Welcome, Clover Health. From where you sit in the organization, you probably realize health care is more complicated than it needs to be. What if you could be part of the solution to transform health care as we know it – to make it more affordable, predictable and simple? Working together, we can take on your toughest challenges, expose opportunities to reduce costs and increase profitability, and help you prepare for what’s next.
Clover Health
See how we helped a client grow their Medicare business
We offer the guidance and support necessary to help our clients improve in quality outcomes and Star ratings.
Implementation and innovation success story
Hear about a real clients' experience implementing their plan and their clients with Express Scripts.
Transforming care ... together
Hear from Tim Wentworth, President of Health Services, about how we focus on your growth priorities.
Your trusted partner in regulated markets
We understand Clover Health’s data-driven focus on health care quality is central to your identity. Choosing a partner who shares that vision is critical to reaching your goals. Our unmatched focus on Medicare, constant pursuit of improvement, and market-leading clinical programs deliver quantifiable value through higher Stars scores. We offer a designated Medicare Strategist as a core member of your account team to consult on the complex Medicare market.
Medicare Stars Quality
Express Scripts is committed to helping Clover Health realize the potential $15.6M in 2021 quality bonus payments available to your plan H5141 for reaching a 4 Star rating. We are the partner to help you stabilize your plan quality, managing the clinical utilization with a constant influx of new members. Our first-of-its-kind clinical model, Health Connect 360SM, offers a risk sharing arrangement that leverages industry-wide best-in-class services and allows you to place financial guarantees on the Stars metrics of your choice.
Formulary Matters
Choosing an MAPD performance formulary doesn’t mean you need to limit the number of drugs available to prospective members. In your current MAPD markets, other PBMs are offering 10% to 12% more drugs on their MAPD formularies, positioning your formulary more in line with the PDP market. Express Scripts offers our plans multiple standard formularies and utilization management options to maximize member access, control costs, and provide rigorous compliant options to win in your market.
Recent news
Get a sneak peek at the latest happenings in pharmacy and regulated markets, and how they may impact your plan.
Clinical insights for Clover Health
Within Clover Health's population, we've identified several clinical opportunities to maximize savings, while continuing to provide the care and medications your population needs.
Fragmented drug management strategies may be costing you
Medical drug spending is expected to increase by 33% by 2023. With specialty costs rising rapidly, you may be seeking new ways to manage spend and optimize administrative efficiencies. See how our approach to integrating medical drug management optimizes drug savings across pharmacy and medical benefits, enabling better efficiency, greater savings and improved safety.
of claims in the highest specialty spend categories are duplicating work within plans.
higher specialty drug approvals vs. traditional approvals within the last 4 years1.
projected medical spend in 2023 – a 33% increase from $96B in 20182.
References:
1. FDA traditional and specialty approvals for 2016 – projected 2019 – does not include vaccines and diagnostic tests, as of September 2019
2. Evaluation using data from 2018 Altarum institute projection of non-retail drug expenditure for Medical Benefit Growth Rate; CMS, IQVIA and the 2019 Economic Report on US Pharmacies and PBMs, Drug Channels. Analysis assumes most medical drug spend is specialty.
1. FDA traditional and specialty approvals for 2016 – projected 2019 – does not include vaccines and diagnostic tests, as of September 2019
2. Evaluation using data from 2018 Altarum institute projection of non-retail drug expenditure for Medical Benefit Growth Rate; CMS, IQVIA and the 2019 Economic Report on US Pharmacies and PBMs, Drug Channels. Analysis assumes most medical drug spend is specialty.