The Exec: How One Payer CEO Leverages a Tech-Healthcare Background to Maximize Clinician and Member Support

Andrew Toy takes the helm at Clover Health and talks to HealthLeaders about how open networks, early disease detection and management, and health equity are intertwined.

Editor's note: This article appears in the June 2023 edition of HealthLeaders magazine.

In January of this year, Andrew Toy assumed the role of CEO of Clover Health. It was not only the time but his time. Toy served first as the payer's CTO then president and board member before becoming its chief executive. In this exclusive interview, Toy shares his love of solving ''bigger and bigger problems'' in service of the healthcare industry and society at large.

HealthLeaders: Describe your background and how you leverage it in your new role.

Andrew Toy: I have a varied background but you wouldn't know that from how I grew up. I was a software engineer-computer science person. I got my first computer when I was six years old. I came to the U.S. from Hong Kong to study computer science and got a master's degree from Stanford. All of this helped me as I came into healthcare. I had a startup from 2010 to 2014 that I sold to Google, where I worked on the Google Cloud team. About five years ago in 2018, I joined Clover.

The way I self-identify is that I like to solve problems—business problems, problems for society, and the world hopefully. I use my technical skills as a mechanism to solve those problems and then try to scale up to solve bigger and bigger problems.

HL: What skills does it take to want to solve bigger problems, and what advice would you give young to mid-career professionals who want to do the same?

Toy: I like to encourage myself and others to ''Start with Yes.'' It's easy to look at a big problem or idea and call out why it can't work. The key is, that no problem was ever solved without someone being willing to propose the solution. So, if you are willing to keep proposing ideas and generating answers, you come to realize that rarely does anyone remember how many times you pitched an idea before you found the right one. All that matters is that you reached the solution in the end. The upside of doing that for the business, the world, and your career far exceeds the actual risk. It just takes courage.

HL: Describe your Clover leadership transition and why now was the time?

Toy: My vision has not necessarily been, 'How do I become CEO?' but rather 'How do I deliver the biggest impact?'—for Clover as an organization, our members, and to help society.

I had been the CEO of my own company and knew it would make sense one day to take the CEO chair due to my relationship with the prior CEO (and founder Vivek Garipalli) and our mutual belief that the next generation of health will be deeply enmeshed with technology. The reason I'm taking the helm now is that everything is different coming out of the pandemic. The world reset in lots of ways and in the next few years, healthcare will have to continue to change significantly.

Vivek spoke to this when he transitioned to his new full-time role as executive chair of Clover's Board. [See Vivek Garipalli's post highlighting what Clover strives to deliver through its MA plans—''open, zero [or low] cost-access to any primary care physician,'' and how he sees the company's Clover Assistant for ''a core driver of [the kind of] clinical value creation'' for providers that healthcare will need to deliver in the next decade.]

HL: Talk more about Clover's open network design, PCP and care management focus, and how they both support heath equity.

Toy: There's a degree of futurism to how fast things are changing, but at the end of the day, the CEO's job is the mission and the vision. Clover's mission is to improve the everyday lives of people on Medicare. Our vision is to be a powerful, motivating force in the early detection and management of disease burden. The mission and the vision are simple but the details are complicated.

I describe it as the physics of healthcare.

The utilization of narrow provider networks by payers means that patients may be pushed to engage with a PCP they don't know or trust—and trust between a patient and their PCP is a crucial aspect of successful care management. In addition, there aren't enough doctors in the U.S. as it is. The narrow network approach exacerbates this problem, particularly in lower-income and underserved communities. These networks are implemented for financial reasons.

We believe low- to no-cost open networks will lead the way to a more equitable healthcare system. [See Clover's health equity white paper.] Our PPO-centric approach allows our members to avoid the painful decision of choosing between the insurance they can afford and the doctor they trust. When we present our members with choice, we believe they will visit their PCPs more and be more proactive about managing their own health. 

HL: What role does Clover Assistant play in the open network approach and health equity?

Toy: Healthcare's biggest problem is health inequity because it can only be solved by helping everyone. We see a massive opportunity for technology here, and that's why we're so focused on bringing Clover Assistant to the widest network of physicians as possible. For doctors, it provides them with additional resources and support to do what they love to do: practice medicine. 

At Clover, we're thinking about how we can leverage software to synthesize data in real time to build machine learning models that we put in the hands of our physicians. It's a totally different way of thinking about how you invest, spend, and get return on investment.

The analogy I use for Clover Assistant is the GPS. It provides useful, specific data that could inform a better route that supplements or complements a provider’s clinical care. Everyone finds that helpful. We're not trying to tell a doctor how to practice medicine.

HL: Did your background as a software engineer lead you to the broader value of open networks?

I have always seen an opportunity for technology to fix large-scale problems, and software engineers like to do that by creating structure and layers of abstraction. That's something networks of all kinds do well. 

This idea of breaking free of centralized, siloed hubs is an interesting trend across multiple areas of technology and is becoming more about how we live our lives every day. The trend of decentralizing from the traditional ''networks'' of employment, transport, power, connectivity, etc., is going to be the future.

Healthcare is the only place where we are centralizing more every day, and we need to reverse this trend. It makes sense then that open and inclusive systems are also the future of healthcare. Open networks spur better, more accessible and often, more culturally appropriate care for our members. You can get care when and where it makes sense for you. Open architecture and interoperability allow our technology to seamlessly integrate with other systems, like virtual care.

To advance health equity—to truly help everyone—we need more open, distributed networks with broader care capability.