Episode Transcript
[00:00:01] Speaker A: You're seeing Clover, who actually grew 53% during the last annual enrollment period. We didn't build our model around unsustainable benefits. We feel like it's really built around something much more durable. We're using our technology to make physicians better and we're really concentrating our growth in the communities where we feel that we've earned trust and also where our Clover Assistant technology is deeply embedded. And that allows us then to have cohort discipline which will allow us to grow in areas where others maybe won't.
Welcome to the A and M Significant Healthcare Voices podcast series featuring insights on healthcare trends and hot topics direct from industry leaders.
[00:00:41] Speaker B: Welcome to Alvarez and Marcel's Significant Healthcare Voices podcast series. I'm Christina Park, a Managing Director in A&M's Healthcare Industry Group. I'm joined by my colleague Susan Trimble as Senior Director in our practice and we're so excited to have Jamie Reynoso joining us for our podcast today. Jamie is the Chief Executive Officer of Medicare Advantage at Clover Health, a physician enablement technology company committed to bringing access to great health care to everyone on Medicare. This includes a focus on seniors who have historically lacked access to affordable, high quality health care. Clover Strategy is powered by their software platform Clover Assistant, which is designed to aggregate patient data from across the healthcare ecosystem to to support clinical decision making and to improve health outcomes through the early identification and management of chronic disease. For members, Clover provides PPO and HMO Medicare Advantage plans in several states with a differentiated focus on their flagship wide network High Choice PPO plans.
Jamie has more than 30 years of healthcare experience and is responsible for leading Clover's success over the past few years, overseeing the plan's operations, service, network, clinical and it, and previously served as its Chief Operating Officer. Jimmy also spent over 16 years at UnitedHealthcare Group and is the Vice President of Emerging Business there. We're excited to learn more and look forward to diving into our conversation. Welcome to the podcast.
[00:02:09] Speaker C: Welcome, Jamie.
[00:02:10] Speaker B: Thank you. Well, Jamie, as our first question, we'd really like to start talking today about the very dynamic healthcare landscape and, and really looking across the changing Medicare Advantage market. So many things have been shifting in the past year, including demographic shifts, the regulatory changes, product design, rethinks across the board, and member preferences. Clover seems very uniquely positioned, given its sort of technology first capabilities to really effectively address some of these headwinds. What are you anticipating as your priorities that will most significantly shape Clover health's performance in 2026?
[00:02:46] Speaker A: Yeah, it's a, it's a great question. You're right. The Medicare Advantage market is really at an inflection point. I think you've seen a lot of years of benefit inflation. You've seen brokers who are actively switching, you know, helping to switch members. And you're really seeing a lot of regulatory changes that are out there where CMS is really pushing the industry to say we need to have more sustainable product design for members.
But what you're seeing right now is there's a lot of plans out there that are pulling back. So they're either cutting their benefits, they're exiting markets, or they're contracting their membership. But on the flip side, you're seeing Clover, who actually grew 53% during the last annual enrollment period. Well, why was that? We feel it's because we didn't build our model around unsustainable benefits. We feel like it's really built around something much more durable. We're using our technology to make physicians better, and we're really concentrating our growth in the communities where we feel that we've earned trust and also where our Clover Assistant technology is deeply embedded. And that allows us then to have cohort discipline which will allow us to grow in areas where others maybe won't.
So, as I think about 2026 and what my priorities are, it's really three things. So first, that's making sure that of the approximately 153,000 members we have, that they have a great experience and that our new member cohort performs as expected.
Second, it's really around continuing to deepen our Clover Assistant coverage and the adoption of that with PCPs in our core markets. And then third, it's really demonstrating that market leading growth and a path to profitability can actually coexist in Medicare Advantage. I think a lot of people are thinking in this industry that that's still not possible, but we believe we're going to be able to prove it this year.
[00:04:27] Speaker C: Jamie, that growth of 53%, that's amazing. So congratulations on that. I would love to hear what accomplishments over the past year best showcase the drivers behind that growth.
And also how do you ensure that you're balancing the growth with quality of
[00:04:42] Speaker A: care for your members?
Yeah, thank you, Susan. That's really a great question. I think, you know, it's something that we're really proud of. I would actually push back a little bit on the idea that you can't really balance growth and quality. I think for us, it's really the same thing. So the reason that we can grow is that we believe our quality is strong and One way that that has shown is we're the number one PPO plan nationally on our core HEDIS quality measures. And for us, that's the second year in a row. And for us, that's really. It's not a vanity metric, but really, we're saying that's really what is driving our mission, to drive member retention, position trust, and to ultimately improve our financial performance.
