Latest news with #managedcare
Forbes
06-08-2025
- Health
- Forbes
Why Patients Must Remain The Focus As AI Revolutionizes Healthcare
Ankit Agarwal, Chief Technology Officer, Palco. Smart, scalable and people-centered solutions should be at the heart of everything we do in healthcare. Before the digital revolution transformed healthcare, paper-based systems and traditional contact centers were the foundation of most operational workflows. However, today's demands and fast-paced environment have rendered these manual processes unsustainable, inefficient and prone to risk. Having spent my career leading digital innovation across a range of healthcare organizations—including managed care organizations, Medicaid programs and self-directed care providers—I've always been fascinated by how tools can improve outcomes, reduce friction and give individuals more control over their care. But innovation, including technologies like AI, is only meaningful when it serves people. Let's look at how we can work to deliver future-ready healthcare systems with AI that put people at the center. The Manual Challenge Historically, managing paper records has required significant time and labor, leading to frequent delays, lost productivity, escalating administrative costs and quality issues. Similarly, legacy contact centers face limitations with high agent turnover, long wait times and outdated tools. These factors not only impact efficiency but also drastically take away from the overall patient experience. As a study from the National Library of Medicine comparing paper-based with electronic patient records found, 'Inconsistencies between a patient's electronic and paper-based medical record can lead to significant problems for the health care staff in daily practice.' The modern consumer expects fast, personalized support across multiple channels. In fact, as reported by The Lund Report, 30% of patients have left an appointment due to long waits, and 20% have switched doctors for the same reason. Traditional methods are also often vulnerable to data loss, security risks, limited accessibility and service inconsistencies that may hinder both communications and compliance. These challenges highlight an urgent need for smarter, scalable solutions in healthcare operations. The New Age Of AI AI has quickly evolved from a niche technology to a transformative force in healthcare. What began with automating simple tasks like appointment scheduling or form processing has now expanded into sophisticated applications such as predictive analytics, natural language processing and real-time clinical decision support. But the concern is that AI could cause healthcare to lose the human touch. To solve this, humanized AI seeks to use AI to create a blended approach that enhances rather than replaces humans. This idea is founded in empathy and context awareness to create systems that support patients and providers in more intuitive, effective ways. Dr. Jonathan H. Chen, assistant professor of medicine at Stanford, sums up the idea nicely: "'What is a computer good at? What is a human good at?' We may need to rethink where we use and combine those skills and for which tasks we recruit AI." Organizations are using humanized AI to create scalable, more intentional experiences for their teams and patients. For example, NRC Health created an AI engine, Huey, to keep the human experience at the center of healthcare. From AI-powered chatbots delivering 24/7 support to predictive models that flag high-risk patients before emergencies occur, these tools can reshape healthcare delivery. Humanized AI solves some of healthcare's most persistent operational burdens, such as streamlining patient intake systems, verifying data in real time, reducing administrative workload and providing multilingual support, which enables human teams to focus on more complex and personal interactions. As Dr. Rachel Callcut, associate professor of surgery at the University of California, San Francisco, explains in a recent report from GE Healthcare and the MIT Technology Review, "By focusing on areas that patients, providers or systems are invested in addressing, we have set the stage for more rapid adoption and dissemination of AI.' A Phased Approach to Transforming Care What excites me most about AI in healthcare isn't just the technology itself—it's the potential to remove friction from people's lives. Leading the implementation of humanized AI at my organization was both an exciting and humbling experience. From the beginning, our goal was clear: to automate repetitive, paper-based workflows and contact center processes so we could improve efficiency and reduce human error. Throughout the process, however, I learned some valuable lessons: The first is to engage early and often. We initially thought we had accounted for every business need—but our team quickly flagged key issues we hadn't considered. It's, therefore, crucial to involve subject matter experts and frontline team members in the earliest stages of planning. Second, always have a backup plan. We pushed forward with an aggressive implementation timeline but overlooked the fact that AI systems operate on preset logic and improve over time. The lesson here is simple: Build a plan B to ensure business continuity while AI systems are learning. Finally, implement in phases. Rolling everything out at once sounds efficient, but we learned that a phased approach gave us the space to incorporate real-time feedback and refine our plan for long-term success. A the GE Healthcare and MIT Technology Review report cited above found, '80% of business and administrative healthcare professionals believe AI will make them more competitive providers.' I agree with this. AI tools can transform how patients experience care. But it's not about replacing people or implementing AI at the expense of the patient experience. It's about making healthcare more responsive, more human and more efficient. Not someday, but today. Forbes Technology Council is an invitation-only community for world-class CIOs, CTOs and technology executives. Do I qualify?
