… U.S. Healthcare: A Wild Ride …

Over $40 billion in annual sales…

Centene is a unique managed care conglomerate based in St. Louis, Missouri which has quietly grown into an industry leader. Founded in 1984, Centene has over 30,000 employees and generates over $40 billion in annual sales. Their book of business includes 12 million members located across 28 states; a large number of them covered via government-sponsored health plans. Centene’s many accreditations include NCQA, URAC and Phase III / CAHQ Core.

Specialized markets, services and plans…

Centene is well known in Medicaid and Medicare markets. Their Medicaid business unit supports TANF, CHIP, foster care, ABD and long term care sectors. Centene’s Medicare business is centered on Medicare Advantage dual-eligible special needs and Medicare / Medicaid plans. Centene’s health insurance marketplace unit (HIM) offers benefits through which some members qualify for government subsidies; these benefit programs are marketed via their Ambetter brands.

Centene operates in an array of unique markets:

  • Casenet: population health and care management software
  • Celtic: commercial insurance for the uninsured
  • Centurion: correctional systems healthcare
  • Evolve: supplemental health benefits, administrative support
  • Health Net Federal Services: military and veteran communities
  • LifeShare: integrated long term care
  • U.S. Medical Management (USMM): integrated home health care

Business challenges…

Much of Centene’s business is considered to be more complex to administer with potentially lower revenues when compared to conventional health plans and market sectors. In many cases, other insurers have reduced focus in these segments to avoid the burden of complex benefit management tied to government funding. They equate this business equation with higher operating costs, lower premiums / margins resulting in less revenue / profit. Various insurers including Aetna, Anthem, Cigna, Humana, UHC and a number of others have business in these areas but limit the scope of their exposure. They prefer to allocate organizational resources to more predictable, traditional, profitable health insurance offerings and customer segments. Centene successfully engages government-sponsored healthcare and other non-mainstream markets as a routine, well-executed core strategy of their business model.

A growing organization…

Centene has been able to grow organically and through a series of strategic acquisitions. Their latest expansion purchases are sizable. In September, 2017, they announced their acquisition of Fidelis Care (New York State Catholic Health Plan) for $3.7 billion. In 2016 they completed their deal to buy Health Net for $6.8 billion. Despite the scale of these additions to an already formidable corporate entity, Centene is not on the radar of most business and consumers when it comes to healthcare insurance / managed care.

Centene’s empire, excelling in offbeat healthcare market sectors, continues to pursue business and grow where other companies failed to meet their goals…

In 2018 the company projects to do business in 3 additional states (Kansas, Missouri and Nevada) by offering plans on those states’ health insurance exchanges. They seek to expand business in several states including Florida, Ohio, Texas and Washington next year. As other insurers reduce or entirely exit Obamacare markets, Centene sizes up those gaps as opportunities. They strategically develop benefit plans to introduce to those areas and execute effective go-to-market strategies to launch and promote their offerings and capture new business.

Moving ahead…

Centene’s low-key, ongoing growth is impressive and it appears to be well-positioned to continue the trend. It has built up considerable administrative, clinical, financial, marketing, operational and sales experience over the years with successful results. Complex risk management is something they take in stride. This enables it to accurately assess difficult markets and develop viable health insurance and other solutions for consumers plus additional customer stakeholders. Their tolerance for unconventional markets and higher risk is greater because that is their specialty; they assertively manage this business to their advantage to generate sales and profits where others can’t.

Centene is ranked 66th in the Fortune 500 and 27th in Fortune’s 100 fastest growing companies…

New or established competitors find it challenging to perform at Centene’s level given the markets they have to play in. As medical and pharmacy costs increase, government-sponsored plans change and healthcare insurance industry churn continues, Centene has a promising future ahead with a fluid business model that productively generates sales and grows the organization.

Thank you for reading this article; check out these other stories about healthcare companies, corporate development and strategic business model innovation; connect with me further through reading my other Medium articles or through my social media links:




John G. Baresky — Brand Marketing, Product Management, Digital Marketing, Marketing Leadership, Product Launches, Marketing Strategy, Digital Strategy, Social Media, Market Access, Market Research, Marketing And Sales Collaboration

Horse photo courtesy of Anne M. Eberhardt/The Horse