Latest / Becker’s Payer Issues Podcast / Inside Clever Care Health Plan’s Growth: Blending Cultures, Community, and Value-Based Care

Transcript

Inside Clever Care Health Plan’s Growth: Blending Cultures, Community, and Value-Based Care · Becker’s Payer Issues Podcast

• 0:00
  Hello, everyone. This is Jacob Emerson with the
• 0:02
  Becker's Payer Issues podcast.
• 0:04
  Thrilled today to be joined by Richard Green,
• 0:06
  who is the president of CleverCare Health Plan.
• 0:09
  Richard, thank you so much for taking the
• 0:11
  time to be with me on the podcast
• 0:12
  today. Thank you, Jacob. It's my pleasure.
• 0:15
  Absolutely. And, Richard, before we dive into everything
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  we wanna talk with you about, can you
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  tell us a little bit more about yourself,
• 0:20
  your background in health care, and what it
• 0:22
  is that you do today at CleverCare?
• 0:24
  Happy to. I'm the president of CleverCare health
• 0:27
  plan.
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  CleverCare was founded to provide a culturally sensitive
• 0:31
  and competent Medicare Advantage health plan.
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  We give members access to care that's delivered
• 0:37
  in their own language and with their own
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  unique cultural traditions in mind. And we have
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  a value based care model that essentially blends
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  eastern and western.
• 0:54
  Moved into the role of president, where I
• 0:56
  oversee the day
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  moved into the role of
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  president where I oversee the day to day
• 1:01
  operations of the company as well as the
• 1:03
  financial strategy.
• 1:05
  Before,
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  joining CleverCare,
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  I
• 1:09
  really dedicated my career nearly thirty years to,
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  financial and operations
• 1:15
  roles across both payers as well as groups.
• 1:19
  And most recently, I served as the COO
• 1:22
  and CFO of AppleCare
• 1:23
  Medical Management, which was one of the first
• 1:26
  acquisitions
• 1:27
  within OptumCare.
• 1:29
  Wonderful. Well, like I said, we really appreciate
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  you taking the time to join us today,
• 1:33
  Richard. And I I wanted to get started
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  by talking about some recent news from CleverCare.
• 1:38
  The company has just opened its its new
• 1:40
  flagship community center,
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  and which is now the fourth CleverCare community
• 1:45
  center in California as I understand it. So
• 1:48
  talk to us a little bit about this
• 1:49
  new center and and what role your community
• 1:52
  centers play in in the overall growth and
• 1:55
  retention strategy at CleverCare and how you wanna
• 1:58
  measure their impact on on member experience, on
• 2:01
  outcomes,
• 2:02
  engagement. Give our listeners a full picture of
• 2:04
  of how you're thinking about this.
• 2:06
  Absolutely.
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  You're right. The Rolling Heights Community Center is
• 2:10
  our fourth location, and our community centers
• 2:13
  are really at the heart of our mission.
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  And these centers are part of how we
• 2:18
  invest in our members and deliver
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  on our commitment
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  of being a reliable partner.
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  What makes the center special is that they
• 2:27
  blend eastern and western approaches to wellness.
• 2:30
  Our members can attend tai chi classes,
• 2:33
  participate in community classes on mental health
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  and dental care,
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  or come together for
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  community
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  building events that might include
• 2:43
  lessons on technology,
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  book clubs, birthday celebrations.
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  And we even have,
• 2:50
  found some talent within both our associates and
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  our members with, live music. We like to
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  do a lot of, sing alongs.
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  Everything is offered
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  in
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  languages primarily spoken by our members
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  covering, Mandarin, Cantonese, Vietnamese, and Korean.
• 3:06
  The Rowland Heights Center,
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  as I mentioned, is our fourth center joining
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  our centers in Monterey Park,
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  Westminster,
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  and Koreatown.
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  In 2024,
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  our three
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  legacy
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  centers generated nearly four, 18,000 visits, which tells
• 3:23
  generated nearly four, 18,000 visits, which tells us
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  our members are actively engaging,
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  and we're seeing that engagement,
• 3:30
  translate into better satisfaction,
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  better retention,
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  and, you know, really increased connectivity with our
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  members. These centers, are actively engaging, and,
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  connectivity with our members.
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  And
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  these centers position us to deliver an exceptional
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  member experience and build deeper, more meaningful relationships
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  with the communities we serve.
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  And these centers are places
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  of connection and belonging, and that's
• 3:53
  a foundation of our growth.
• 3:55
  That's fantastic. And then it's amazing to continue
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  to see to build out these community centers
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  in the in the markets that you serve,
• 4:01
  Richard.
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  I also wonder if, you know, I I
• 4:03
  wanna talk a little bit about, the the
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  Medicare Advantage landscape more broadly and some of
• 4:08
  the news and trends we've been seeing this
• 4:11
  year,
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  with with companies all over the country.
• 4:14
  We've as you know, we're seeing plans consolidate
• 4:17
  their offerings, tighten margins heading into 2026.
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  So I wonder if you could explain for
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  us how CleverCare specifically is navigating some of
• 4:25
  these industry headwinds while continue continuing to invest
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  in in what you just talked about, these
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  culturally tailored care and and community based services.
• 4:34
  Yes.
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  We believe
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  our combination of eastern and western medicine,
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  along with teachers like the community centers resonate
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  with the, with our community.
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  And we're focused on investing and expanding
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  much like our Rowan Heights Center, which just
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  opened,
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  as as a as a perfect example.
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  We're able to do this because we've proven