And I would say the accomplishment that I'm most proud of from 2025 is what I would say we call it our playbook replication. And what that means is we had 27% growth in 2025, and then we had our over 50% growth in 2026, and we learned a lot about it and we learned how to do it right.
What we believe is where we have our Clover Assistant coverage is the strongest, and in markets where we have deep provider relationships and we know. In markets where we know how to support our members through their first year in our plans, we actually believe that's our playbook. And we took it and we replicated it and we were able to scale it.
And 97% of our members are actually in our flagship wide network ppo. And for us, we are extremely proud of the fact that not only did we have the growth, but we also had exceptional retention. And I think everybody sees when you have retention, that's your membership saying, hey, we're staying with you, because we believe there's value.
And at the core, our members who came from us actually were switchers from other plans. And so they didn't choose us just based on the benefits that we offer.
They chose us because of who we are. And it wasn't because we outbid somebody on our supplemental benefits. They just, they said, wow, we really like what Clover is offering.
And so that's how we're saying we can balance growth with quality. You grow where you're. You have clinical infrastructure in place. You can actually support those members when they come on board. And that is a principle that we continue to have the temptation that you want to scale and you want to go everywhere, but we believe we need to take the model that we have today and we need to be able to replicate it in order to grow.
And for us, retention is really pretty straightforward. Members are going to stay with you when they feel that they're getting value and they can see the doctors that they want and that they experience consistency from day to day.
So for us, the way that we're doing that is one value. Of course, we believe we have attractive, affordable benefits that members can Understand they have broad access through our wide network PPO and so again they can have the, they can see the providers that they want to see and it's experience right every single day you want to have, they want to have reliability in the customer service area and I think it's much more important than people think. So we have a continued focus on how do we continue to improve our experience and then clinical continuity. As members remain with us longer, care becomes more proactive and coordinated and we do that through our technology where we're reinforcing satisfaction and trust.
So for us as we continue to scale, execution is going to matter even more and we're going to continue this year to really focus on delivering excellent onboarding experience and we're also going to accelerate clinical activation for new members and we're going to do that through our deeper Clover Assistant engagement and provider integration.
[00:08:01] Speaker B: I'm so glad you brought that up, Jamie. I think the ability to scale and continue to maintain the quality and really kind of create that rich experience for your members is going to is so compelling and agree with you around people leaving the market and you guys continuing to have the success that you're having as you move forward.
I'd be a little remiss given you are a technology enabled organization to not kind of ask you a little bit about technology and AI enablement as we look at the industry and it's on the forefront of everybody's mind.
And given those unique capabilities of Clover, would you tell us a little bit more about sort of the technology enablement of CloverAssist and how it supports improving the patient outcomes and empowering clinicians and where you see AI kind of converging with the way that you're going to market and that you are really kind of engaging with your members.
[00:08:50] Speaker A: Yeah, I would love to talk about it. I think I would probably start off by saying I think the most important thing to understand is our Clover Assistant technology is not a pilot, it's not a proof of concept. It's actually a live production scale AI platform that we've been running inside a real Medicare Advantage plan for many years and it's being used by our primary care physicians across our wide network every single day.
What it does for us is it really brings together the entire healthcare ecosystem. It's bringing together a lot of data. It's bringing lab pharmacy claims, hospitalizations, ER visits, imaging specialist notes anywhere people are accessing healthcare and it's surfacing that data as actionable clinical insights at the point of care before a physician actually walks into the room to see a clover member. They can actually see the gaps, they can see any flags, they can see history that might otherwise be invisible to them. And what I think matters for the audience is our AI is clinician facing. So there's a lot of AI out there in healthcare that we hear about, but it's really aimed at consumers, which I think again is great. There's a role for that. But the clinical complexity of the Medicare population, seniors who are often having to manage 4, 5, 6 chronic conditions simultaneously, that's going to require a physician to have better information. And it's not going to be on an app, on someone's phone.
We're in the business of empowering the doctors and we believe that Clover assistant is how we can do that at scale.
[00:10:14] Speaker C: I'm going to pivot just a little bit and ask you a little bit
[00:10:16] Speaker A: more about your career.
