Core Insights - Clover Health Investments, Corp. reported a 53% year-over-year growth in Medicare Advantage (MA) PPO plans for the 2026 plan year, reaching approximately 153,000 members, indicating disciplined growth in core markets and strong retention [1][5] - The company anticipates achieving its first-ever full year GAAP Net Income profitability in 2026, driven by strong cohort economics and operational efficiencies [5][4] Key AEP and Business Highlights - Clover's AEP performance reflects the effectiveness of robust plan benefits, Clover Assistant-enabled clinical performance, and a deepening market presence, leading to market-leading growth [3][4] - The company maintained stable plan benefits year-over-year, achieving over 95% member retention during the AEP, reinforcing the stability of its membership base [5] - Over 97% of Clover's January 1, 2026 membership is in its flagship PPO plan, which is ranked 1 nationally on core HEDIS metrics for the second consecutive year, showcasing the company's commitment to clinical quality [4][5] Strategic Growth Initiatives - Clover's growth strategy focuses on concentrated efforts in established core markets, leveraging strong Clover Assistant coverage and a differentiated Home Care offering to enhance care delivery and improve cohort performance [5][4] - The company expects significant improvements in new member cohort performance, supported by a 4.0 Stars rating for its PPO plans, favorable CMS rate updates, and continued operational leverage as SG&A efficiency improves with scale [5][4]

Core Insights - Clover Health Investments, Corp. reported a 53% year-over-year growth in Medicare Advantage (MA) PPO plans for the 2026 plan year, reaching approximately 153,000 members, indicating disciplined growth in core markets and strong retention [1][4][5] - The company anticipates achieving its first-ever full year GAAP Net Income profitability in 2026, driven by strong cohort economics and operational efficiencies [5][4] Key AEP and Business Highlights - Clover's AEP performance reflects the successful integration of robust plan benefits, Clover Assistant-enabled clinical performance, and a deepening market presence, leading to market-leading growth [3][4] - The company maintained stable plan benefits year-over-year, achieving over 95% member retention during the AEP, which reinforces the stability of its membership base [5][4] - Over 97% of Clover's January 1, 2026 membership is in its flagship PPO plan, which is ranked 1 nationally on core HEDIS metrics for the second consecutive year, showcasing the company's commitment to clinical quality [4][5] Strategic Growth Initiatives - Clover's growth strategy focuses on concentrated growth in established core markets, leveraging strong Clover Assistant coverage and a differentiated Home Care offering to enhance member care [5][4] - The company expects significant improvements in new member cohort performance, supported by a 4.0 Stars rating for its PPO plans, favorable CMS rate updates, and continued operational leverage as SG&A efficiency improves with scale [5][4] - Clover aims to enhance Clover Assistant coverage and primary care provider (PCP) adoption to further drive member engagement and retention [5][4]

Core Insights - Counterpart Health, Inc. continues to demonstrate that unified data and real-time insights enhance clinical and financial outcomes for healthcare providers [1] Clinical Quality and Financial Performance Outcomes - In 2025, Counterpart released three new retrospective data analyses confirming the effectiveness of Counterpart Assistant (CA) in improving chronic disease management through real-world data [2] - The platform's impact is reflected in thousands of improved clinical decisions made during patient visits [2] Technological Innovation and Enterprise Scaling - Counterpart has evolved into an end-to-end clinical operating system for value-based care, expanding its support beyond the point of care to encompass the entire care continuum [3] Clinician Adoption - There was a greater than 450% year-over-year increase in live third-party customer clinicians, now numbering in the hundreds across multiple states [4] - Clover Health members whose primary care physicians use CA showed an approximate 1,500 basis point MCR differential compared to those whose PCPs do not [4] Quality Metrics - Counterpart's technology achieved the 1 HEDIS score nationwide for a PPO Medicare Advantage plan for the second consecutive year, across a wide network of non-employed physicians [4] Earlier Disease Identification - New members under the care of a CA PCP were 75% more likely to be diagnosed with COPD in their first year, with COPD patients having an 18% higher average number of outpatient pulmonology visits [5] - Relationships with CA PCPs were associated with an 18% lower rate of all-cause hospitalizations for Congestive Heart Failure and a 15% lower rate for COPD [5] Support for Disadvantaged Neighborhoods - In resource-constrained neighborhoods, CA attribution was linked to 70-89% higher diagnosis rates across four major chronic diseases, with earlier identification of patients [5] Integrated Ambient Scribing and Natural Language Chat - Counterpart offers a fully integrated solution that allows physicians to focus on patients while utilizing advanced technology for real-time visit documentation [6] - The platform includes next-generation capabilities for clinicians to inquire about patient medical histories in natural language, ensuring a PHI-safe environment [6] Vision for Value-Based Care - The CEO of Counterpart Health emphasized that better outcomes and lower costs stem from improved clinical decisions made during patient visits, aiming to set a new standard for care delivery [7] - The company envisions a future where numerous informed decisions lead to extraordinary outcomes for patients, clinicians, and communities [8] Company Overview - Counterpart Health, a subsidiary of Clover Health Investments, is an AI-powered physician enablement platform focused on transforming care delivery and improving patient outcomes while reducing healthcare costs [9]

