CLOVER HEALTH INVESTMENTS, CORP. /DE – 10-Q – Management's Discussion and Analysis of Financial Condition and Results of Operations
The following discussion and analysis provides information that management believes is relevant to an assessment and understanding of our consolidated results of operations and financial condition. The discussion should be read in conjunction with the unaudited condensed consolidated financial statements and notes thereto for the three and nine months endedSeptember 30, 2022 , contained in this Quarterly Report on Form 10-Q (the "Form 10-Q") and the consolidated financial statements and notes thereto for the year endedDecember 31, 2021 , contained in the Company's Annual Report on Form 10-K for the year endedDecember 31, 2021 , filed with theSecurities and Exchange Commission (the "SEC") onFebruary 28, 2022 (the "2021 Form 10-K"). This discussion contains forward-looking statements and involves numerous risks and uncertainties, including, but not limited to, those described in the "Risk Factors" section of the 2021 Form 10-K. Actual results may differ materially from those contained in any forward-looking statements. See "Cautionary Note Regarding Forward-Looking Statements" for additional information. Unless the context otherwise requires, references in this "Management's Discussion and Analysis of Financial Condition and Results of Operations" to "we," "us," "our," "Clover," "Clover Health ," and the "Company" mean the business and operations ofClover Health Investments, Corp. and its consolidated subsidiaries.
Overview
AtClover Health , we are singularly focused on creating great, sustainable healthcare to improve every life. We have centered our strategy on building and deploying technology that we believe will enable us to solve a significant data problem while avoiding the limitations of legacy approaches. By empowering physicians with access to data-driven, personalized insights at the point of care through our software platform, Clover Assistant, we believe we can improve clinical decision making. We operatePreferred Provider Organization ("PPO") andHealth Maintenance Organization ("HMO") Medicare Advantage ("MA") plans for Medicare-eligible consumers. We aim to provide great, affordable healthcare for all. We offer most members in our MA plans (the "members") among the lowest average out-of-pocket costs for primary care provider co-pays, specialist co-pays, drug deductibles and drug costs in their markets. We deeply believe in providing our members provider choice, and we consider our PPO plan to be our flagship insurance plan. An important feature of our MA product is wide network access. We believe the use of Clover Assistant and related data insights allows us to improve clinical decision-making through a highly scalable asset-light approach. As ofSeptember 30, 2022 , we operated our MA plans in nine states and 209 counties, with 88,136 members. OnApril 1, 2021 , our subsidiary,Clover Health Partners, LLC ("Health Partners "), began participating as a Direct Contracting Entity ("DCE") in the Global and Professional Direct Contracting Model ("DC Model") of theCenters for Medicare and Medicaid Services ("CMS"), which will transition to the Accountable Care Organization Realizing Equity, Access, and Community Health Model ("ACO Reach") in 2023. Our DCE assumes full risk (i.e., 100.0% shared savings and shared losses) for the total cost of care of aligned Original Medicare beneficiaries (the "Non-Insurance Beneficiaries" and, collectively with the members, "Lives under Clover Management" or the "beneficiaries"). Through ourDirect Contracting operations, we focus on leveraging our technology platform, Clover Assistant, to enhance healthcare delivery, reduce expenditures, and improve care for our Non-Insurance Beneficiaries. As ofSeptember 30, 2022 , we had approximately 1,555 contracted participating providers who manage primary care for our Non-Insurance Beneficiaries. Additionally, as ofSeptember 30, 2022 , we had approximately 1,630 preferred providers and preferred facilities in our DCE network. In connection with the 2023 performance year, we plan to strategically reduce the number of ACO REACH participating physicians, which we expect will result in a shift in our beneficiary alignment. Our participation in the DC Model has enabled us to move beyond the MA market and target the Medicare fee-for-service ("FFS") market, which is the largest segment of Medicare. We believe that expanding into the FFS market is not only a strategic milestone for Clover but also demonstrates the scalability of Clover Assistant.
As of
Lives under Clover Management, which included 88,136 Insurance members and
166,432 aligned Non-Insurance Beneficiaries.
Recent Developments
Geographic Expansion
OnJuly 14, 2022 , we announced plans to make our MA plans available in 13 new counties beginning in 2023. The expansion, which is subject to CMS approval, would make our MA plans available in a total of 220 counties across eight states.
Impact of COVID-19
The societal and economic impact of the Coronavirus Disease 2019 ("COVID-19")
pandemic and its variants continues to evolve, and the ultimate impact on our
business, results of operations, financial condition, and cash flows is
uncertain and difficult to predict. The global pandemic has severely impacted
businesses worldwide, including many in the health insurance sector.
