SAN FRANCISCO, July 7, 2025 /PRNewswire/ -- On July 2, 2025, investors in Centene Corp. (NYSE: CNC) saw the price of their shares of this normally low-volatility stock crash 40%, after the company withdrew its guidance, blaming preliminary discussions and data generated by an independent actuary, Wakely.The unusual circumstances and severe investor reaction has prompted national shareholders rights firm Hagens Berman to open an investigation into whether Centene may have violated the securities laws. The fi ...

SAN FRANCISCO, July 03, 2025 (GLOBE NEWSWIRE) -- On July 2, 2025, investors in Centene Corp. (NYSE: CNC) saw the price of their shares of this normally low-volatility stock crash 40%, after the company withdrew its guidance, blaming preliminary discussions and data generated by an independent actuary, Wakely. The unusual circumstances and severe investor reaction has prompted national shareholders rights firm Hagens Berman to open an investigation into whether Centene may have violated the securities laws. ...

Key Takeaways CNC withdrew its 2025 guidance due to higher-than-expected market morbidity and slowing growth. An expected $1.8B drop in risk adjustment revenue may cut 2025 EPS by approximately $2.75. CNC plans 2026 rate hikes to offset losses, signaling a more defensive pricing strategy ahead.A leading healthcare company, Centene Corporation (CNC) , has unexpectedly pulled its earnings guidance for 2025, shaking up the managed care industry. This change comes after an unexpected shift in the dynamics of ...

Core Viewpoint - Centene has withdrawn its 2025 guidance due to lower-than-expected market growth in over 20 states, impacting its risk adjustment revenue expectations significantly [2][3]. Group 1: Market Analysis - An independent actuarial firm's analysis indicated that the overall market growth in 22 states where Centene operates is lower than anticipated, with morbidity levels being significantly higher than the company's previous assumptions [3]. - The analysis covers 22 of the 29 states where Centene sells individual coverage, representing approximately 72% of the company's marketplace membership [3]. Group 2: Financial Impact - Centene's preliminary analysis suggests a reduction in its full-year net risk adjustment revenue transfer expectation by about $1.8 billion, which translates to an adjusted diluted EPS impact of approximately $2.75 [4]. - The estimate is based on paid claims data through April 30, 2025, and includes projections for the remaining eight months of the year [4]. Group 3: Enrollment Trends - Centene's enrollment in Obamacare increased by 29% to 5.6 million members in the first quarter of the year, up from 4.3 million a year ago, despite a decrease of over 330,000 enrollees in Medicaid coverage [4]. Group 4: Legislative Context - The announcement coincides with the U.S. Senate passing a budget bill that could lead to 11 million Americans losing health insurance coverage, primarily affecting those enrolled in Obamacare and Medicaid, which Centene administers [5]. Group 5: Future Reporting - Centene is currently closing its second quarter and analyzing data, with plans to report its second quarter 2025 results and provide further insights on July 25 [6].

Core Viewpoint - Centene Corporation has withdrawn its previous 2025 GAAP and adjusted diluted earnings per share (EPS) guidance due to lower-than-expected market growth and higher morbidity rates in the Health Insurance Marketplace [1][3]. Group 1: Financial Guidance and Market Analysis - The company analyzed 2025 Marketplace data from Wakely, covering 22 of its 29 states, which represents approximately 72% of its Marketplace membership [2]. - The preliminary analysis indicates a reduction in the full year net risk adjustment revenue transfer expectation by approximately $1.8 billion, leading to an adjusted diluted EPS impact of about $2.75 [4]. - The company anticipates further reductions in net risk adjustment revenue transfer expectations for the remaining seven states based on observed morbidity trends [5]. Group 2: Future Pricing and Market Strategy - Centene has begun the process of refiling 2026 Marketplace rates to reflect a higher projected baseline of Marketplace morbidity than previously expected [6]. - The company expects to implement corrective pricing actions for 2026 in states representing a substantial majority of its Marketplace membership [6]. Group 3: Medicaid and Medicare Performance - The Medicaid business has seen a step-up in medical cost trends, particularly in behavioral health, home health, and high-cost drugs, with expectations for a higher Medicaid Health Benefits Ratio (HBR) in Q2 2025 compared to Q1 2025 [8]. - The Medicare Advantage and Medicare Prescription Drug Plan businesses are performing better than expected in Q2 2025, contributing positively to the company's overall financial performance [9]. Group 4: Upcoming Reporting - The company is in the process of closing Q2 2025 and will report results and provide additional insights on July 25, 2025 [10].