Yahoo
28-07-2025
- Business
- Yahoo
Centene Corporation (CNC) Cuts Outlook After $1.8B ACA Revenue Hit
We recently compiled a list of Centene Corporation tops our list for being one of the most undervalued stocks. Centene Corporation (NYSE:CNC) tops the list for being one of the cheap stocks to buy. It is a major U.S. managed care organization, serving over 1 in 15 Americans through government programs like Medicaid, Medicare, and ACA exchanges, with a focus on underinsured populations. In July 2025, the company withdrew its 2025 earnings guidance after uncovering challenges in the ACA Marketplace. New actuarial data from 22 of its 29 states showed slower-than-expected membership growth and higher morbidity, meaning enrollees are sicker and costlier than anticipated. As a result, the business revised its risk adjustment revenue down by $1.8 billion, which could impact earnings by $2.75 per share. In response, Centene Corporation (NYSE:CNC) is re-evaluating its 2026 ACA pricing to reflect rising claims and morbidity trends, particularly in states with the largest member base. The company is also emphasizing its operational improvements, streamlining its business, divesting non-core assets, and strengthening its Medicaid and Medicare services. 15 States with the Best Healthcare in the US This development echoes a broader industry trend, as competitors face similar volatility in the ACA exchanges. With enhanced federal subsidies set to expire in 2026, it will be a pivotal year, making pricing corrections and policy adaptations crucial. Centene Corporation (NYSE:CNC) remains focused on core government-backed offerings, investing in Medicare quality and expanding behavioral health, aiming for resilience amid uncertainty. While we acknowledge the potential of CNC as an investment, we believe certain AI stocks offer greater upside potential and carry less downside risk. If you're looking for an extremely undervalued AI stock that also stands to benefit significantly from Trump-era tariffs and the onshoring trend, see our free report on the best short-term AI stock. READ NEXT: The Best and Worst Dow Stocks for the Next 12 Months and 10 Unstoppable Stocks That Could Double Your Money. Disclosure: None. Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data
Yahoo
24-07-2025
- Business
- Yahoo
Bear of the Day: Centene (CNC)
Centene Corporation (CNC), a giant of managed care expected to cross $175 billion in revenues this year, unexpectedly pulled its earnings guidance for 2025 on July 2. This change came after an unexpected shift in the dynamics of the health Insurance Marketplace, which could impact earnings more significantly than what was initially decision followed industry risk adjustment data from the independent actuarial firm Wakely, which analyzed 22 out of Centene's 29 Marketplace states, representing approximately 72% of its Marketplace membership. According to the company, these data showed higher-than-expected overall market morbidity and a slower pace of market is anticipating a shortfall of about $1.8 billion in net risk adjustment revenues, which would mean a $2.75 impact on adjusted diluted EPS for 2025. Although it does not have data from the other seven states, management anticipates a further decline in risk-adjusted revenues due to similar morbidity the revelation, Wall Street analysts slashed their EPS projection for this year, cutting the Zacks profit consensus in half from $7.29 to $3.55 and discounting more of the Good, the Bad, and the UglyDespite headwinds, CNC shared that the final 2024 risk-adjusted results from the Centers for Medicare and Medicaid Services aligned with their expectations, and its Medicare Advantage and Medicare PDP segments are performing better than its expectations in the second quarter of 2025. However, Medicaid is facing challenges due to rising costs in behavioral health, home care and expensive medications, particularly in states like New York and we look toward 2026, Centene is taking proactive steps to adjust its rates, aiming to account for a higher morbidity baseline. This adjustment is seen as a necessary move to help balance out potential losses. The company plans to make these pricing changes in the states where it conducts most of its marketplace business. The early refiling of 2026 rates by CNC suggests a more defensive pricing approach in the of many Wall Street investment banks, Wells Fargo downgraded CNC shares to Equal-Weight and cut their price target from $72 to $30.A close look at second-quarter earnings and data analysis is required to move forward. CNC's second-quarter 2025 results are slated to be released on Friday July 25. Want the latest recommendations from Zacks Investment Research? Today, you can download 7 Best Stocks for the Next 30 Days. Click to get this free report Centene Corporation (CNC) : Free Stock Analysis Report This article originally published on Zacks Investment Research ( Zacks Investment Research 擷取數據時發生錯誤 登入存取你的投資組合 擷取數據時發生錯誤 擷取數據時發生錯誤 擷取數據時發生錯誤 擷取數據時發生錯誤