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We are continuing to monitor the ongoing financial impact of COVID-19 on our
business and operations and are making adjustments accordingly. A large portion
of our membership is elderly and generally in the high-risk category for
COVID-19, and we have worked closely with our network of providers to ensure
that members are receiving necessary care. During the first three quarters of
2022 and all of 2021, we incurred elevated costs as compared to prior to the
outbreak of the pandemic in 2020 to care for those members who have contracted
the virus, and indirect costs attributable to the COVID-19 pandemic were
elevated as well, as deferral of services and increased costs related to
conditions that were exacerbated by a lack of diagnoses and treatment in the
earlier periods of the pandemic contributed to increased utilization.
Additionally, CMS is currently increasing inpatient hospital fees by 20.0% for
any patient diagnosed with COVID-19 regardless of whether that patient was
admitted directly for COVID-19 or for a different condition or procedure. We
will continue to monitor the pandemic's emerging treatment-related trends as
well as the impact on our beneficiaries. Additionally, CMS risk adjustment
requires that a member's health issues be documented annually regardless of the
permanence of the underlying causes. Historically, this documentation was
required to be completed during an in-person visit with a patient. As part of
relief measures adopted pursuant to the Coronavirus Aid, Relief, and Economic
Security Act (the "CARES Act"), CMS is allowing documentation prepared during
video visits with patients to serve as support for CMS risk adjustments. Due to
fewer visits in 2020, the providers' ability to document health conditions
accurately and formulate treatment plans was adversely impacted due to COVID-19.
However, we experienced improvements in documentation in 2021 with increased
utilization of health services, impacting our 2022 risk score. We believe that
this increase in documentation has supported our provider partners with better
diagnosis accuracy and improved care planning and that this will result in
increased revenue and a reduced medical care ratio ("MCR").
Key Performance Measures of Our Operating Segments
Operating Segments
We manage our operations based on two reportable operating segments: Insurance andNon-Insurance . Through our Insurance segment, we provide PPO and HMO plans to Medicare Advantage members in several states. OurNon-Insurance segment consists of our operations in connection with our participation in theDirect Contracting program, which will transition to the ACO Reach model in 2023. All other clinical services and all corporate overhead not included in the reportable segments are included within Corporate/Other. These segment groupings are consistent with the information used by our Chief Executive Officer, our chief operating decision maker, to assess performance and allocate resources. We review several key performance measures, discussed below, to evaluate our business and results, measure performance, identify trends, formulate plans, and make strategic decisions. We believe that the presentation of such metrics is useful to management and counterparties to model the performance of healthcare companies such as Clover. Insurance segment
Through our Insurance segment, we provide PPO and HMO plans to members in
several states. We seek to improve care and lower costs for our Insurance
members by empowering providers with data-driven, personalized insights at the
point of care through our software platform, Clover Assistant.
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Nine Months Ended September 30, 2022 2021
Total PMPM (1) Total PMPM (1)
(Premium and expense amounts in thousands, except PMPM amounts)
Insurance members as of period end (#) 88,136 N/A 67,281 N/A
Premiums earned, gross $ 814,920 $ 1,050 $ 598,760 $ 1,000
Premiums earned, net 814,566 1,049 598,390 999
Insurance medical claim expense incurred,
gross 747,250 962 641,300 1,071
Insurance net medical claims incurred 746,612 962 640,624 1,069
Medical care ratio, gross (2) 91.7 % N/A 107.1 % N/A
Medical care ratio, net 91.7 N/A 107.1 N/A
(1) Calculated per member per month ("PMPM") figures are based on the applicable
amount divided by member months in the given period. Member months represents
the number of months members are enrolled in a Clover Health plan in the period.
(2) Defined as Insurance gross medical claims incurred divided by premiums
earned, gross.
Membership and associated premiums earned and medical claim expenses.
We define new and returning members on a calendar year basis. Any member who is active onJuly 1 of a given year is considered a returning member in the following year. Any member who joins a Clover plan afterJuly 1 in a given year is considered a new member for the entirety of the following calendar year. We view our number of members and associated PMPM premiums earned and medical claim expenses, in the aggregate and on a PMPM basis, as important metrics to assess our financial performance because member growth aligns with our mission, drives our total revenues, expands brand awareness, deepens our market penetration, creates additional opportunities to inform our data-driven insights to improve care and decrease medical claim expenses, and generates additional data to continue to improve the functioning of Clover Assistant. Among other things, the longer a member is enrolled in one of our Insurance plans, the more data we collect and synthesize and the more actionable insights we generate. We believe these data-driven insights lead to better care delivery as well as improved identification and documentation of members' chronic conditions, helping to lower PMPM medical claim expenses.
Premiums earned, gross.
