How can we explain the 20% increase in hospital readmission rates for Clover Health members using our in-home care services during Q2?

Introduction

The 20% increase in hospital readmission rates for Clover Health members using in-home care services during Q2 is a critical issue that demands immediate attention. This analysis will systematically identify, validate, and address the root cause while considering both short-term and long-term implications for our members and the business.

I'll approach this problem by first clarifying key details, ruling out external factors, and then diving deep into our product, user journey, and metrics. From there, I'll form data-driven hypotheses, conduct root cause analysis, and propose validation methods and solutions.

Step 1

Clarifying Questions (3 minutes)

• Looking at the timing, I'm thinking there might be seasonal factors at play. Have we seen similar Q2 increases in previous years?

Why it matters: Helps distinguish between cyclical patterns and new issues. Expected answer: No significant Q2 increases in previous years. Impact on approach: If true, focuses analysis on recent changes or new factors.

• Considering the scope, I'm curious about the distribution of this increase. Is the 20% rise consistent across all member segments or concentrated in specific groups?

Why it matters: Identifies whether this is a systemic issue or affects particular demographics. Expected answer: Increase is more pronounced in elderly members with chronic conditions. Impact on approach: Directs investigation towards specific member needs and service aspects.

• Thinking about recent changes, have there been any modifications to our in-home care service model or provider network in the past 3-6 months?

Why it matters: Pinpoints potential internal causes related to service delivery. Expected answer: Recent expansion of provider network and introduction of new care protocols. Impact on approach: Focuses on evaluating the impact of these changes on care quality and consistency.

• Considering data integrity, has there been any change in how we're measuring or recording readmission rates?

Why it matters: Ensures the increase is real and not a result of measurement changes. Expected answer: No changes to measurement methodology or systems. Impact on approach: If confirmed, validates the need to look at actual service and member-related factors.