Oscar Has Tough 3Q; Clover Reveals It Will Scale Back ACO REACH Business

Startup insurers that have gone public in recent years continued to lose money in the third quarter of 2022, although Oscar Health, Inc., Bright Health Group, Inc. and Clover Health Investments Corp. all varied in their performance on individual financial metrics. Perhaps the most notable part of the companies’ earnings conference calls, however, was executives’ discussion about decisions to pare down certain books of business amid profitability and execution struggles.

Clover Health executives, for example, revealed during their Nov. 7 conference call to discuss quarterly results that the firm plans to scale back its participation as a Direct Contracting Entity (DCE) in CMS’s Global and Professional Direct Contracting model. The program — which allows participants to share risk and receive capitated payments for serving fee-for-service Medicare beneficiaries — starting in January 2023 will transition into the revamped ACO Realizing Equity, Access, and Community Health (REACH) Model.

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