My previous post of the trigrams elicited a wide range of comments. I think there's an opportunity here to explore and educate the fine audience of this sub-reddit the nuance between western and eastern medicine and appreciate the kind of opportunity Clover Assistant represents to those who are conducting AI experiments and medical practitioners in the near future.

First off, I don't consider myself an expert in eastern or western medicine but I'm fascinated in the philosophical approach these cultures take toward health. As we look into the differences, it's easy to make a two-sided table and call it a finished topic. I challenge the reader to go a bit further than the surface detail and look at how a logical and harmonious healthcare system will look like at impacting the larger Medicare TAM.

And this is the focal point of the wider issue of fixing the US healthcare system as a whole. Payments in medicare are a larger per capita of healthcare spending because the elderly have more complications, ailments and health "debt" as is naturally the case. Subsequently, the healthcare provider system is skewed towards fixing healthcare in the elderly because it's the best bang for buck per time spent problem solving. It's alluding to the time when you go to the physician's office with a common cold and they just moreorless shoo you away. You're eating up the doctor's most valuable resource, their time. In short, it's clever to approach the Medicare population first as Clover Health has because when you fix medicare, you can map the strategy to fix the problems downstream (aside from medicaid because poverty is a whole other set of issues way beyond the scope of health).

But focusing on health for a moment. Clover's problem thesis ultimately comes in the form of solving the problem of the lowest hanging fruit. That lowest hanging fruit is chronic condition detection as articulated in their IPO/de-SPAC video from 2020. 80% has 1 or more chronic conditions and 60% has 2 or more. It's beginning to look a lot like a power law function. If that were the case, 3+ cc would be 50%, 4+ 40%, 5+ 32% and 6+ 26%. I mean, it's not entirely predictive but the assumption that a quarter of the senior population has 6 or more chronic conditions is an overwhelmingly surprising result that we should be aware about when thinking about solving for the healthcare system. Additionally, the higher spend for the higher end of conditions is disproportionate. The crisis of healthcare is that the 6+ chronic condition patient is no longer considered an outlier event or statistic but it's an undetected nuisance for payors and are treated as such.

It's not that Clover is unique when it comes to understanding the problem. It's what they do about that is worth a standing ovation. What I said about a high % of 6+ chronic condition senior being a payor's worst nightmare, it's not to insult the incumbent payors and say the obvious thing like they are not being well regulated enough. Regulators have a stick but they can't really use it or else they will break this system as the flood of polychronic sick seniors flood the healthcare system with issues as seen during Covid. In many ways, the long lines, high costs and inconveniences dealing with the healthcare system via frustrating the customer are necessary levees erected to prevent the zombies from chewing the medicare coffers into ruin.

Clover Health addresses the truth value of health conditions rather than gamifying and subverting the consumer. There's a word of caution to the investor about this approach simply for it being untested and quite different from incumbents. But what makes Clover Assistant a wise application of eastern medicine principles is this notion of letting go of expectations and trusting/amplifying the unique strengths of physicians and patient trust. I wrote about this in strictly western sense before about how polychronic "detection" is under-weight in today's US healthcare system. There's a reason why Andrew emphasizes this +0.85 net new diagnosis per patient per year because that's how far behind non-CA physicians are when it comes to serving the overall patient population.

It's useful to apply an eastern lens just to get a grasp of some of these KPIs that are thrown around here and add some context for you about the uncertainty of medicine today. Assuming that a patient has 6+ chronic conditions but is only diagnosed for 4, the physician from a western medicine background will look at the patient health history and assume either it's true or err to the side of caution. The 4 treatments/medications can be constructed to not cause side effects impacting the other conditions but it could worsen health conditions if #5 or #6 isn't detected. The latent undetection of conditions is the induced complexity of the system that western medicine struggles with because the western market system captures the decision making framework and uses it as a slave. EHR accuracy is the real crisis here.

Some believe that the accuracy is about 85% but when you apply this to Shannon-Hartley C=B*log2(1+S/N) where S/N = signal-to-noise ratio, that 85% is equivalent of a 17% reduction of information channel compared to 90% accuracy, 36% from 95% and 58% from 99%. I mean it's pretty clear that the crisis for physicians is dealing with an unknown-unknown on a case-by-case basis without the ability to trust medical records because the scale of health information is not well incentivized. Doctors have to choose what they see as truth for a diagnosis whether it's the patient in front of them or the records that they see that could be inaccurate or thinking non-hippocratically and selfishly about how can they get paid without wasting time haggling with insurance cos. I also charted preliminarily how the decision making for a PCP can be hi-jacked if not properly incented.