Premiums earned, gross is the amount received, or to be received, for insurance policies written by us during a specific period of time without reduction for premiums ceded to reinsurance. We believe premiums earned, gross provides useful insight into the gross economic benefit generated by our business operations and allows us to evaluate our underwriting performance without regard to changes in our underlying reinsurance structure. Premiums earned, gross excludes the effects of premiums ceded to reinsurers, and therefore should not be used as a substitute for premiums earned, net, total revenue or any other measure presented in accordance with generally accepted accounting principles inthe United States ("GAAP"). Premiums earned, net. Premiums earned, net represents the earned portion of our premiums earned, gross, less the earned portion that is ceded to third-party reinsurers under our reinsurance agreements. Premiums are earned in the period in which members are entitled to receive services, and are net of estimated uncollectible amounts, retroactive membership adjustments, and any adjustments to recognize rebates under the minimum benefit ratios required under the Patient Protection and Affordable Care Act. Premiums earned, gross is the amount received, or to be received, for insurance policies written by us during a specific period of time without reduction for premiums ceded to reinsurance. We earn premiums through our plans offered under contracts with CMS. We receive premiums from CMS on a monthly basis based on our actuarial bid and the risk-adjustment model used by CMS. Premiums anticipated to be received within twelve months based on the documented diagnostic criteria of our members are estimated and included in revenue for the period including the member months for which the payment is designated by CMS. Premiums ceded is the amount of premiums earned, gross ceded to reinsurers. From time to time, we enter into reinsurance contracts to limit our exposure to potential losses as well as to provide additional capacity for growth. Under these agreements, the "reinsurer," agrees to cover a portion of the claims of another insurer, i.e., us, the "primary insurer," in return for a portion of their premium. Ceded earned premiums are earned over the reinsurance contract period in proportion to the period of risk covered. The volume of our ceded earned premium is impacted by the level of our premiums earned, gross and any decision we make to adjust our reinsurance agreements. 35 --------------------------------------------------------------------------------
Insurance gross medical claims incurred.
Insurance gross medical claims incurred reflects claims incurred excluding amounts ceded to reinsurers and the costs associated with processing those claims. We believe gross medical claims incurred provides useful insight into the gross medical expense incurred by members and allows us to evaluate our underwriting performance without regard to changes in our underlying reinsurance structure. Insurance gross medical claims incurred excludes the effects of medical claims and associated costs ceded to reinsurers, and therefore should not be used as a substitute for net claims incurred, total expenses or any other measure presented in accordance with GAAP.
Insurance net medical claims incurred.
Insurance net medical claims incurred are our medical expenses and consists of the costs of claims, including the costs incurred for claims net of amounts ceded to reinsurers. We enter into reinsurance contracts to limit our exposure to potential catastrophic losses. These expenses generally vary based on the total number of members and their utilization rate of our services.
Medical care ratio, gross and net.
We calculate our MCR by dividing total Insurance medical claim expenses incurred by premiums earned, in each case on a gross or net basis, as the case may be, in a given period. We believe our MCR is an indicator of our gross margin for our Insurance plans and the ability of our Clover Assistant platform to capture and analyze data over time to generate actionable insights for returning members to improve care and reduce medical expenses.
OurNon-Insurance segment consists of operations in connection with our participation in theDirect Contracting program, which we began inApril 2021 and which will transition to the ACO Reach model in 2023. As part of ourNon-Insurance operations, we empower providers with Clover Assistant and offer a variety of programs aimed at reducing expenditures and preserving or enhancing the quality of care for our Non-Insurance Beneficiaries. Nine months ended September 30, 2022 2022 2021 Total PBPM Total PBPM (Revenue and claims amounts in thousands, except PBPM amounts) Non-Insurance Beneficiaries as of period end (#) 166,432 N/A 61,818 N/A Non-Insurance revenue$ 1,757,579 $ 1,148 $ 439,020 $ 1,175 Non-Insurance net medical claims incurred 1,815,771 1,186 469,972 1,258 Non-Insurance MCR (1) 103.3 % N/A 107.1 % N/A
(1) Defined as
Non-Insurance Beneficiaries.
A Non-Insurance Beneficiary is defined as an eligible Original Medicare covered life that has been aligned to our DCE,Health Partners , via attribution to a DCE-participating provider through alignment based on claims data or by beneficiary election through voluntary alignment. A beneficiary alignment is effective as of the first of the month, for the full calendar month, regardless of whether eligibility is lost during the course of the month.
Non-Insurance revenue represents CMS' total expense incurred for medical services provided on behalf of Non-Insurance Beneficiaries during months in which they were alignment eligible during the performance year.Non-Insurance revenue is calculated by taking the sum of the capitation payments made to us for services within the scope of our capitation arrangement and FFS payments made to providers directly from CMS.Non-Insurance revenue is also known in the DC Model as performance year expenditures and is the primary component used to calculate shared savings or shared loss versus the performance year benchmark.Non-Insurance revenue includes a direct reduction or increase of shared savings or loss, as applicable. Premiums and recoupments incurred in direct relation to the DC Model are recognized as a reduction or increase inNon-Insurance revenue, as applicable. We believeNon-Insurance revenue provides useful insight into the gross economic benefit generated by our business operations and allows us to evaluate our performance without regard to changes in our underlying reinsurance structure. 36 --------------------------------------------------------------------------------
Non-Insurance net medical claims incurred consists of the total incurred expense that CMS and we will remit for medical services provided on behalf of Non-Insurance Beneficiaries during the months in which they are alignment eligible and aligned to the DCE. Additionally,Non-Insurance net medical claims incurred is inclusive of fees paid to providers for Clover Assistant usage, care coordination, and any shared savings or shared loss agreements with providers.
