Here’s the One Thing That Could Make or Break Clover Health Stock

After Clover Health (NASDAQ:CLOV) reported solid fourth-quarter 2021 results on Feb. 23, investors poured in and drove CLOV stock up 31%  before pulling back yesterday. 

Person holding smartphone with logo of healthcare company Clover Health (CLOV Stock) Investments Corp on screen in front of website
Source: Wirestock Creators /

What happened on Thursday to fuel an almost 14% — between regular hours and after-hours trading? Read on, and I’ll explain what that one thing could be.   

The Positives Behind CLOV Stock

As I said in the intro, Clover Health’s Q4 2021 results on the top line delivered very healthy growth. Revenue in the period increased 160% over last year to $432.0 million, with 2021 revenue up 119% to $1.47 billion. In 2022, it expects total revenue to be $3.2 billion at the midpoint of its guidance, 118% higher than in 2021. 

President Andrew Toy was excited about the future:

“In 2021, physicians responded to nearly one million Clover Assistant suggestions, and the Clover Assistant drove an improvement of more than 1,000 basis points in the MCRs for our Medicare Advantage members whose primary care providers used the Clover Assistant compared to members whose providers didn’t,” he was quoted in the company’s press release. 

Also contributing to the good cheer was a 124% increase in total lives under Clover Management in 2021 to 129,996. It expects this number to increase by 90% or more in 2022. 

That led to a normalized Medicare Advantage (MA)-to-Medical Care Ratio (MCR) of 94.5%, 140 basis points lower than 2020. It expects MA-MCR to fall some more in 2022 and 2023. 

However, the top line isn’t what bothers investors. It’s the fact that Toy and his team can’t make money. Its normalized adjusted earnings before interest, taxes, depreciation and amortization (EBITDA) in 2021 was minus $213.4 million, 51% worse than in 2020. 

On the plus side, Clover Health expects to reduce its adjusted operating expenses as a percentage of revenue by 700 basis points to 11% at the midpoint of its guidance from 18% in 2021. That should lower its normalized adjusted EBITDA in 2022.

Adding Growth Woes to Profitability Worries

Of the company’s $1.47 billion in revenue in 2021, its direct contracting business accounted for 45%. In 2022, it expects $2.15 billion in revenue from direct contracting, 222% higher than in 2021 and accounting for 67% of overall revenue for the year. 

Given the company’s not making money, it can’t afford to see any of this revenue disappear. Adding growth woes to profitability woes would be the kiss of death.

Annotated CLOV Stock Price Chart
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Source: Koyfin

On Feb. 24, the Centers for Medicare & Medicaid Services (CMS) announced that the Direct Contracting Model would remain, albeit in a redesigned format. The new model is called the Accountable Care Organization (ACO) Realizing Equity Access, and Community Health (REACH).              

“The Biden-Harris Administration remains committed to promoting value-based care that improves the health care experience of people with Medicare, Medicaid and Marketplace coverage,” said CMS Administrator Chiquita Brooks-LaSure. 

The ACO REACH will be test-run from Jan. 1, 2023 through the end of 2026

I’ve already seen several positive and negative responses from Wall Street. I think it’s too early to tell what this will mean for Clover Health and the rest of the companies operating a direct contracting model. As more information becomes available, investors will have an easier time deciding if the move by CMS is a good one for the company.

In the meantime, until Clover Health can demonstrate a pathway to profitability, the prospects of CLOV rising from penny-stock status seem remote. 

The Bottom Line on CLOV Stock

When I last wrote about Clover Health in December, I suggested that its share price had bottomed. CLOV stock was trading at $4 at the time. We know in hindsight that bottom wasn’t quite in.

Although I remain cautiously optimistic about its business, I don’t get a warm fuzzy feeling about the shares. I certainly wouldn’t be buying CLOV stock. However, should the company comment on the changes and what it means for its business going forward, I think the shackles could come off its share price. 

If you’re an aggressive investor, despite the 31% move over the past week, I’m not sure there’s a ton of downside at this point. The direct contracting model is sticking around. That’s all that matters.

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On the date of publication, Will Ashworth did not have (either directly or indirectly) any positions in the securities mentioned in this article. The opinions expressed in this article are those of the writer, subject to the Publishing Guidelines.

Will Ashworth has written about investments full-time since 2008. Publications where he’s appeared include InvestorPlace, The Motley Fool Canada, Investopedia, Kiplinger, and several others in both the U.S. and Canada. He particularly enjoys creating model portfolios that stand the test of time. He lives in Halifax, Nova Scotia.

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