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  our model, which honors culture and tradition, delivers
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  financial results.
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  Since '23, we've more than doubled in size,
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  growing to nearly 30,000
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  members.
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  As you alluded to, it's no secret
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  that national payers have found the transition to
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  value based care challenging.
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  Outcomes based models
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  tend to take time to deliver on cost
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  savings,
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  but we feel as though we're leading the
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  way with a sustainable
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  model that works.
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  Central to our success
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  is the trusted relationship
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  we've developed with providers in our network.
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  We ensure seamless claims processing,
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  timely and accurate claims payments.
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  And unique to CleverCare,
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  our network
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  includes 700
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  directly
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  contracted acupuncturists and other nontraditional
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  specialists.
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  We've also maintained stable and reliable benefits
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  over the last couple of years, giving
• 5:57
  both our members and our brokers
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  confidence in our commitment to them. That stability
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  combined with our financial performance is what has
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  allowed us to continue to invest
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  in things like our community center while others
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  may be pulling back.
• 6:13
  Sure. That makes a lot of sense. And
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  and, clearly, CleverCare is a very unique health
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  plan in terms of its, its offerings and
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  benefits, and it's clearly working in terms of
• 6:22
  the growth you've seen in enrollment over the
• 6:24
  last few years, Richard. I wonder in that
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  vein where you see the biggest openings for
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  innovation or or differentiation
• 6:31
  in in Medicare Advantage over the next few
• 6:32
  years, whether that's in,
• 6:35
  growth in your benefit design, care delivery, member
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  engagement.
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  How do you continue to see CleverCare innovate
• 6:41
  in in the MA space?
• 6:43
  Sure. I think the biggest opportunity
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  is exactly,
• 6:47
  what we've been doing at CleverCare
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  is just continuing to create a model that
• 6:51
  blends eastern and western medicine
• 6:54
  while focusing on removing barriers and improving outcomes.
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  In, benefit design, there's a real opportunity to
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  reflect members' actual health traditions.
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  As I mentioned earlier, our network includes 700
• 7:09
  directly contracted acupuncturists,
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  and these aren't extras.
• 7:14
  In fact, for many people, they are core
• 7:16
  to how they approach
• 7:18
  health and wellness
• 7:19
  and help create a sense of real connection.
• 7:24
  In care delivery,
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  being a reliable, transparent, and trustworthy partner matters
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  and creates a foundation for better care delivery.
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  And in member engagement, physical presence in communities
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  through our centers makes a difference.
• 7:39
  Engagement,
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  especially when delivered
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  in our members'
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  own language, is what drives better outcome.
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  And the plans that will differentiate themselves are
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  the ones that genuinely understand and serve their
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  members' unique needs
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  while maintaining
• 7:57
  financial stability to deliver on their commitments year
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  after year.
• 8:01
  Absolutely. And and we're for sticking on that
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  is our is our last question, Richard, in
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  terms of some of the advice or final
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  thoughts you would offer all the other insurers
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  listening
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  what what would you
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  share with them? At first, I would I
• 8:17
  would say
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  don't chase unsustainable growth.
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  Build something that lasts through strong operational
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  foundations,
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  genuine relationships
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  with the provider network,
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  and a clear understanding of the communities you
• 8:33
  serve.
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  The industry is at such a critical moment,
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  so it's crucial to understand that sustainable growth
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  requires a different approach than the past.
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  Our approach is to focus on maintaining the
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  stability
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  that allows us to invest for the long
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  term.
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  And to that point,
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  we're posed for continued growth in investing.
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  And over the last few months, we've brought
• 8:57
  on a new chief information officer,
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  vice president of operations,
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  and vice president of sales, all seasoned leaders
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  that understand Medicare Advantage. And that's the kind
• 9:08
  of investment that
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  positions ourselves as well as others for sustainable
• 9:14
  successful growth.
• 9:16
  Wonderful. Well, Richard, I hope you keep us
• 9:18
  posted on the continued innovations and and growth
• 9:21
  at CleverCare.
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  But I wanna thank you for taking the
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  time to chat with us and and for
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  sharing your insights about all the new stuff
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  going on at the at your company. We
• 9:29
  really appreciate it.
• 9:31
  Thank you very much, Jacob. I appreciate the
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  opportunity.
• 9:34
  Yeah. And to our listeners, if you'd like
• 9:36
  to listen to more podcasts from Becker's Health
• 9:38
  Care, you can visit beckershospitalreview.com.