This is where eastern medicine kind of takes the cake. I'm not going into full-blown oriental mode but just want to introduce the basic stuff about subjectivity, data and layers. There's a notion that western precision medicine is superior but only when the stars align and you have the information and lab tests to fully vet and warrant the precision approach. When we're dealing strictly with diagnosis and a brief 15 minute check. It's difficult for the physician to penetrate the details to ascertain a 5th or 6th chronic condition from the onion layers and overlapping symptoms of the 4 existing chronic conditions. Eastern medicine attempts to tackle these 4 existing chronic conditions "imprecisely" but in a more strategic framework as to not disturb the undetected 5 or 6. That's not to say that Clover Health will be suggesting mushroom ginseng caps as a substitute or anything any time soon. But what this does open up is a radical rethinking of strategic approaches to therapies that have been isolated from the toolkit of every day physicians.

Particularly in the field of suggestions, a physician isn't intimately aware of the longitudinal health data of the patient because the interaction is so brief. The key insight that Clover Assistant provides for the next marginal under-diagnosed multiple condition is valuable because it's an either true/false positive diagnosis that was untested which ultimately leads to a 0.85 new diagnosis per patient per year. So we have two dynamics at play now where the physicians could be unaware of the condition exhibited by the patient. Something like this in trigram terms would look like this:

In this depiction, the upper yao represents the subjectivity of doctor unable to see the true objective case of the patient in the lower yao. The middle yao is the clover assistant layer bridging the data and suggestion gap for doctor.

When you look at both trigrams you will see that Swamp ALWAYS precedes Heaven. Because it's ALWAYS the case that the middle layer between your subjectivity and objectivity flows a new insight that leads to truth.

Right now, I hope you have one of the biggest Ahas in your life. But if your mind isn't blown yet. Give me another 5 minutes.

Andrew mentioned that doctors agree with Clover Assistant about ~60ish% of the time. Many western critics might view that as a bad thing. Some shills or pumpers would say don't worry, it'll only get better. My take is that this is fundamentally an aspect of "uncertainty/learning" medicine. You need a disagreement in order to inquire but how does one inquire in a useful way. This "aspect" is the key advantage I think eastern medicine philosophy "represented" in the Clover Assistant can provide to physicians in a scale-able "Google" type way. It's a long-shot but as I wrote before, the 60ish% agree/disagree isn't a bug as much as it is a feature shannon entropy which, believe it or not, is captured well in the trigram approach. Allow me to demonstrate.

Even if they both agree, there is a chance that both can be wrong or clover assistant "led" the doctor into believing there is a condition when there isn't one. This is the "upcoding" problem in medicine. But incumbents incentivize upcoding via higher pay whereas clover's pay is flat. This difference is important because eliciting truth value is how you get the harmony that is needed to perform trigram-approach. When we look at the trigrams here we can basically take out the earth by way of probabilities because that's the case where patient, doctor, clover assistant doesn't know what to do, call it a true unknown unknown. the remaining disagreements are 57% or 4/7 possibilities. It's where the 0.85 diagnosis per patient per year comes from. The net agreement value from just complete randomization is an improvement of 3/7->60% which is arguable doubling of information channel or an approximate 10x in signal to noise from a WebMD bot.

Now you have a little bit of an intro to using the Bagua to analyze a few "static" assumptions that you hold in your life and apply a more dynamic framework.

My suggestion for management and maybe Andrew if he's reading this is to look into how Clover Assistant can be used to manage the company's financial prosperity top-down. It's another order of complexity and from my understanding of data warehousing, you guys separate business logic and clinical value logic. I would suggest looking deeper into the 64 hexagrams for inspiration.

Many investors clamor for clover assistant to not "give away" too much value or constrain the layer so to speak and let chronic conditions fester in members. Those opinions are unprincipled and unaligned with the company's approach. I don't think you should bend to their will. However, this new concept of smart growth requires feedbacking discovered concepts of choosing your customers for the best LTV and that requires more than just being an interface between physicians and patients but governing the resources of your data intake/compression/layers and incentive structure.

Beggars can't be choosers and I think in marketing, clover has one hand tied behind on the cash front. Therefore, I think the best way is adopt and manifest a 4th alternative to financing: one that isn't debt, reinsurance, equity, and look at the other quadrant. *wink wink.

TL;DR rocket emoji