CONTENT FROM CENTENE
FOR MODERN HEALTH INSURERS, processing claims quickly and
improving health outcomes are the heart and soul of their operations. Cen-
tene—a St. Louis–based, diversified, multinational healthcare enterprise—is
engaging artificial intelligence (A.I.) and other cutting-edge technology to
better serve its more than 15 million members.
One of Centene’s proprietary machine-learning tools is Interpreta, a
powerful analytics engine that interprets clinical data and can ping real-time
messages to providers. Interpreta can analyze 12 million medical data points
in less than one minute and immediately identify medical red flags and care
gaps. Along with other Centene-derived A.I. tools, it can help identify mem-
bers who are likely to be at risk of opioid addiction, those who might benefit
more from care management, those least likely to comply with a diabetes-
care regimen, and those most likely to require hospital readmission. Predict-
ing such health scenarios enables providers and patients to get a jump on
heading off a health crisis—while reducing healthcare costs in the process.
To further enable cost savings and improve member
and provider satisfaction, Centene deploys “bots” to
process complex claims faster and more efficiently than
humans, reducing manual process time significantly. As
a result of improved productivity, employees who were
once tasked with time-consuming manual administra-
tive processes are able to shift their talents to more
substantial activities, including customer care.
Centene’s use of A.I. extends into the realm of
prescription drug use. Its investment in and partnership
with RxAdvance helps doctors identify potential lower-
cost but clinically equal options within various therapeu-
tic categories. In addition, the company’s proprietary
Casenet and TruCare solutions use integrated care
models to manage complex populations by integrating
data from case management, behavioral health, disease
management, and utilization management processes to
enable care managers to quickly identify gaps in care.
“Our innovations help us consistently refine, tailor,
and improve the care we provide to our members,” says
Michael Neidorff, chairman, president, and chief execu-
tive officer of Centene. “They help us gather and analyze
data quickly, giving providers a comprehensive picture
of our members’ healthcare needs.”
The company’s strategic investments and initiatives
have paid off—and gained some attention this year. As
the largest Medicaid managed care organization in the
country, and the largest insurer in the Health Insur-
ance Marketplace, Centene ranked among Fortune’s
Most Admired Companies in 2019. Due to its leader-
ship in removing barriers to care, it landed at No. 7 on
Fortune’s 2019 Change the World list. And it was ranked
No. 1 on Fortune’s 2019 list of the 100 Fastest-Growing
Companies, based on its 10-year revenue growth. In
2019, it expects to generate revenue exceeding $70
billion—powered by its commitment to A.I.
As Neidorff explains: “Developing complex
algorithms through machine learning to
better predict human behavior means we
can proactively deliver specialized pro-
grams and targeted interventions to the
populations most in need.” ■POWERING PREMIUM
HEALTHCARE WITH
ARTIFICIAL INTELLIGENCE
Centene is harnessing the power of
machine learning and artificial intelligence
to provide better healthcare.
In 2019, Centeneexpects to generaterevenue exceeding$70 billion.