Centene Corporation (Centene) is an important payer for our clients, and we have tracked the trends with this payer to implement successful payer advocacy strategies for market access. This payer manages benefits for a wide range of plan types including traditional Medicaid, commercial, Medicare, and Tricare. However, traditional Medicaid dominates the plan types managed by Centene and in December 2020, the traditional Medicaid enrollees had grown from 8,683,600 in 2019 to 13,610,100 on December 31, 2020. There also was a significant trend in managed care expansion. On December 31, 2020, managed care membership was 25.5 million, representing a 67%, over December 31, 2019.
With the continued expansion of Medicaid and managed care populations, the pause on redeterminations, and the acquiring of Magellan, total, revenues have also increased and were $28.3 billion for the fourth quarter of 2020, representing 50% growth compared to the fourth quarter of 2019, and $111.1 billion for the full year 2020, representing 49% growth year-over-year.
In 2021, these trends have continued and Centene’s profits were $699 million for the first quarter of 2021.
Some Key Centene Trends
Medicaid enrollees continue to grow: The Centene Medicaid population grew from 13.6 million on December 31, 2020 to 13.8 million Medicaid members at the end of the first quarter in 2021. This trend is expected to continue due to recent Medicaid managed care contracts and agreements In Hawaii, Oklahoma, and North Carolina.
The drop in Medicare Enrollment in 2021 was softened by the extended special enrollment period. Although Medicaid enrollment grew, Medicaid enrollment decreased slightly. As 2021 continues, the extended special enrollment period for the Federal Marketplace continues to impact the payer market. According to Michael Neidorff, CEO of Centene, a continued pause on Medicaid redeterminations is also a factor for expansion, as “people who lose Medicaid coverage could pick up marketplace.” In January, Centene expanded Ambetter, this payer’s marketplace product, in nearly 400 new counties across 13 states.
The payer trends are dynamic: The state of California will end its contract with Centene’s pharmacy benefit manager and instead carve out the PBM by switching its Medicaid managed care plans to a fee-for-service contract.
The Implication of Centene’s Trends for Your Product:
Is Medicaid managed care an important payer market for your products? If so, Centene is an important payer to track. It is a top Medicaid managed care payer managing a large number of Medicaid enrollees benefits. Its Medicaid managed care plans are expanding through contracts and agreements. The trends for the ACA and commercial products are dynamic and also worth tracking in key markets. Tracking and strategizing the trends of key payers like Centene will:
- allow you to present your rationale for coverage to the appropriate decision makers at the appropriate time,
- your accounts to identify the correct billing, coverage and payment guidelines.
Let our GIRS Payer Advocacy Compass® team help get your accounts where they need to be in time to take advantage of dynamic payer trends.
Disclaimer: The information in this blog is based on payer information which is dynamic. It is accurate at the time of posting but should not be construed to be reimbursement or legal advice. CPT® is the trademark of the American Medical Association (AMA).
Sources:
- https://fynefettle.com/5-takeaways-from-centenes-699-million-q1/
About GIRS
For more than 19 years, GIRS has been assisting medical technology manufacturers with their market uptake and reimbursement strategies so that patients can have access to the care that they need. To implement successful market access strategies, the GIRS Value Discovery Landscape Assessments® team and the Payer Advocacy Compass® team work together to develop and implement foundation reimbursement landscape and payer advocacy strategies to obtain positive coverage, appropriate payment, and innovative payer contracting arrangements to improve market uptake. For more information, email us at info@girsinc.com or call us at 901-834-9119.
Sources: https://www.prnewswire.com/news-releases/centene-corporation-reports-2020-results-301224417.html