Spiras Health today announced a five-year agreement with Clover Health, an innovative technology company improving health outcomes for America’s seniors, to provide complex care management services to Medicare members in Kansas and New Jersey. The value-based contract will provide Spiras Health’s personalized multi-modal approach to some of Clover’s most vulnerable patients.
As Clover scales Clover Home Care, its in-home primary care program for medically complex and homebound members, through the U.S. Centers for Medicare and Medicaid Services’ (CMS) new Direct Contracting model, Spiras Health will support the growing number of Clover-aligned beneficiaries with complex chronic conditions with its unique model that includes home-based services, virtual care and remote patient monitoring at no cost to patients. A dedicated clinical team will provide eligible individuals with in-home, virtual and telephonic visits to promote treatment compliance, identify social determinants that may impact their health, and support the patients’ physicians and care teams.
“Spiras Health and Clover Health share a commitment to addressing the needs of patients with complex chronic conditions with a unique and specialized home-based approach focused on improving the patient’s health and quality of life while reducing costs,” said Scott A. Bowers, CEO, Spiras Health. “We are excited to work with Clover Health’s technology platform and provider network to bring a value-based approach to their most vulnerable patients right in their own homes.”
Within the new Direct Contracting program from CMS, Clover will use its proprietary platform, the Clover Assistant, to proactively identify fee-for-service Medicare patients with complex chronic conditions who are eligible for Clover Home Care and may benefit from Spiras Health’s high-touch individualized delivery model. Spiras’ Clinical Care Teams, led by an Advanced Care Nurse Practitioner and including state-licensed nurses, respiratory therapists, and other allied health professionals, work with each patient’s physician to diagnose, treat, educate, and engage the patient in self-care.
“As Clover scales Clover Home Care, we’ll be searching for like-minded partners. We believe Spiras Health has the right combination of home-based and virtual support to help address multiple issues that contribute to poor health outcomes and high utilization of care for patients with complex chronic conditions,” said Kumar Dharmarajan, Chief Scientific Officer of Clover. “Many of these patients are frequently hospitalized or in the ER with exacerbations that could be prevented. With the help of Spiras Health, we look forward to scaling our in-home primary care program to bring a high level of complex care management to the fee-for-service Medicare population.”
About Spiras Health
Spiras Health is a clinical provider of care management and other health-related services to individuals with complex and chronic needs. Our approach to care delivery includes a combination of home-based services, telehealth, 2-way digital communications and remote patient monitoring with focus on reducing costs associated with avoidable hospital utilization. By identifying and assessing members with an elevated probability of avoidable costs, we develop actionable plans of care and address barriers including social determinants of health. Spiras Health optimizes engagement and activation by building trusting relationships. The multi-modal care approach delivers improved satisfaction and clinical metrics as well as financial savings to its partners. Savings are achieved through substantial and sustained reductions in hospital and emergency department utilization through a geographically and economically scalable delivery model.
About Clover Health
Clover Health (Nasdaq: CLOV) is a next-generation insurance company dedicated to achieving health equity for all Americans. While our mission is to improve every life, we particularly focus on seniors who have historically lacked access to affordable high quality healthcare.
We aim to provide great care, in a sustainable way, by having a business model built around improving medical outcomes while lowering avoidable costs. We do this while taking a holistic approach to understanding the health needs and social risk factors of those under our care. This strategy is underpinned by the company’s proprietary software platform, the Clover Assistant, which aggregates patient data from across the health ecosystem to support clinical decision-making by providing physicians with real-time, personalized recommendations at the point of care.
Making care more accessible is at the heart of our business, and we believe patients should always have the freedom to choose their doctors. To support this belief, we offer two models of care: affordable Medicare Advantage plans with extensive benefits; and care coordination for Original Medicare beneficiaries through Direct Contracting. In both cases, we provide primary care physicians with the Clover Assistant and also make comprehensive home-based care available via the Clover Home Care program.
With corporate headquarters in Nashville, Clover’s workforce is distributed around the U.S. with a team of world-class technologists based in Hong Kong. The company manages care for Medicare beneficiaries in eleven states, including Arizona, Georgia, Kansas, Mississippi, New Jersey, New York, Pennsylvania, South Carolina, Tennessee, Texas and Vermont.