Core Insights - Clover Health Investments (CLOV) is positioned for growth due to its diverse product offerings and technology-driven care model, evidenced by strong membership growth, increasing revenues, and sustained adjusted EBITDA profitability [2][3] - However, the company faces near-term challenges including high medical costs, margin pressure, and execution risks related to scaling its Clover Assistant platform [2] Financial Performance - CLOV shares have decreased by 12.5% over the past six months, while the industry has declined by 16.3%, and the S&P 500 has increased by 16.3% during the same period [3] - The company has a market capitalization of $1.36 billion and anticipates a 350% earnings decline for Q4 2025, with a return to growth expected in 2026 [3] - Earnings have surpassed estimates in two of the last four quarters, with an average surprise of 50% [4] Growth Drivers - Clover Assistant is a key component of the company's economic model, generating approximately $217 in contribution profit per member per month for returning members, compared to a loss of about $110 for first-year members [5] - The company achieved a 35% year-over-year membership growth and nearly 50% revenue growth in Q3 2025, maintaining a retention rate above 90% [7][9] - Management views 2025 as a transitional year, with 2026 expected to be an inflection point as a larger base of profitable returning members begins to dominate results [10] Strategic Initiatives - Counterpart Health represents a strategic extension of Clover Assistant, targeting smaller, independent physicians and presenting a "blue ocean" opportunity for revenue diversification [11] - The expansion of Counterpart's capabilities and resources has shown early traction with provider groups and payers, potentially evolving into a scalable revenue stream [12] Challenges - The company is experiencing near-term margin compression due to a higher-than-expected mix of first-year members, which carry elevated medical costs and marketing expenses [13] - Increased utilization across inpatient and outpatient services has impacted medical costs and margins, particularly in oncology, cardiac, and surgical procedures [15] - Clover received a 3.5-star rating for the 2026 payment year, falling short of its goal of achieving 4 stars, which limits near-term reimbursement upside [17][18] Estimate Trends - The Zacks Consensus Estimate for earnings has remained stable at 4 cents per share for 2025, with Q4 2025 revenue and loss per share estimates at $472.5 million and 5 cents, respectively [19]

Company Overview - Clover Health Investments, Corp. is a physician enablement technology company focused on providing access to quality healthcare for Medicare recipients, particularly seniors who have historically faced challenges in accessing affordable healthcare [2] - The company utilizes its software platform, Clover Assistant, to aggregate patient data across the healthcare ecosystem, supporting clinical decision-making and improving health outcomes through early identification and management of chronic diseases [2] - Clover Health offers PPO and HMO Medicare Advantage plans in multiple states, emphasizing its flagship wide-network, high-choice PPO plans [2] Technology and Impact - The technology platform has demonstrated positive impacts on various health metrics, including Medication Adherence, Congestive Heart Failure, Chronic Obstructive Pulmonary Disease, and outcomes in Underserved Populations [2] - The company aims to enhance patient outcomes and reduce healthcare costs on a nationwide scale through its subsidiary, Counterpart Health, which extends the benefits of its data-driven technology to a broader audience [2] Upcoming Events - The CEO of Clover Health, Andrew Toy, is scheduled to present at the J.P. Morgan 2026 Healthcare Conference on January 15, 2026, at 11:15 a.m. Eastern Time, with a live webcast available on the company's investor relations website [1]

Company Overview - Clover Health is a health care insurance plan focused on improving health care for seniors in Medicare Advantage through a differentiated vision and approach [2] - The company utilizes technology to enable earlier diagnosis and treatment of chronic diseases, aiming for better quality of care and health outcomes at a lower total cost [2] Technology and Innovation - Clover Health's software platform, powered by AI, allows physicians to perform at the top of their license, enhancing the overall care delivery process [3] - The technology has been developed over the last decade using large data sets and machine learning, resulting in dozens of patents related to its proprietary clinical platform [3] Market Potential - The Medicare Advantage market is substantial, exceeding $500 billion annually, with over 35 million seniors currently enrolled [3] - Clover Health primarily focuses on the PPO segment of Medicare Advantage, with nearly 100% of its members enrolled in PPO plans [4]