Non-Insurance MCR.
We calculate our MCR by dividingNon-Insurance net medical claims incurred byNon-Insurance revenue in a given period. We believe our MCR is an indicator of our gross profitability and the ability to capture and analyze data over time to generate actionable insights for returning beneficiaries to improve care and reduce medical expenses. Results of Operations
Comparison of the Three Months Ended
The following table summarizes our condensed consolidated results of operations for the three months endedSeptember 30, 2022 and 2021. The period-to-period comparison of results is not necessarily indicative of results for future periods. Three Months Ended Change between September 30, 2022 and 2021 2022 2021 ($) (%) (in thousands) Revenues Premiums earned, net (Net of ceded premiums of$116 and$120 for the three months ended September 30, 2022 and 2021, respectively)$ 267,892 $ 203,657 $ 64,235 31.5 % Non-Insurance revenue 585,311 222,647 362,664 162.9 Other income 3,614 859 2,755 320.7 Total revenues 856,817 427,163 429,654 100.6 Operating expenses Net medical claims incurred 839,799 436,325 403,474 92.5 Salaries and benefits 70,142 73,364 (3,222) (4.4) General and administrative expenses 47,832 45,846 1,986 4.3 Premium deficiency reserve (benefit) expense (27,657) 20,761 (48,418) 233.2 Depreciation and amortization 616 120 496 413.3 Total operating expenses 930,732 576,416 354,316 61.5 Loss from operations (73,915) (149,253) 75,338 (50.5) Change in fair value of warrants payable - (115,152) 115,152 * Interest expense 404 404 - - Amortization of notes and securities discount 9 22 (13) (59.1) Loss on investment 980 - 980 * Net loss$ (75,308) $ (34,527) $ (40,781) 118.1 % * Not presented because the current or prior period amount is zero or the amount for the line item changed from a gain to a loss (or vice versa) and thus yields a result that is not meaningful.
Premiums Earned, Net
Premiums earned, net increased$64.2 million , or 31.5%, to$267.9 million for the three months endedSeptember 30, 2022 , compared to the three months endedSeptember 30, 2021 . The increase was primarily due to a 31.0% increase in the number of our Insurance members, from 67,281 atSeptember 30, 2021 , to 88,136 atSeptember 30, 2022 . Risk adjustment revenue of$10.5 million was recognized during the three months endedSeptember 30, 2022 . 37 --------------------------------------------------------------------------------
Non-Insurance Revenue
OurNon-Insurance revenue was$585.3 million for the three months endedSeptember 30, 2022 , up$362.7 million compared to$222.6 million for the three months endedSeptember 30, 2021 . This increase was largely driven by the increase in the number of our aligned Non-Insurance Beneficiaries from 61,818 atSeptember 30, 2021 , to 166,432 atSeptember 30, 2022 .
Other Income
Other income increased$2.8 million , or 320.7%, to$3.6 million for the three months endedSeptember 30, 2022 , compared to the three months endedSeptember 30, 2021 . The increase was largely due to a$2.7 million increase in net investment income.
Net Medical Claims Incurred
Net medical claims incurred increased$403.5 million , or 92.5%, to$839.8 million for the three months endedSeptember 30, 2022 , compared to the three months endedSeptember 30, 2021 . The increase was primarily driven by an increase in net medical claims attributable to our Non-Insurance Beneficiaries from$228.1 million for the three months endedSeptember 30, 2021 , to$609.7 million for three months endedSeptember 30, 2022 , which was driven by an increase in the number of our aligned Non-Insurance Beneficiaries from 61,818 atSeptember 30, 2021 , to 166,432 atSeptember 30, 2022 , and an increase of$22.6 million in net medical claims attributable to our Insurance members, which was primarily driven by an increase in Insurance members from 67,281 atSeptember 30, 2021 , to 88,136 atSeptember 30, 2022 .
Salaries and Benefits
Salaries and benefits decreased$3.2 million , or 4.4%, to$70.1 million for the three months endedSeptember 30, 2022 , compared to the three months endedSeptember 30, 2021 . The decrease was primarily driven by a$4.2 million decrease in stock-based compensation expense, partially offset by increased headcount and additional cash awards.
