Clover Health, New Jersey

[rhcbp]

Anyone know how they did enrollment wise in AEP?

I did not carry them this year, the plan seemed too good to be true.

 

[enyce]

I was not very excited on this plan, Since it indeed seems too good to be true, However my business this aep was 50/50 with United Healthcare and Clover.

As long as the plan stays true to its claims and I get my prompt commission then all is good.

What I hated about this plan was that apparently their captive agents were trained to enroll SNP recipients to their PREMIER PPO plan, Which is very misleading. Why enroll those people to a plan with hospital and presciption co-payments? Or am I missing something here... (Upon meeting many of them I immediately enrolled them to United Dual SNP which benefited them adequately)

 

[rhcbp]

Seeing as Clover does not have a Medicaid contract in NJ, selling duals their Premier plan is going to blow up in their face. The State of NJ is not going to be happy that their is no coordination of benefits.

CMS has already told them that every doctor that accepts Medicare does not have to accept their plan and to retrain their agents not to say that.

I am sure CMS is looking into Clover very closely and it is my understanding Clover is worried about being shut down.

As far as your commissions go, I am sure you would eventually get them but I do not think they are going to be timely. Put yourself in Ritter's position. How is he going to pay all these brokers in February and then if they dis-enroll he has to track down the brokers to get his money back.

I also heard that all of the Clover new enrollees are going to be getting a letter from CMS, that is never a good sign.

 

[craig_ritter]

Seeing as Clover does not have a Medicaid contract in NJ, selling duals their Premier plan is going to blow up in their face. The State of NJ is not going to be happy that their is no coordination of benefits.

CMS has already told them that every doctor that accepts Medicare does not have to accept their plan and to retrain their agents not to say that.

I am sure CMS is looking into Clover very closely and it is my understanding Clover is worried about being shut down.

As far as your commissions go, I am sure you would eventually get them but I do not think they are going to be timely. Put yourself in Ritter's position. How is he going to pay all these brokers in February and then if they dis-enroll he has to track down the brokers to get his money back.

I also heard that all of the Clover new enrollees are going to be getting a letter from CMS, that is never a good sign.

I'll weigh in on a few things. First, the situation with the out of network benefit and second why I'm working with Clover and, finally, the commission issue.

Regarding OON, I had an issue with their position that OON Docs must treat their members. I communicated this with them before AEP when the trainings first started. They had a couple CMS-approved pieces on this that made that claim. I'm not sure how/why they got approved, but they did. Anyway, now CMS has clarified and Clover will be cooperating fully with CMS and will be communicating the members and brokers that OON docs can treat but may refuse to treat their members.

I began working with Clover 18 months ago. I do both FMO-type services and TPA-type services and Clover (like many smaller plans) needed some expertise around external agent distribution services (they already had a strong broker channel), so that's how I initially got involved.

The entire MA market is moving toward narrow network gatekeeper HMO plans to control costs due to the cuts in reimbursements. Clover is taking a different approach in trying to give very broad access to care and using their technology to control costs through active member engagement. They tend to service a lower income population with a lot of LIS and PAAD members. They've brought on some notable investors recently with technology backgrounds.

Their early results are promising, but they have a lot of work to do. They need to get through this and then focus on their member service.

Regarding commissions, I met with them last week to discuss the AEP payment and, of course, this CMS issue came up. I understand that there may be cancellations and potential charge backs. Clover committed to pay me on AEP business by 1/31 and I intend to make the full payment to brokers within a few days of receipt of their commission file.

While it's possible that a small minority of brokers could have a negative balance, I just can't see punishing the vast majority of honest brokers by not paying them 100% of what is due them.

Regarding enrolling dual eligibles in their plans, I think it's a bad idea. Because of this, I monitor the broker side of the business. If we find agents enrolling a significant percentage of duals, we have a conversation with them because it's in no one's interest to have coordination issues down the road (plus there are better options out there). Overall, the external agents have enrolled a very insignificant number of duals, so they are clearly doing the right thing in this regard. I only have visibility to the external force, of course.