Core Viewpoint - Clover Health Investments reported a mixed earnings performance for Q3 2025, with revenues increasing significantly but missing earnings expectations, leading to a decline in stock price [2][3][10]. Financial Performance - Clover Health reported adjusted quarterly earnings per share (EPS) of break-even, missing the Zacks Consensus Estimate of 2 cents, compared to an adjusted loss of 2 cents in the same period last year [2]. - Revenues for the quarter reached $496.7 million, reflecting a year-over-year increase of 50.1% and surpassing the Zacks Consensus Estimate by 4.5% [3]. - Insurance revenues totaled $479.1 million, up 48.5% year over year, driven by a 35% increase in Medicare Advantage membership and strong member retention [4]. Expense and Loss Analysis - The Insurance Benefit Expense Ratio (BER) was reported at 92.4%, up from 85.4% in the previous year, attributed to new-member growth and increased medical utilization [5]. - Net medical claims rose 70.5% year over year to $428.9 million, while total operating expenses increased by 53.3% to $521 million [7]. Financial Position - At the end of Q3 2025, Clover Health had cash and cash equivalents of $190.1 million, slightly up from $188.6 million at the end of the previous quarter [8]. - Net cash provided by operating activities from continuing operations was $1.2 million, a significant decrease from $129.5 million a year ago [8]. Guidance and Outlook - The company raised its sales outlook for 2025, estimating Insurance revenues between $1.85 billion and $1.88 billion, indicating a 39% year-over-year growth at the midpoint [10]. - Adjusted Net Income guidance was lowered to a range of $15 million to $30 million, down from a previous estimate of $50 million to $70 million [10]. - The Insurance BER projection was raised to 90-91%, and average Medicare Advantage membership is expected to grow by 33% year over year [11]. Market Position and Comparisons - Clover Health has a Zacks Rank of 3 (Hold), indicating an expectation of in-line returns in the coming months [14]. - In comparison, Omnicell, a peer in the Medical Info Systems industry, has seen a stock gain of 13.3% over the past month, highlighting a contrasting performance within the sector [15].

Financial Data and Key Metrics Changes - Clover Health reported a year-to-date membership growth of 33% as of September 30, 2025, with an adjusted EBITDA of $45 million, which is exceptional given the typical loss-making nature of new membership growth [4][8] - The company has improved its selling, general, and administrative (SG&A) expenses as a percentage of revenue by 370 basis points [15] - The normalized year-to-year cost trend, excluding pharmacy, is approximately 4%, while the company is growing membership by 35% [15][47] Business Line Data and Key Metrics Changes - The company focuses on the PPO side of Medicare Advantage, with nearly 100% of its members enrolled in PPO plans, allowing for greater freedom of choice in healthcare providers [3][5] - The contribution profit per member per month for new members is approximately $110, while returning members generate about $217 PMPM [19][53] Market Data and Key Metrics Changes - The Medicare Advantage market is valued at over $500 billion annually, with over 35 million seniors currently enrolled [3] - Clover Health's primary markets are New Jersey and Georgia, where it has a strong membership base and physician network [4][65] Company Strategy and Development Direction - Clover Health aims to leverage its proprietary AI-powered software platform, Clover Assistant, to improve healthcare outcomes and reduce costs by enabling earlier diagnosis and treatment of chronic diseases [2][12] - The company is focusing on priority markets with existing member bases and physician networks to manage growth effectively [4][17] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in achieving GAAP net income profitability for fiscal 2026, driven by strong voluntary member retention and improved financial performance from returning members [16][74] - The company anticipates a four-star rating for its Medicare Advantage plans in the upcoming year, which would provide a financial boost [42][74] Other Important Information - Clover Health has developed a strong home care business unit that focuses on high-acuity patients, differentiating itself from traditional nurse-led home care models [8] - The company is in a growth phase for its Counterpart Health offering, which targets third-party payers and risk-based providers [14] Q&A Session Summary Question: How does the improvement in medical cost ratio (MCR) relate to the entire population versus Clover Assistant users? - The improvement includes the total population, but the impact for Clover Assistant users is expected to be higher [23] Question: What percentage of members are treated with Clover Assistant after year one? - Approximately two-thirds to 70% of the total membership base receives care under Clover Assistant technology [24] Question: How is Clover Assistant differentiated in its AI scribing capabilities? - The scribing capability is fully integrated into Clover Assistant, reducing administrative loads for physicians [28] Question: What headwinds does the company foresee for the upcoming year? - The company is closely monitoring cost trends, which are currently at 4%, compared to 7.5%-8% for larger managed care organizations [46][47] Question: What initiatives are being taken to improve Part D performance? - The company is working with its PBM to enhance performance and is integrating Part D into Clover Assistant for better medication management [50][52]