General and Administrative Expenses
General and administrative expenses increased$2.0 million , or 4.3%, to$47.8 million for the three months endedSeptember 30, 2022 , compared to the three months endedSeptember 30, 2021 . The increase was driven in part by a$1.3 million increase in public company costs and legal and other professional fees to support our growth, residual commissions, which are attributable to members retained by the Company from the previous plan year, which increased by$1.1 million , and an increase in supplemental administrative costs of$0.7 million . Additionally, for the three months endedSeptember 30, 2022 , we recognized$1.9 million of deferred acquisition costs related to the acquisition of new members, compared to$1.1 million for the three months endedSeptember 30 , 2021.These increases were partially offset by a$1.9 million decrease in software application costs.
Premium Deficiency Reserve (Benefit) Expense
A$27.7 million premium deficiency reserve benefit was recorded for the three months endedSeptember 30, 2022 , which includes amortization associated with a previously recorded reserve. A$20.8 million premium deficiency reserve expense was recorded for the three months endedSeptember 30, 2021 , which includes amortization associated with a previously recorded reserve and a reserve deemed necessary for the remainder of 2021.
Change in Fair Value of Warrants Payable
There was no change in fair value of warrants payable to report for the three months endedSeptember 30, 2022 , as there were no warrants outstanding. The change in fair value of warrants payable of$115.2 million for the three months endedSeptember 30, 2021 was due to the mark-to-market adjustment of the public warrants (the "Public Warrants") and the private placement warrants (the "Private Placement Warrants") assumed by the Company in connection with itsJanuary 2021 business combination with an affiliate ofSocial Capital Hedosophia Holdings Corp. III (the "Business Combination"). For additional information, see Note 5 (Fair Value Measurements) and Note 13 (Warrants Payable) in our 2021 Form 10-K. Interest Expense
There was no change in interest expense for the three months ended
2022
Amortization of Notes and Securities Discounts
Amortization of notes and securities discounts were less than
both the three months ended
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Loss on Investment
We recorded a loss on investment of$1.0 million for the three months endedSeptember 30, 2022 , on our minority equity investment inCharacter Biosciences, Inc. (f/k/aClover Therapeutics Company ) ("Character Biosciences"), attributable to our proportionate share of the loss on equity of that entity during the period. Prior to the first quarter of 2022, this entity was consolidated on the Company's financial statements, and therefore the Company did not recognize a loss or gain on investment in this entity for the three months endedSeptember 30, 2021 .
Comparison of the Nine Months Ended
The following table summarizes our condensed consolidated results of operations for the nine months endedSeptember 30, 2022 and 2021. The period-to-period comparison of results is not necessarily indicative of results for future periods. Nine Months Ended Change between September 30, 2022 and 2021 2022 2021 ($) (%) (in thousands) Revenues Premiums earned, net (Net of ceded premiums of$354 and$370 for the nine months endedSeptember 30, 2022 and 2021, respectively)$ 814,566 $ 598,390 $ 216,176 36.1 % Non-Insurance revenue 1,757,579 439,020 1,318,559 300.3 Other income 5,751 2,550 3,201 125.5 Total revenues 2,577,896 1,039,960 1,537,936 147.9 Operating expenses Net medical claims incurred 2,560,307 1,109,248 1,451,059 130.8 Salaries and benefits 209,724 201,555 8,169 4.1 General and administrative expenses 152,569 130,110 22,459 17.3 Premium deficiency reserve (benefit) expense (82,971) 48,661 (131,632) (270.5) Depreciation and amortization 2,028 398 1,630 409.5 Other expense - 191 (191) * Total operating expenses 2,841,657 1,490,163 1,351,494 90.7 Loss from operations (263,761) (450,203) 186,442 (41.4) Change in fair value of warrants payable - (66,146) 66,146 * Interest expense 1,197 2,790 (1,593) (57.1) Amortization of notes and securities discount 27 13,708 (13,681) (99.8) Gain on investment (10,187) - (10,187) * Net loss$ (254,798) $ (400,555) $ 145,757 (36.4) %
* Not presented because the current or prior period amount is zero or the
amount for the line item changed from a gain to a loss (or vice versa) and thus
yields a result that is not meaningful.
Premiums Earned, Net
Premiums earned, net increased$216.2 million , or 36.1%, to$814.6 million for the nine months endedSeptember 30, 2022 , compared to the nine months endedSeptember 30, 2021 . The increase was primarily due to membership growth of 31.0% from 67,281 Insurance members atSeptember 30, 2021 , to 88,136 Insurance members atSeptember 30, 2022 . Risk adjustment revenue of$51.7 million was recognized during the nine months endedSeptember 30, 2022 .
