Clover Health does not have direct competitors, CFO Peter Kuipers says.
"We don't really have a direct competitor, or peer, the way we approach a health plan," Mr. Kuipers told Becker's. "We do, of course, have competition. But if you just look at a plan basis, the technology [we use] is not available. They're not used by competitors."
Founded in 2014, the company reported its first-ever profitable quarter in July. "Scaling and maturing" is the driving force behind Clover's improving financial results, Mr. Kuipers said.
The Tennesee-based insurer has around 80,000 Medicare Advantage members. Clover Health executives have said the company's technology and focus on PPO-plans have built it to withstand the headwinds facing Medicare Advantage.
In April, Clover CEO Andrew Toy said the company did not observe the increased costs in Medicare Advantage that most major payers reported in 2023 and 2024.
Mr. Toy wrote that other MA organizations could be struggling to manage costs in PPO plans, an area where they have "chased growth" in the past few years.
New risk adjustment from CMS and the two-midnight rule could have "very little impact" on Clover, Mr. Kuipers said, because of its PPO focus and the data it gets through its technology.
"We're really architected based on PPO. PPO is newer for some of the other players. It has different mechanics. You have a really great connection with your general physicians, and that's what we have. We have direct visibility," he said.
Mr. Kuipers joined the company in April. He was previously CFO of healthcare technology company Omnicell. Before jumping into healthcare, he was CFO of the Weather Company and regional CFO of Yahoo.
The connecting theme across his career? Building and scaling platforms, Mr. Kuipers said.
In May, Clover Health made Clover Assistant, its clinical decision support tool, available to external payers and providers. Clover Health says the technology has helped cut medical cost ratios by 1,000 basis points.
The company is scaling its external business and hiring the team to support it, Mr. Kuipers said.
"Our infrastructure, and teams, our methodology and technology is very scalable," he said.