the
5:43
physicians that care take care of them,
5:46
and which is very unique.
5:48
You know, most plans focus on an HMO,
5:51
delivery model,
5:52
but we don't. But we are still able
5:54
to maintain quality by even giving wide access
5:58
to our members. So that's first. And secondly,
6:01
we engage with our providers.
6:03
We are our care platform that's our Clover
6:05
Assistant,
6:07
CA technology,
6:08
which is the leader in clinical AI.
6:12
We synthesize
6:13
hundred plus data sources,
6:15
including electronic health records,
6:18
pharmacy data, physician notes,
6:21
lab data, claims data,
6:23
and generate insights
6:25
from more than hundred propriety models that deduplicate,
6:29
they normalize the data, they enrich the clinical
6:32
data repository,
6:34
and they surface the most
6:36
relevant and meaningful,
6:39
suggestions
6:40
to the clinicians
6:41
at the time of that
6:43
patient encounter.
6:45
So when I see patients
6:47
using Clover Assistant,
6:49
I can see a consolidated view,
6:51
of the patient's specific insights.
6:53
Right? What are their existing medical problems?
6:56
What are their medications?
6:58
Review their medications.
6:59
Have they filled them? When did they fill
7:01
them? Are there any gaps?
7:03
Did they
7:04
get admitted to the hospital? Did they ever
7:06
go and receive ED care, their recent labs,
7:10
their discharge notes? And, you know, I am
7:12
able to review
7:13
their care gaps. So all of this
7:17
and some more, because of our AI based
7:19
model, we are even able to present to
7:22
the clinicians,
7:23
feed the risk of future adverse events or
7:26
suspected diagnoses
7:28
that'll help with timely diagnosis and treatment,
7:31
you know, for our members.
7:32
Focus on preventative care,
7:34
focus on medication adherence,
7:36
and other quality measures.
7:38
As a physician,
7:40
I feel that nothing is more important
7:42
than timely diagnosis and treatment,
7:45
for my patient. And I can make the
7:47
best decisions for my patients if I have
7:50
the right information
7:52
when I actually see them.
7:54
Because of this, you know, technology that we
7:56
have,
7:57
our Clover Home Care cohort,
8:00
those are physicians,
8:02
managing our patients
8:03
using CA technology,
8:05
have shown significantly
8:08
improved
8:08
MCR,
8:09
you know, for our highest equity population
8:13
through managing them at home, focusing on readmission
8:16
prevention,
8:17
and also looking and assessing for unknown and
8:20
emerging risk. So empowering every physician with technology
8:25
to identify,
8:26
manage,
8:27
treat chronic conditions earlier
8:29
leads to higher clinical care,
8:32
better outcomes at lower cost.
8:34
We publish white papers that support proof of
8:37
concept for some of the disease conditions that
8:40
are so commonly prevalent,
8:42
in our population such as diabetes and chronic
8:44
kidney disease.
8:46
For example,
8:47
we've
8:48
shown that by using our CA technology,
8:51
you can actually diagnose diabetes earlier.
8:54
We can actually manage it better with lower
8:58
blood sugars, lower use of insulin,
9:00
and lower instances of hypoglycemia.
9:03
That is profoundly meaningful
9:06
for any physician.
9:07
CA has also used,
9:09
you know, has also correlated very well with
9:12
medication adherence.
9:13
So I think in a sense, what I
9:16
would say is even though that the regulatory
9:19
landscape can change,
9:21
if you have the best practices
9:23
and the
9:24
tools to take care of your members,
9:27
good results are just inevitable
9:29
and,
9:30
will eventually lead to good outcomes.
9:33
Well, that was just fascinating, and thank you
9:35
for going into such great detail there. I
9:38
wanna pivot the conversation a little bit. So
9:40
looking ahead, what do you see as the
9:42
biggest opportunity for payers to lead the charge
9:45
in transforming care delivery and driving better outcomes
9:48
for all stakeholders?
9:49
And how can leaders take a step in
9:51
this direction now?
9:53
Excellent question. I feel that the biggest opportunity,
9:57
in transforming care delivery for better outcomes
10:00
is home based care for managing chronic disease
10:04
conditions.
10:05
Whilst this may not sound very novel because
10:09
home based care has existed
10:11
in a variety of ways for decades,
10:14
but the approach
10:15
has largely been to meet some short term
10:18
organizational
10:19
goals,
10:21
be it in a post discharge,
10:23
transition of care visit, a thirty day readmission
10:26
prevention program,
10:27
and some common value based contractual process measures.