Non-Insurance Revenue
OurNon-Insurance revenue was$1,757.6 million for the nine months endedSeptember 30, 2022 , compared to$439.0 million for the nine months endedSeptember 30, 2021 . The increase was primarily driven by an increase in the number of our aligned Non-Insurance Beneficiaries from 61,818 atSeptember 30, 2021 , to 166,432 atSeptember 30, 2022 , and the fact that our DCE did not begin participation inDirect Contracting until the second quarter of 2021. 39 --------------------------------------------------------------------------------
Other Income
Other income increased$3.2 million , or 125.5%, to$5.8 million for the nine months endedSeptember 30, 2022 , compared to the nine months endedSeptember 30, 2021 . The increase was largely due to a$3.4 million increase in net investment income. Net Medical Claims Incurred Net medical claims incurred increased$1,451.1 million , or 130.8%, to$2,560.3 million for the nine months endedSeptember 30, 2022 , compared to the nine months endedSeptember 30, 2021 . The increase was primarily driven by an increase in net medical claims attributable to our Non-Insurance Beneficiaries from$470.0 million for the nine months endedSeptember 30, 2021 , to$1,815.8 million for the nine months endedSeptember 30, 2022 , which was driven by an increase in the number of our aligned Non-Insurance Beneficiaries from 61,818 atSeptember 30, 2021 , to 166,432 atSeptember 30, 2022 and the fact that our DCE did not begin participation inDirect Contracting until the second quarter of 2021, and an increase of$106.0 million in net medical claims attributable to our Insurance members, which was primarily driven by an increase in Insurance members from 67,281 Insurance members atSeptember 30, 2021 , to 88,136 Insurance members atSeptember 30, 2022 .
Salaries and Benefits
Salaries and benefits increased$8.2 million , or 4.1%, to$209.7 million for the nine months endedSeptember 30, 2022 , compared to the nine months endedSeptember 30, 2021 . The increase was primarily driven by increased headcount and additional cash awards, partially offset by a$7.3 million decrease in stock-based compensation expense.
General and Administrative Expenses
General and administrative expenses increased$22.5 million , or 17.3%, to$152.6 million for the nine months endedSeptember 30, 2022 , compared to the nine months endedSeptember 30, 2021 . The increase was driven in part by increases in legal and other professional fees to support our growth and public company costs, including costs associated with obtaining and maintaining directors' and officers' liability insurance. Legal and professional fees increased$9.0 million for the nine months endedSeptember 30, 2022 , compared to the nine months endedSeptember 30, 2021 . Residual commissions, which are attributable to members retained by the Company from the previous plan year, increased by$7.6 million . For the nine months endedSeptember 30, 2022 , we recognized$15.6 million of deferred acquisition costs related to the acquisition of new members, compared to$9.6 million for the nine months endedSeptember 30, 2021 .
Premium Deficiency Reserve (Benefit) Expense
A$83.0 million premium deficiency reserve benefit was recorded for the nine months endedSeptember 30, 2022 , which includes amortization associated with a previously recorded reserve. A$48.7 million premium deficiency reserve expense was recorded for the nine months endedSeptember 30, 2021 , which includes amortization associated with a previously recorded reserve and a reserve deemed necessary for the remainder of 2021.
Change in Fair Value of Warrants Payable
There was no change in fair value of warrants payable to report for the nine months endedSeptember 30, 2022 , as there were no warrants outstanding. There was a decrease of$66.1 million for the nine months endedSeptember 30, 2021 , due to the mark-to-market adjustment of the Public Warrants and Private Placement Warrants recognized for the nine months endedSeptember 30, 2021 . For additional information, see Note 5 (Fair Value Measurements) and Note 13 (Warrants Payable) in our 2021 Form 10-K.
Interest Expense
Interest expense decreased$1.6 million , or 57.1%, to$1.2 million for the nine months endedSeptember 30, 2022 , compared to the nine months endedSeptember 30, 2021 , primarily related to the voluntary prepayment and termination of the remaining principal and interest associated with our Term Loan Notes.
Amortization of Notes and Securities Discounts
Amortization of notes and securities discounts decreased by 99.8% primarily due to the completion of the Business Combination onJanuary 7, 2021 , whereby the unamortized discount associated with theAugust 2019 tranche of theConvertible Securities was accelerated, as well as the termination of our Term Loans during the nine months endedSeptember 30, 2021 .
Gain on Investment
InFebruary 2022 , Character Biosciences completed a private capital transaction in which it raised$17.9 million from the issuance of 16,210,602 shares of its preferred stock. After evaluating our ownership interest in Character Biosciences, we began applying the equity method of accounting during the nine months endedSeptember 30, 2022 , and recorded a gain on investment of$10.2 million , 40 -------------------------------------------------------------------------------- which is attributable to our proportionate share of the gain on equity of that entity during that period. Prior to the first quarter of 2022, this entity was consolidated on the Company's financial statements, and therefore the Company did not recognize a loss or gain on investment in this entity for the nine months endedSeptember 30, 2021 .