[00:10:18] Speaker C: Jamie, how has your experience as a woman shaped your approach to leadership? Decisions you've made, for example, around payer operations, remember, outcomes.
[00:10:26] Speaker A: Can you give us an example?
Yeah, I would love to. It's a question that I have thought about a lot over my career because I think the honest answer is it actually shapes you in ways that you don't recognize when it's actually happening. So when you're in a room and you're the only woman or you're one of very few, you develop a certain kind of attention. You learn to listen differently. You also learn to be more precise with the words that you use because you know you're going to be held to a higher standard or rigor. I'm not sure that's necessarily fair, but I think it's made me a better operator.
So I would say probably a really good example that I could share is early on in my career, I noticed that when we were in rooms, the boardroom, or we were in large meetings, the way that we were talking about our members and how they actually experienced health care was different from those who were actually using it. And so I felt like the metrics that we were tracking didn't always match with what we were seeing. So if you think about a 72 year old woman who's in New Jersey and they're trying to navigate their healthcare, the question I kept asking is, but what does it look like from where they're sitting and how do we put ourselves in their shoes?
So I think that's a question that I continue to ask. And you want to make sure that again, we're building a system that is designed for those members and what they need and not necessarily from our perspective. And I would say at Clover, where that really shows up for us is in things like our home care program and we have our community pharmacy work that we do in New Jersey. So what we're saying is we're looking and seeing what does that support look like for those members in their actual life, in their actual community, and not just what looks good on a quality measure, but what is actually going to be meaningful to that member.
So from my perspective, I feel like you get better outcomes when your leadership style is actually built around the kind of genuine curiosity you have about the people you serve and not necessarily the metrics that you're measuring to.
[00:12:13] Speaker B: Yeah, I love that. I think the empathetic point of view and really kind of taking that to heart, to be able to serve your community is so important. It is so important as you kind of grow your career and, you know, you've had a remarkable career in healthcare, Jamie, and a tremendous impact in the healthcare market overall with everything you've been able to achieve and accomplish. Can you help give us a few pointers and thoughts and lessons from your journey that have kind of shaped your leadership philosophy as a CEO? And what's the best advice you've received along the way that you would share with others as they are up and coming female leaders in the industry?
[00:12:48] Speaker A: Yeah, I would love to. I would say the most important lesson I've learned is that operational detail is not beneath the strategy, but it really is the strategy in healthcare.
So the most expensive mistakes I've seen the industry make is when executives are just too far away from how that care is actually delivered. I've always myself, personally tried to stay very close to the operational reality.
So whether that's understanding how provider appeals get processed or how a member actually navigates their first year in a plan, that closeness is what's going to drive good decisions.
So in terms of advice that I could give to women who are upcoming in healthcare leadership, I think there's a couple of things.
First, find operators to learn from. So not just strategies. Don't go to somebody who's just a strategist at heart, but like somebody who can actually show you how things work on the ground and not just something in a bunch of slides. Actually get in there, roll up your sleeves and do the work.
Second, I would say, and this is probably the most important, don't wait for readiness. I've seen so many talented women over the years that continue to wait until they're fully prepared to take on a bigger role. And I think what you have to do is your preparation is going to come from doing the job. So really step into that stretch and figure it out, because I think that you're going to get the most benefit and value from doing that.
And I would say probably the best piece of advice I ever received, it was from a mentor early in my career that said, you know, your job is to make a decision, not find the right answer. Because I think in healthcare you have to understand, I think we all live this. You know, data is imperfect, situations are complex, but the stakes are real. So I think what we have to do is you have to learn to be confident. You have to make well reasoned decisions, even in uncertainty. And then what you need to do is just make sure that you can adjust when you learn more you, and that's really the core skill that you need. And I, you know, that is something that I do every single day and that's the lesson I continue to use in my career.
[00:14:39] Speaker C: I love this advice. Thank you so much, Jamie, and thanks for sharing your insights on the industry and your experiences in your career and for taking the time to speak with us today.
[00:14:48] Speaker A: I appreciate it. Thank you so much for this opportunity.
[00:14:51] Speaker B: Yeah, this is fantastic and definitely some great takeaways to everyone who joined us. Thank you for listening. For more information about A and M and to find more of our podcasts, please visit www.alvarezandmarsal.com healthcare. Thanks, Jamie. Thanks, Susan. It was great chatting with you.
[00:15:08] Speaker C: Thank you. Thank you.
[00:15:09] Speaker B: Have a good.