Summary of Astrana Health (ASTH) Conference Call Company Overview - **Company**: Astrana Health - **Industry**: Healthcare Delivery - **Business Model**: Partners with physicians to create managed healthcare networks, focusing on value-based arrangements with payers [4][6] Key Business Metrics - **Physician Partnerships**: Over 12,000 physicians [4] - **Patient Base**: Approximately 1,100,000 patients in value-based arrangements [5] - **Revenue Growth**: Reported a 53% year-over-year revenue growth in Q1 [7] - **Profitability**: Continues to grow profitability and generate cash [7] Recent Acquisition - **Acquisition of Prospect Health**: - **Transaction Value**: $745 million [8] - **Network Size**: 14,000 physicians serving around 600,000 patients [10] - **Geographic Focus**: Primarily Southern California [10] - **Financials**: Prospect generated $94 million in adjusted EBITDA and $1.2 billion in revenue in 2024 [13] - **Synergies Expected**: $12 to $15 million in cost-related synergies within the first 12 to 24 months [14] Integration and Risks - **Integration Experience**: Previous successful acquisitions have built operational capabilities for seamless integration [19] - **Potential Risks**: Concerns about provider network retention during integration; however, positive reception from physicians has been noted [22][24] - **Operational Risks**: Minimal due to similarities in operational models and existing technology platforms [21] Medicare and Market Trends - **Medicare Advantage**: Represents about 60% of Astrana's business; company is not seeing the same negative trends reported by competitors [39][40] - **Risk Adjustment**: Astrana's risk scores are stable and have improved, positioning the company favorably against upcoming reforms [41][42] - **Market Outlook**: Anticipates a material tailwind from Medicare Advantage rate adjustments [50] Medicaid Insights - **Revenue Impact**: Approximately $2.6 billion in revenue, with 28% from Medicaid; potential for a 20-30% reduction in Medicaid members due to stricter eligibility checks [57][58] - **Profitability**: Medicaid is the lowest margin business but still profitable [57] Commercial Business - **Growth Strategy**: Focus on partnerships with Anthem Blue Cross to build co-branded clinics [67] - **Risk Management**: Historically avoided full risk in commercial due to scale concerns, but may explore this in the future [68] Future Guidance - **2027 EBITDA Target**: $350 million, with conservative growth assumptions [69] - **Confidence in Projections**: Strong belief in achieving guidance based on current operational strategies and market conditions [72] Conclusion - **Long-term Vision**: Astrana aims to demonstrate the viability of running a profitable value-based care company while expanding its footprint in California and beyond [73][75] - **Market Position**: Positioned as a leading player in the healthcare delivery space with a focus on quality and cost-effective care [75]

Financial Data and Key Metrics Changes - Oscar Health reported total revenue of $3 billion in Q1 2025, a 42% increase year over year [5] - Net income was approximately $275 million, a significant improvement of $98 million over the prior year period [6][20] - Earnings from operations grew by $112 million to $297 million, with an operating margin of 9.8%, an increase of 110 basis points year over year [6][18] - The medical loss ratio (MLR) increased by 120 basis points year over year to 75.4% [6][15] - The SG&A ratio improved to 15.8%, a 260 basis point improvement year over year, marking the lowest in the company's history [6][17] Business Line Data and Key Metrics Changes - The company closed the quarter with approximately 2 million effectuated members, a 41% increase year over year [7][14] - Membership growth was driven by strong retention and above-market growth during open enrollment [14] Market Data and Key Metrics Changes - Oscar Health is deepening its market presence with new partnerships, including the launch of Oscar Community Resources with Find Help, connecting members to local services [8] - The company is experiencing high levels of digital engagement across its IFP and ICRA membership [7] Company Strategy and Development Direction - Oscar Health's strategic plan focuses on top-line growth, bottom-line performance, and margin expansion [6][12] - The company is advocating for constructive solutions to strengthen the individual market and is engaged with policymakers [10][11] - Oscar aims to create a marketplace that meets consumer and employer expectations for choice, quality, and affordability [12] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in achieving 2025 targets, citing disciplined execution and strong growth [12][22] - The current policy environment, including proposed CMS initiatives, is viewed as positive for long-term market sustainability, despite potential enrollment constraints [10][11] - Management anticipates membership trends to increase in the first half of the year but expects a decline in the latter half due to policy changes [29] Other Important Information - The company reaffirmed its full-year guidance metrics, expecting total revenue in the range of $11.2 billion to $11.3 billion for 2025 [21] - Oscar Health's capital position remains strong, with approximately $4.9 billion in cash and investments [20] Q&A Session Summary Question: Membership expectations for the second quarter and the rest of the year - Management expects membership to trend up in the first half of the year but anticipates a decline in the latter half due to policy changes [28][30] Question: Context around grace period membership and its impact - Management indicated that the gap between effectuated and paid membership is expected to normalize, with a portion of members ending their grace period [34] Question: Utilization patterns between new and retired members - Management noted higher inpatient utilization with favorable pharmacy trends, but no specific condition was driving the inpatient increase [39] Question: Opportunities and risks around competitor exits - Management views competitor exits as an opportunity to attract members and maintain disciplined pricing in the market [42][58] Question: Regulatory environment and enrollment changes - Management supports CMS efforts to strengthen the ACA but expressed concerns about the shortened enrollment period affecting consumer shopping [48] Question: Risk adjustment expectations for 2025 - Management indicated no significant adjustments to risk adjustment payables at this time, but elevated claims could impact future percentages [60] Question: Drivers of SG&A performance - Management attributed SG&A improvements to fixed cost leverage, variable cost efficiencies, and lower exchange fee rates [70][71] Question: Valuation concerns and fraudulent member estimates - Management is conducting its own analysis regarding fraudulent members and remains committed to long-term targets despite market challenges [75] Question: CSR refund proposal and its implications - Management expressed concerns about the practical implementation of CSR refunds and recommended against moving forward with the proposal for 2026 [80]

