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Time Business News
06-07-2025
- Business
- Time Business News
Speculation Mounts Around Possible Clover Health
July 5, 2025 — New York — Talk of a potential partnership between Clover Health's AI division, Counterpart Health, and insurance giant Humana has gained traction after a string of digital breadcrumbs and recent corporate remarks ignited speculation throughout the healthcare and investment communities. While neither company has made a formal announcement, the circumstantial evidence has grown too aligned to ignore, hinting that Humana may be preparing to deploy Clover's AI platform across its vast Medicare Advantage operations. If true, the move could be a game-changer for both companies: a potential multi-billion-dollar opportunity for recently struggling Humana, and a defining moment in Clover Health's reinvention from insurance underdog to healthcare tech disruptor. The speculation began after Humana's June 16 investor meeting, during which executives outlined the company's path forward amid growing challenges. Humana has recently been under significant pressure due to declining Medicare Advantage Star Ratings, rising medical costs, and an increasingly complex regulatory environment. To address these headwinds, the company presented a long-term strategy focused on operational efficiency, automation, and simplification. Humana stated it would 'leverage outsourcing and technology to simplify and automate processes… while driving efficiencies'. What made the presentation even more notable was the timeline Humana laid out. The company projected a gradual improvement in cost efficiency – starting with baseline progress in 2026, and a full impact by 2028. That timeline is nearly identical to the three-year cost savings arc marketed by Counterpart Health, which claims its AI can reduce a payer's Medical Cost Ratio by 7% in year two and up to 15% by year three. While Humana did not mention specific partners, the language prompted the beginning of the speculation. The rumor mill kicked into high gear this week when a publicly available subdomain scan of Counterpart Health's website revealed a curious pattern. Alongside previously announced partners like Duke Connected Care, The Iowa Clinic, and Southern Illinois Healthcare, a number of new subdomains appeared bearing the Humana name. These backend URLs indicate that technical infrastructure might be under development to support a potential relationship between Counterpart and Humana. Notably, the same pattern of subdomains was observed prior to official announcements for Duke, Iowa Clinic, and Southern Illinois Healthcare, all of which later confirmed deals with Counterpart Health. While these web addresses alone don't confirm a deal, their presence strongly suggests that backend systems and integrations are potentially being developed in anticipation of one. Clover Health has touted its Counterpart Assistant platform as a game-changing clinical AI tool that can reduce a payer's Medical Cost Ratio by up to 15%. For context, Clover Health itself posted an MCR of 75.1% in 2024, one of the most efficient in the industry. Meanwhile, Humana has struggled with an increasing MCR due to a variety of headwinds. If Humana were to achieve even a fraction of the cost savings that Clover Health claims are possible, the financial impact could be enormous for the company – potentially saving billions annually. For Clover Health, such a partnership would represent a dramatic turning point. The company, which went public via SPAC in 2021, has spent years battling poor investor sentiment, regulatory scrutiny, and heavy skepticism over its long-term viability. Once seen as just another Medicare Advantage insurer, Clover has been actively repositioning itself around its AI platform, Counterpart Assistant – a tool designed to centralize patient data, assist physicians with real-time clinical insights, and reduce avoidable medical costs. The company attributes its own low MCR of 75.1% to this technology and has begun licensing it to external payers and provider groups under its Counterpart Health brand. A deal with Humana – one of the largest Medicare Advantage organizations in the country – would give Clover Health a level of validation it has never experienced. It would instantly elevate the perception of the company from a traditional insurer to a high-margin, health-AI disrupting SaaS. Investors would no longer value Clover based on insurance metrics, but rather on recurring software revenue, gross margins, and enterprise tech multiples. Although neither Humana nor Clover has commented publicly, and no regulatory filings have confirmed a formal agreement, the emerging pattern is increasingly difficult to ignore: a shared strategic direction, an almost identical cost-cutting timeline, and Humana's digital infrastructure woven into Counterpart Health's operations. If the partnership is ultimately validated, it could mark a major milestone for AI in healthcare – and potentially the long-awaited inflection point in the turnaround journeys of both Clover Health and Humana. TIME BUSINESS NEWS
Associated Press
09-04-2025
- Health
- Associated Press
NCQA Issues Health Care Recommendations for the Trump Administration
