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Clover Health leverages precision prescribing in new in-home primary care program

Medicare Advantage insurer Clover paired its data and care management with YouScript's genomic testing to reduce adverse drug interactions.

Susan Morse, Managing Editor

Clover Health has launched an in-home primary care program using YouScript's drug-gene testing to reduce the adverse effects of medications among its Medicare Advantage members. 

The new initiative comes as the broader field of precision medicine gains momentum. The overall market, in fact, is predicted to reach $141.7 billion by 2026, according to a recent report by BIS Research. And Intermountain said on Monday that its Precision Genomics Core Laboratory is expanding its RxMatch pharmacogenomics service and making it available to all of its providers. 

Clover Health, for its part, said that resulting reduction in hospital admissions is expected to significantly lower costs among a population that has a high incidence of adverse drug interactions. Five percent of Medicare beneficiaries drive more than 40 percent of hospital admissions and readmissions, and account for 42 percent of the program's costs, according to a released statement from the companies. 

Clover Health will perform voluntary pharmacogenomic, or drug-gene testing of its Medicare beneficiaries in the in-home program to determine the potential risk of a prescription. The testing looks for variants in the genes that may determine whether a medication would be an effective treatment, or would result in an adverse reaction.

Enrollment in the home-based primary care program is voluntary and is available at no cost. 

Clover's physician-led care team of primary care physicians, nurses, social workers, medical assistants and care coordinators are assigned a small panel of members and are exclusive to Clover, which allows them to see each member in the program multiple times a month.

Members benefit from regularly scheduled personal check-ins, active monitoring, and home-based lab and radiology testing. Care teams understand each member's social context and medical needs to help physicians provide direct interventions. 

Clover also collaborates with its in-network physicians to determine which members are best suited for the in-home primary care program.

"We are constantly identifying new ways to improve member outcomes using new data streams and advanced models of care," said Vivek Garipalli, Clover co-founder and CEO. "Our in-home care program combines our expertise as a data and technology company with our ongoing joint desire to bring access and care directly to those most in need."

The partnership combines San Francisco-based Clover Health's data and analytics technology platform with the medication therapy management of YouScript in Seattle, Washington. 

Clover has enrolled approximately 500 members in its in-home care program in New Jersey and will be scaling this model to meet the needs of its members wherever Clover is available.

Clover Health's structure is heavily dependant on information technology to manage population health. With this data, it's possible to manage a diverse population, drive improved outcomes and lower the cost of plans while making a larger margin than the competition.

Garipalli based his company solely on Medicare Advantage plans. 

"Ninety-three percent of costs Medicare Advantage are driven by comorbid conditions," Garipalli said in a 2016 interview. "The return on investment is helping patients with chronic diseases get better. It allows you to take savings and lower costs for the following year to grow more market share."

YouScript has 15 years of technology development experience behind its precision prescribing and clinical decision support tool. The company was founded in 2016 in a spin-off from Genelex Labs.

"YouScript's technology simulates a team of clinical pharmacists delivering evidence-based guidance in real time, and this in-home program validates our impact at scale," said YouScript CEO Kristine Ashcraft. "We are excited to work with Clover Health, to provide the tools necessary to identify and positively impact the most at-risk patients, while bending the healthcare cost curve."

Twitter: @SusanJMorse
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