Financial Data and Key Metrics Changes - For Q1 2025, total revenue was $1.53 billion, down from $1.6 billion in Q1 2024, primarily due to market and partnership exits, partially offset by premium growth [21] - Membership at the end of Q1 2025 was 491,000, a decrease from 523,000 in Q1 2024, reflecting a cautious approach to growth and partner exits [19] - Medical margin for Q1 2025 was $128 million, down from $157 million in Q1 2024, driven by elevated utilization and costs [21][22] - Adjusted EBITDA for Q1 2025 was $21 million, compared to $29 million in Q1 2024, reflecting ongoing elevated cost trends [23] Business Line Data and Key Metrics Changes - ACO REACH membership decreased to 114,000 in Q1 2025 from 131,000 in Q1 2024, primarily due to exiting an underperforming partnership [20] - Medical costs for Q1 2025 were in line with expectations, driven by elevated utilization and flu-related costs [22] - The medical cost trend for year two plus markets was 5.5% in Q1 2025, down from 6.7% in Q1 2024 [24] Market Data and Key Metrics Changes - The Medicare Advantage market continues to expand, with CMS data showing a year-over-year growth trend of 3.9% [10] - Overall market trends in 2025 remain consistent with the prior year, with an expected full-year trend of 5.3% [9] Company Strategy and Development Direction - The company is focused on disciplined growth, reducing exposure to costs outside of its control, and enhancing clinical and operational capabilities [6][12] - Investments in technology and clinical programs are expected to drive competitive advantages and improve quality outcomes [13][14] - The company anticipates a more favorable environment in 2026, supported by improved payer bids and final rate notices from CMS [11][18] Management's Comments on Operating Environment and Future Outlook - Management expressed optimism about the final rate notice from CMS for 2026, which is expected to address high cost and utilization trends [6][18] - The company is taking a cautious approach to membership growth, with expectations for retroactive membership assignments in Q2 [5][19] - Management highlighted the importance of early identification and management of chronic diseases as a key focus of their model [7][10] Other Important Information - The company ended Q1 2025 with $369 million in cash and marketable securities, expecting to use approximately $110 million of cash in 2025 [27] - The company is maintaining a disciplined approach to capital allocation to support business objectives while aiming for cash flow breakeven in 2027 [27] Q&A Session Summary Question: Impact of V-28 risk model transition on value-based care companies - Management indicated that the risk adjustment perspective for 2025 is in line with expectations, with a 2% net increase year over year, despite a 3% headwind from V-28 [33][34] Question: Contribution from previously exited areas - Management noted that unfavorable development from exited markets would not impact 2025 significantly, with minimal remaining IBNR [37][38] Question: 2026 MA final rate notice and its flow-through - Management confirmed that 40% of membership was repriced for January 2025, with expected benefits from the average 9% increase across the network [41][42] Question: Risk scores and patient movement - Management clarified that the 2% increase in risk adjustment is on a same member basis, with some movement between payers noted but not significantly affecting care models [49][52] Question: Expectations for 2026 MA bit cycle - Management expressed optimism about the 2026 environment, with a focus on quality incentives and clinical cost-saving initiatives tracking well [58][61] Question: Medical cost trends and visibility on completed claims - Management stated that medical cost trends were in line with expectations, with improved visibility from the new financial data pipeline [65][66] Question: Potential membership reduction due to Part D - Management indicated that they are making progress in reducing Part D exposure and do not anticipate a reduction in membership for 2026 [75][76] Question: Clinical programs and their impact - Management confirmed that while 2025 is an investment year for new clinical programs, benefits are expected to materialize in 2026 and beyond [104][106]

Humana (HUM) Q1 2025 Earnings Call April 30, 2025 08:00 AM ET Company Participants Lisa Stoner - Vice President-Investor RelationsJames Rechtin - President & CEOCeleste Mellet - CFOBen Hendrix - Vice PresidentGeorge Renaudin - President of Medicare & Medicaid and DirectorAndrew Mok - DirectorA.J. Rice - Managing DirectorJoshua Raskin - Partner - Managed Care & ProvidersLance Wilkes - Managing DirectorLisa Gill - Managing DirectorDavid Windley - Managing Director Conference Call Participants Sarah James - An ...

Centene (CNC) Q1 2025 Earnings Call April 25, 2025 03:39 PM ET Company Participants Jennifer Gilligan - Senior Vice President, Finance & Investor RelationsSarah London - CEOAndrew Asher - Executive VP & CFOA.J. Rice - Managing DirectorDave Windley - Managing DirectorAndrew Mok - DirectorLance Wilkes - Managing DirectorJohn Stansel - VP - Equity ResearchMichael Halloran - Associate Director of Research Conference Call Participants Joshua Raskin - Research AnalystJustin Lake - Analyst - Healthcare ServicesAnn ...