Proposal outlines vision for evolving the quality measurement ecosystem to support patient-centered, cost-effective, integrated care WASHINGTON, D.C., WASHINGTON, D.C. / ACCESS Newswire / April 9, 2025 / The National Committee for Quality Assurance (NCQA) today released recommendations for the Trump Administration and the 119th Congress to build a more transparent, integrated and interoperable health care system. The National Committee for Quality Assurance: Recommendations for the Trump Administration outlines a vision for evolving the current U.S. quality measurement ecosystem to support patient-driven, cost-effective, integrated care and highlights three key themes: alleviate chronic disease burden; create a digital health infrastructure to support health care innovation; and address the behavioral health crisis. 'For 35 years, NCQA has worked to improve health care quality through measurement, transparency, and accountability,' said NCQA President Margaret E. O'Kane. 'We believe that advancements in quality measurement, care integration and interoperability are needed to create a more efficient and accountable health care system and urge the new administration to prioritize innovative care and payment models that align incentives with improved patient outcomes.' Optimize Value-Based Care & Alternative Payment Models to Alleviate Chronic Disease The U.S. health care system is fragmented and difficult to navigate, making decision-making both time-consuming and expensive. This issue is pronounced for the 133 million Americans living with chronic disease. While digital health technologies have the potential to improve communication, coordination, and care management, without appropriate integration and standardization, care may become even more fragmented. To address these issues, NCQA recommends that the administration expands the U.S. Department of Health and Human Services (HHS) commitment to ensure that all Medicare beneficiaries are in value-based arrangements by 2030. Additionally, the Center for Medicare and Medicaid Innovation's (CMMI) new leadership create models that prioritize integration through technology and dynamic care plans, the Centers for Medicare and Medicaid Services (CMS) should introduce Medicare Advantage Star Ratings metrics that promotes standardized data exchange, and HHS should prioritize more effective use of patient-generated data, including person-reported outcomes measures. Create a Lasting Digital Health Infrastructure to Support Health Care Innovation While the availability of electronic health data has grown, the use and exchange of such data to foster health care innovation is impeded by misaligned policy incentives and payment programs. Stronger support from the administration, through government payment programs, can drive industry implementation, accelerate data exchange and stimulate innovation. To address these issues, NCQA recommends that HHS expedites adoption of a digital quality measures (dQM) reporting architecture, develops a comprehensive health care data quality framework that supports a digital health data exchange ecosystem, and accelerates alignment with the CMS Universal Foundation across HHS quality reporting and value-based payment programs. Address the Behavioral Health Crisis More than 20% of American adults live with mental illness, and recent estimates place the resulting economic strain at over $280 billion. To address this crisis, we must strengthen efforts by increasing funding for fundamental quality improvement, establish national standards, and advance technology. To address these issues, NCQA recommends that the administration work with Congress to incentivize behavioral health provider adoption of certified EHRs, expand access to medication for opioid use disorder as first-line, evidence-based treatment, and support states in evaluating prevention, treatment and recovery efforts through development, collection and reporting of opioid use disorder quality measures. Additionally, NCQA recommends that the administration instructs HHS to fund creation of a quality measures framework for substance use disorder care, require independent accreditation for SAMHSA's Certified Community Behavioral Health Centers certification, and urges the administration to collaborate with Congress to finalize policies that ensure telehealth and virtual care become permanent fixtures of American health care. 'The U.S. health care system faces numerous challenges including high costs, access to care, and varying degrees of quality of care,' said NCQA Vice President Federal Affairs Eric Musser. 'By leveraging NCQA's expertise, evidence-based practices, and resources, the new administration could make significant strides in addressing the systemic issues within the U.S. healthcare system, ultimately leading to a more efficient use of resources, and better health outcomes for all Americans. We look forward to working with the new administration to realize our common goals.' NCQA is eager to collaborate with the Trump administration as it drives innovation and works to create a more cohesive, less fragmented experience for all stakeholders across the American health care ecosystem. Read NCQA's complete recommendation to the Trump administration: NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA Accredits and Certifies a wide range of health care organizations. It also Recognizes clinicians and practices in key areas of performance. NCQA's Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. NCQA's website ( contains information to help consumers, employers and others make informed health care choices. NCQA can also be found at X @ncqa and on LinkedIn. # # #
