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Specialty Services: How Does Centene Manage Them?

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Specialty health insurance

Aside from the standard healthcare policies, players in the private health insurance industry (IYH) also offer specialty insurance. Centene’s (CNC) specialty segment offers services like behavioral health management, care management software, dental benefits management, in-home health services, life and health management, managed vision, pharmacy benefits management, specialty pharmacy, and telehealth services.

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The above graph shows Centene’s enrollments in behavioral health and correctional facility services. These are the major specialty services provided by the company. Also, Centene contracts with third-party providers on a negotiated fee basis for physical therapy, home healthcare, dental, diagnostic laboratory tests, x-ray examinations, transportation, ambulance services, and durable medical equipment.

Behavioral health insurance

The Affordable Care Act stipulates that coverage for mental health and substance abuse treatment must be included in health insurance plans sold on public health exchanges. As a result, major health insurance companies—like Centene, Humana (HUM), Cigna (CI), and UnitedHealth Group (UNH)—offer behavioral health insurance services to their enrollees.

Centene offers behavioral health services through its subsidiary, Cenpatico. It contracts with behavioral health providers to determine the coverage and payment structures. The company also operates school-based programs for students with special needs. It also provides speech and therapy services.

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Care management software

To take advantage of the US healthcare industry rapidly adopting technology to improve coordination and control costs of services, Centene offered an enterprise-wide software to automate and coordinate administrative, technical, and clinical aspects of the care provided. This software is offered through its subsidiary, Casenet.

Correctional healthcare service

To control prison costs, about 20 states in the US outsourced prison healthcare to private health insurance players. It’s estimated that these contracts are worth $3–$4 billion per year. Centene recognized this untapped market. It provides healthcare services to prison inmates in Massachusetts, Texas, and Tennessee state correctional facilities through Centurion—a joint venture subsidiary of Centene and MHM Services.

Effective February 2015, Centene will also provide correctional healthcare services to the Vermont Department of Corrections.

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