Liquidity and Capital Resources
We manage our liquidity and financial position in the context of our overall business strategy. We continually forecast and manage our cash, investments, working capital balances, and capital structure to meet the short-term and long-term obligations of our businesses while seeking to maintain liquidity and financial flexibility. As ofSeptember 30, 2022 , we had cash, cash equivalents, and short-term investments of$536.7 million . Additionally, as ofSeptember 30, 2022 , we had$246.1 million of available-for-sale and held-to-maturity investment securities, and an outstanding balance of$23.2 million on convertible notes issued by Seek. Our cash equivalents, short-term investments, and investment securities consist primarily of money market funds andU.S. government debt securities. Historically, we have financed our operations primarily from the proceeds we received through public and private sales of equity securities, funds received in connection with the Business Combination, issuances of convertible notes, premiums earned under our MA plans, borrowings under our term loan facility and, most recently, with ourNon-Insurance revenues. We expect that our cash, cash equivalents, short-term investments, and our current projections of cash flows, taken together, will be sufficient to meet our projected operating and regulatory requirements for the next 12 months based on our current plans. Our future capital requirements will depend on many factors, including our needs to support our business growth, to respond to business opportunities, challenges or unforeseen circumstances, or for other reasons. We may be required to seek additional equity or debt financing to provide the capital required to maintain or expand our operations. Any future equity financing may be dilutive to our existing investors, and any future debt financing may include debt service requirements and financial and other restrictive covenants that may constrain our operations and growth strategies. In the event that additional financing is required from outside sources, we may not be able to raise it on terms acceptable to us, or at all. If we are unable to raise additional capital when desired, our business, results of operations, and financial condition would be adversely affected. We operate as a holding company in a highly regulated industry. As such, we may receive dividends and administrative expense reimbursements from our subsidiaries, two of which are subject to regulatory restrictions. We continue to maintain significant levels of aggregate excess statutory capital and surplus in our state-regulated insurance subsidiaries. Cash, cash equivalents, and short-term investments at the parent company,Clover Health Investments, Corp. , were$169.1 million and$350.9 million as ofSeptember 30, 2022 , andDecember 31, 2021 , respectively. This decrease at the parent company primarily reflects operating expenses and capital contributions made to our regulated insurance subsidiaries. Additionally, our parent company held$113.9 million and$79.3 million of available-for-sale and held-to-maturity investment securities as ofSeptember 30, 2022 , andDecember 31, 2021 . Our unregulated subsidiaries held$132.7 million and$52.2 million of cash, cash equivalents, and short-term investments as ofSeptember 30, 2022 , andDecember 31, 2021 , respectively. Our unregulated subsidiaries held no available-for-sale and held-to-maturity securities as of bothSeptember 30, 2022 andDecember 31, 2021 . Our regulated insurance subsidiaries held$234.8 million and$190.7 million of cash, cash equivalents, and short-term investments as ofSeptember 30, 2022 , andDecember 31, 2021 , respectively. Additionally, our regulated insurance subsidiaries held$132.1 million and$118.0 million of available-for-sale and held-to-maturity investment securities as ofSeptember 30, 2022 , andDecember 31, 2021 , respectively. Our use of operating cash derived from our unregulated subsidiaries is generally not restricted by departments of insurance (or comparable state regulatory agencies). Our regulated insurance subsidiaries have not paid dividends to the parent, and applicable insurance laws restrict the ability of our regulated insurance subsidiary to declare and pay dividends to the parent. Insurance regulators have broad powers to prevent reduction of statutory surplus to inadequate levels, and there is no assurance that dividends of the maximum amounts calculated under any applicable formula would be permitted. State insurance regulatory authorities that have jurisdiction over the payment of dividends by our regulated insurance subsidiary may in the future adopt statutory provisions more restrictive than those currently in effect. For a detailed discussion of our regulatory requirements, including aggregate statutory capital and surplus as well as dividends paid from the subsidiaries to the parent, please refer to Notes 24, 25, and 26 in our 2021 Form 10-K. 41 --------------------------------------------------------------------------------
Cash Flows
The following table summarizes our condensed consolidated cash flows for the
nine months ended
Nine Months EndedSeptember 30, 2022
2021
(in
thousands)
Cash Flows Data: Net cash provided by (used in) operating activities$ 5,442 $ (202,150) Net cash provided by (used in) investing activities 82,477 (328,956) Net cash (used in) provided by financing activities (5,018) 641,022 Increase in cash and cash equivalents$ 82,901 $ 109,916 Cash Requirements Our cash requirements within the next twelve months include medical claims payable, accounts payable and accrued liabilities, current liabilities, purchase commitments, and other obligations. We expect the cash required to meet these obligations to be primarily generated through cash flows from current operations and cash available for general corporate use.