10:31
Most time, patients are lost to follow-up
10:34
after the initial outreach, and we do not
10:38
see a huge impact at a national level
10:41
except
10:42
where organizations
10:43
have taken some bold steps
10:46
creating health care delivery models that are more
10:49
comprehensive,
10:50
holistic, and longitudinal in nature. So I feel
10:53
there are several aspects to this,
10:56
that I would really like to, you know,
10:58
kind of,
10:59
focus on. One, I think technology.
11:02
Right? Technology is really important
11:05
because it is surfacing
11:07
the right information
11:09
for clinicians
11:10
managing the patients at home.
11:12
The right technology tools,
11:15
including connectivity, which can be a huge issue
11:18
in the rural remote areas,
11:20
is a huge benefit in managing our members'
11:23
expectations.
11:24
For example,
11:25
you have to think about,
11:27
are people getting into an acute exacerbation of
11:30
their chronic disease? How will we find that
11:32
out? Can we actually do better remote monitoring,
11:36
better point of care testing,
11:38
and how can our own,
11:40
you know, ML based,
11:42
clover resistant platform
11:44
help in proactively
11:46
identifying
11:47
who's at risk, when are they gonna exacerbate,
11:50
and how can we manage that and reduce
11:52
their risk. So one of the things that
11:54
I think is so important is utilizing technology
11:59
to reduce burdensome processes
12:01
via
12:02
AI scribing perhaps,
12:04
reducing the burden of documentation and billing for
12:07
physicians so that they can actually focus on
12:09
patient care,
12:11
and make a huge difference in the Medicare's,
12:14
you know, in our Medicare population.
12:16
Second, I think, is skilled workforce.
12:19
Do we have the right clinical workforce,
12:21
that can manage the, chronic disease at home?
12:25
It's really important to invest
12:27
in training,
12:29
skill building,
12:30
and the right ratios of the n b
12:33
you know, MD physicians,
12:34
nurse practitioner,
12:36
and nurse and nurses.
12:38
This is really critical,
12:40
because vis a vis a cost containment strategy
12:43
where
12:44
this ratio of the n MD,
12:47
NP, and nurse is being compromised
12:50
cost for quality. So I would say that
12:52
we really need to relook at how we
12:56
manage with what skills we manage, and then
12:59
only we'll see a huge difference.
13:01
Thirdly, I would say that people need to
13:04
invest in access to medical care. Right? I
13:06
think home based care can solve for access
13:10
to care with the right time, you know,
13:12
with the right team at the right time
13:14
using technology, especially in rural areas.
13:18
I think there was a recent KFF report
13:20
that highlighted
13:21
the paucity of specialist care,
13:25
specifically
13:25
in Georgia.
13:27
And interestingly, we just recently launched a clinical
13:30
program,
13:31
longitudinal
13:32
based, home based,
13:34
comprehensive
13:35
longitudinal
13:36
clinical care model in Georgia. And I can
13:38
tell you through my personal experience
13:41
that it is profoundly impacting.
13:44
Patients are so happy
13:45
to see an MD and a nurse practitioner
13:48
in their home
13:49
helping manage their chronic conditions,
13:51
awarding ED visits and hospitalizations,
13:55
and actually navigating
13:56
and helping them make the right health care
13:58
decisions
13:59
involving their caregivers,
14:02
so that,
14:03
the right decision is made and the next
14:05
action item occurs,
14:07
smoothly.
14:08
So I feel that
14:10
coordination of care,
14:11
you know, is really important, and leaders can
14:14
support,
14:15
promote,
14:17
building these sustainable
14:19
home based chronic care,
14:21
programs
14:22
above and beyond,
14:24
you know, what are the standard care management,
14:27
you know, processes,
14:29
today. This requires
14:31
a reset.
14:32
It requires,
14:34
more investment.
14:36
It requires
14:37
a unique way of,
14:39
you know, operating.
14:41
And it actually requires not only investment, but
14:44
I think it requires commitment,
14:46
to, you know, create sustainable programs.
14:49
And then when you see good outcomes,
14:51
I think share the wealth,
14:53
you know, share it with other communities,
14:56
and then, you know, we can absolutely
14:59
make some good,
15:00
progress.
15:02
I think that will what is, you know,
15:04
that is, what will lead to, or drive
15:07
appropriate
15:09
changes in national policies
15:11
because
15:12
without give having good data showing good outcomes,
15:15
it's very difficult to influence change at a
15:18
national level,
15:20
and that is really what is required.
15:22
So thank you.
15:24
Well, doctor, thank you so much for meeting
15:26
me with me today. Again, this is Haley
15:28
Recker with the Becker's Payer podcast
15:30
recorded live at the Becker's third annual spring
15:33
payer issues roundtable.