Financial Data and Key Metrics Changes - The company reported a 33% year-to-date growth in membership as of September 30, 2025, which is exceptional in the Medicare Advantage (MA) market [4][8] - Adjusted EBITDA for the year-to-date is $45 million, which is notable given the new membership growth typically incurs losses in the first year [4][8] - The company has reduced Selling, General and Administrative (SG&A) expenses as a percentage of revenue by 370 basis points [15] Business Line Data and Key Metrics Changes - The company focuses on the PPO side of Medicare Advantage, with nearly 100% of members enrolled in PPO plans, allowing freedom of choice for physicians and providers [3][5] - The company has a strong home care business unit that provides care for high-acuity patients, utilizing the same proprietary software for disease management [7][8] Market Data and Key Metrics Changes - The Medicare Advantage market is valued at over $500 billion annually, with more than 35 million seniors currently enrolled [3] - The company is primarily focused on its core markets of New Jersey and Georgia, where it has a significant member base and physician network [4][17] Company Strategy and Development Direction - The company aims to achieve GAAP net income profitability for fiscal 2026, driven by high member retention rates and improved financial performance from returning members [16][20] - The company is strategically managing growth by focusing on priority markets with existing member bases and physician networks [17][37] - The company plans to enhance its technology platform, Clover Assistant, to further improve care quality and operational efficiency [20][26] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in continued growth, citing a strong voluntary member retention rate of over 90%, which is likely the highest in the industry [16][20] - The company anticipates a favorable macroeconomic environment for 2026 and 2027, with expected improvements in profitability and cash flow [29][30] Other Important Information - The company has developed proprietary technology over the last decade, which is integral to its operations and differentiates it from traditional players in the market [2][6] - The company is experiencing strong interest from third-party payers and risk-based providers for its software platform, indicating a robust pipeline for future growth [14][26] Q&A Session Summary Question: How does the improvement in medical cost ratio (MCR) include the entire population? - The improvement in MCR is based on the total population, but the impact for Clover Assistant members is expected to be higher [23] Question: What percentage of members are treated with Clover Assistant after year one? - Approximately two-thirds to 70% of the total membership base receives care under Clover Assistant technology [24] Question: What differentiates Clover's AI scribing capabilities? - The integration of AI scribing into Clover Assistant reduces administrative burdens for physicians, allowing them to focus on clinical activities [25] Question: What prevents larger managed care plans from replicating Clover's model? - The company's unique vision, culture, and decade-long development of technology create a defensive mode against larger competitors [26] Question: How does Clover balance growth and profitability? - The company focuses on priority markets with existing strong membership bases and uses targeted marketing strategies to manage growth effectively [36][37]

Financial Performance & Growth - Clover Health achieved Adjusted EBITDA profitability in 2025 and anticipates GAAP Net income in FY26[9, 25] - The company experienced a +33% year-over-year increase in Medicare Advantage (MA) membership[9] - Clover Health's Insurance revenue grew by +39% year-over-year in 3Q YTD[26] - Adjusted SG&A as a percentage of total revenues improved by 370 bps year-over-year in 3Q YTD[23] Clover Assistant & Clinical Outcomes - Clover Assistant is correlated with ~36 months earlier diagnosis & treatment for diabetes on average[18] - Clover Assistant is correlated with ~18 months earlier diagnosis of Chronic Kidney Disease (CKD) stage 3 & higher on average[18] - Clover Assistant is correlated with 18% lower all-cause hospitalizations & 25% lower 30-day readmissions for Congestive Heart Failure (CHF)[18] Market Positioning & Strategy - Clover Health is targeting a ~$500 billion market with >35 million seniors in Medicare Advantage (MA)[9] - The company's PPO-first approach covers 97% of its membership[9] - Clover Health's Medicare Advantage PPO plans received a score of 472 out of 5 Stars on HEDIS Measures for Star Rating Year 2026[51]