Yahoo
24-07-2025
- Business
- Yahoo
Centene Corporation (CNC): A Bull Case Theory
We came across a bullish thesis on Centene Corporation on Waterboy's Substack. In this article, we will summarize the bulls' thesis on CNC. Centene Corporation's share was trading at $29.14 as of July 17th. CNC's trailing and forward P/E were 4.30 and 9.13, respectively according to Yahoo Finance. A healthcare professional discussing a treatment plan with a patient in an outpatient clinic. Centene Corporation, a major player in managed care, has been at the center of the recent rout in health insurance stocks, driven by surging costs, higher utilization, and fraud allegations. Sentiment worsened after President Trump signed the One Big Beautiful Bill Act (OBBBA) on July 4, 2025, which aims to cut Medicaid spending by $1 trillion over the next decade through tighter eligibility and shorter enrollment periods, a material headwind for Centene given its Medicaid-heavy business. Shares have been punished, including a one-day 40% plunge after a $1.8 billion downward adjustment in risk-adjustment payments forced management to withdraw its 2025 EPS guidance, though the balance sheet can absorb the hit, and premiums will likely reprice. Founded in 1984 and built through aggressive acquisitions, Centene now serves 25.8 million members and generated $158.1 billion in premiums in 2024, primarily from Medicaid. Though net profit margins hover around 2%, profits are underpinned by $19.7 billion of investments earning 5.2% and a capital-light model that delivered a 14.2% ROE last year. Five-year average free cash flow of $4 billion implies a mere 4.7x EV/FCF multiple, and management retains $2.23 billion under its $10 billion buyback program, capable of retiring nearly 15% of shares at depressed valuations. While regulatory uncertainty clouds earnings power, most downside appears priced in, leaving a margin of safety rooted in Centene's asset base, sticky contracts, and cash generation. EPS growth will likely slow, but the stock's collapse offers contrarians a chance to buy a resilient franchise at crisis-level multiples with substantial upside if political headwinds ease. Previously, we covered a bullish thesis on Molina Healthcare, Inc. (MOH) by Long-Term Pick in February 2025, which highlighted Marketplace growth and upside from new Medicaid and Medicare contracts despite earnings pressure. The company's stock has depreciated about 23.37% since our coverage, as higher medical costs hit margins. The thesis still stands. Waterboy shares a similar view on Centene Corporation but emphasizes its margin of safety from depressed valuation and a resilient balance sheet. Centene Corporation is not on our list of the 30 Most Popular Stocks Among Hedge Funds. As per our database, 64 hedge fund portfolios held CNC at the end of the first quarter which was 72 in the previous quarter. While we acknowledge the potential of CNC as an investment, we believe certain AI stocks offer greater upside potential and carry less downside risk. If you're looking for an extremely undervalued AI stock that also stands to benefit significantly from Trump-era tariffs and the onshoring trend, see our free report on the best short-term AI stock. READ NEXT: 8 Best Wide Moat Stocks to Buy Now and 30 Most Important AI Stocks According to BlackRock. Disclosure: None. Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data
Yahoo
05-07-2025
- Business
- Yahoo
Jim Cramer on Centene: 'Very Painful Story'
Centene Corporation (NYSE:CNC) is one of the 22 stocks Jim Cramer recently talked about. Cramer expressed a bearish sentiment toward managed care companies, including Centene, and said: 'Today, some of the biggest losers in the market were a handful of managed care companies led by a company called Centene… That stock plunged over 40%. This is the worst single-day performance on record because last night after the close, the company withdrew its full-year forecast… A doctor holding a clipboard in a hospital ward, discussing patient treatment plan with the nurses. Centene (NYSE:CNC) provides healthcare services to underserved populations and commercial clients. The company's operations include Medicaid, Medicare, commercial health plans, clinical services, and administrative support. While we acknowledge the potential of CNC as an investment, we believe certain AI stocks offer greater upside potential and carry less downside risk. If you're looking for an extremely undervalued AI stock that also stands to benefit significantly from Trump-era tariffs and the onshoring trend, see our free report on the best short-term AI stock. READ NEXT: The Best and Worst Dow Stocks for the Next 12 Months and 10 Unstoppable Stocks That Could Double Your Money. Disclosure: None. Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data