Operating Activities
Our largest source of operating cash flows is capitated payments from CMS. Our primary uses of cash from operating activities are payments for medical benefits and payments of operating expenses. For the nine months endedSeptember 30, 2022 , net cash provided by operating activities was$5.4 million , which reflects a net loss of$254.8 million Non-cash activities included a$125.2 million charge to stock-based compensation expense,$83.0 million of amortization of the 2022 premium deficiency reserve, and a$10.2 million gain on investment related to the change in the equity structure of Character Biosciences. Payments due to CMS related to ourNon-Insurance operations increased by$109.4 million . A prepayment of$96.4 million was received during the period from CMS forOctober 2022 . Change in our working capital included an increase in unpaid claims of$1.0 million . For the nine months endedSeptember 30, 2021 , net cash used in operating activities was$202.2 million , which reflects a net loss of$400.6 million . Non-cash activities included a$66.1 million gain as a result of the change in fair value of warrants payable and a$132.5 million charge to stock-based compensation expense. Changes to our working capital included a$48.7 million charge to our premium deficiency reserve and an increase of$13.2 million in surety bonds and deposits related toDirect Contracting .
Investing Activities
Net cash provided by investing activities for the nine months endedSeptember 30, 2022 , of$82.5 million was primarily due to$360.2 million provided from the sale and maturity of investment securities, offset by$276.8 million used to purchase investments. Net cash used in investing activities for the nine months endedSeptember 30, 2021 , of$329.0 million was primarily due to$705.6 million used to purchase investment securities, partially offset by$377.1 million provided from the sale and maturity of investment securities.
For additional information regarding our investing activities, please refer to
Note 3 (
statements included in this Form 10-Q.
Financing Activities
Net cash used in financing activities for the nine months ended
2022
million
Net cash provided by financing activities for the nine months endedSeptember 30, 2021 , of$641.0 million was primarily the result of$666.2 million in proceeds from the reverse capitalization in connection with the Business Combination, net of transaction costs, and$5.5 million in proceeds from the issuance of common stock, partially offset by$30.9 million in principal payments on our outstanding Term Loan Notes. 42 --------------------------------------------------------------------------------
Financing Arrangements
There have been no material changes to our financing arrangements as of
Contractual Obligations and Commitments
We believe that funds from future operating cash flows, cash, and investments
will be sufficient for future operations and commitments, and for capital
acquisitions and other strategic transactions, over at least the next 12 months.
Material cash requirements from known contractual obligations and commitments as ofSeptember 30, 2022 include: (1) the recognition of a performance guarantee of$655.8 million in connection with the Company's participation in the DC Model, (2) operating lease obligations of$6.3 million , and (3) the outstanding principal balance related to the convertible note entered into by Seek, our indirect wholly-owned subsidiary, onSeptember 25, 2020 , for an aggregate principal amount of$20.0 million . These commitments are associated with contracts that were enforceable and legally binding as ofSeptember 30, 2022 , and that specified all significant terms, including fixed or minimum serves to be used, fixed, minimum, or variable price provisions, and the approximate timing of the actions under the contracts. There were no other material cash requirements from known contractual obligations and commitments. For additional information regarding our remaining estimated contractual obligations and commitments, see Note 8 (Notes and Securities Payable), Note 15 (Commitments and Contingencies), and Note 16 (Non-Insurance ) to Financial Statements in this report, and Note 16 (Leases) in the 2021 Form 10-K.
Indemnification Agreements
In the ordinary course of business, we enter into agreements, with various parties (providers, vendors, consultants, etc.), of varying scope and terms pursuant to which we may agree to defend, indemnify, and hold harmless the other parties from any claim, demand, loss, lawsuit, settlement, judgment, fine, or other liability, and all related expenses which may accrue there from (including reasonable attorney's fees), arising from or in connection with third party claims, including, but not limited to, negligence, recklessness, willful misconduct, fraud, or otherwise wrongful act or omission with respect to our obligations under the applicable Agreement.
Off-balance Sheet Arrangements
We do not have any off-balance sheet arrangements, as defined by applicable regulations of theSEC , that are reasonably likely to have a current or future material effect on our financial condition, results of operations, liquidity, capital expenditures, or capital resources.
Critical Accounting Policies and Estimate
We believe that the accounting policies and estimates involve a significant degree of judgment and complexity. There have been no significant changes in our critical accounting policies and estimates during the three months endedSeptember 30, 2022 , as compared to the critical accounting policies and estimates disclosed in the section titled "Management's Discussion and Analysis of Financial Condition and Results of Operations" included in the 2021 Form 10-K.
Recently Issued and Adopted Accounting Pronouncements
See Note 2 (Summary of Significant Accounting Policies) to the Financial Statements in this report for a discussion of accounting pronouncements recently adopted and recently issued accounting pronouncements not yet adopted and their potential impact to our financial statements.



NI HOLDINGS, INC. – 10-Q – Management's Discussion and Analysis of Financial Condition and Results of Operations
American Equity Reports Strong Earnings Driven by Continued Execution of AEL 2.0 Strategy with Private Asset Allocation Growing to 18.4%
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