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Centene

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Centene Corporation is a US Fortune 500 company listed on the New York Stock Exchange. It provides healthcare plans through Medicaid, Medicare, the Health Insurance Marketplace, and traditional insurance companies largely to the under-insured and uninsured in the USA, i.e., low-income households, the elderly and veterans.

Centene Corporation has over 30,000 employees across the USA and operates health plans that serve 2.9 million members in 24 US states.

In the UK, the focus is on working with the NHS and private healthcare companies to increase coordination of care through data analysis, logistics, and the development of IT solutions.

In 2016, Centene acquired a 75% share in The Practice Group (TPG) and through this company has an interest in GP services.

Strategy

As well as being the majority owner of The Practice Group (TPG), Centene operates in the UK under its own subsidiary and according to its website “specialises in enabling effective coordination of care through data analysis, logistics, and the development of IT solutions.”

Centene has also acquired Beacon Health UK, a supplier of mental health services; in September 2018 Beacon Health was rebranded as Simplify Health.

In December 2018, Centene UK Ltd appointed Samantha Jones as its CEO; Jones was head of NHS England’s director of new care models from 2015 to 2017, and previously chief executive of Epsom and St Helier University Hospitals and West Hertfordshire Hospitals trusts.

Financials

Centene UK Ltd is a subsidiary of MH Services International (UK) Ltd, a holding company, that is itself owned by Centene Corporation, the US company.

In the year to end December 2017, Centene UK Ltd reported a loss of almost £2.7 million, up from just over £2.1 million in 2016. The company reported a £1.9 million turnover, however administrative expenses are recorded as almost £3.7 million.

In January 2018, Centene Corporation transferred £3 million to Centene UK Ltd as capital for the company.

Contracts

The company came to the attention of the media in the UK in 2017 when it was given a sub-contract by Capita for part of a contract for the development of an accountable care system (ACS) in Nottinghamshire.

The original one year £2.7 million contract was awarded to Capita by Nottingham and Nottinghamshire STP.

In September 2018, Centene was listed on 9 of the 10 lots on the Government's £300 million framework contract for digital technology in the NHS. The ten lots cover helping health regions to integrate and improve services using technology and external consultants. NHS England has estimated that £300m of business will be done through the framework over four years. The framework is known as Health System Support.

Simplify Health has a contract to manage the CAMHS single point of access service in Surrey for Surrey and Borders Partnership NHS Foundation trust.

Concerns

A major concern in the UK is based on the company's record in the area of accountable care systems, in particular its involvement in the accountable care company Ribera Salud in Spain.

Centene originally owned 50% of Ribera Salud, a Spanish Healthcare company. As of July 2019, Centene now owns 90% of Ribera Salud, after purchasing a stake from Banco Sabadell. Ribera Salud is known for pioneering the development of the public/private partnership model of healthcare in Spain. Centene notes on its website that it will save the NHS money and references its “experience with Ribera Salud in Spain” which it says “is recognised by governments across the world as an example of an effective model of care……[that] produces better results for the patient at less cost to the government.”

In an article in HSJ in June 2017 Ribera Salud’s model of integrated care is also lauded and its capacity for reducing costs praised. Ribera Salud developed an integrated model of healthcare at the Alzira hospital in Valencia, which has become known as the Alzira model.

Under this model, Ribera Salud received a capitated budget from the regional government over a 15-year contract. Ribera Salud must then provide free healthcare to a defined geographical population. In return, it retain profits of up to 7.5% of turnover, but anything above this is returned to the government. The model encompasses hospital services and primary care. According to the HSJ article, the Alzira model spends 25% less than government run hospitals in the area and has been hailed as a major success for integrated care. The Alzira model has been replicated in other areas within Valencia and also in Madrid.

What neither Centene nor the HSJ article mention, is that Ribera Salud is currently under police investigation and there is a process underway in Valencia to take the hospitals back into public control.  The Spanish newspaper El Pais reported in November 2016 that Ribera Salud is under police investigation for fraud, including overcharging, and issues with sub-contracting. In March 2017, El Pais reported that the regional Valencia government is to do a “reversión de la sanidad privatizada” literally a reversion of privatised health, under which as the contracts or “concessions” come to an end, the hospitals will be transferred back into public management.

One of the major election campaign promises for the Green/Socialist/Podemos coalition government in Valencia, which won the regional election in 2015, was stopping and reversing health service privatisation. There have been significant problems with a lack of oversight of the “concessions” given to Ribera Salud, with no effective control, nor checks on the quality of its service, nor in any financial matters, according to Ximo Puig, President of the regional government in Valencia.

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