Sarah London rebuilt Medicaid giant Centene around data after the bloat years (interview)

In a Fortune interview published March 24, 2026, CEO Sarah London describes how she has transformed Centene's portfolio, technology, and culture since taking over in 2022 at 41 — still the youngest woman to lead a Fortune 500 firm. Her predecessor Michael Neidorff built the company from a St. Louis regional Medicaid plan with about $40 million in revenue into the largest US Medicaid managed-care organization; that acquisition-led growth, she says, brought bloat and 'hadn't been as much focus on operating discipline,' so she sold off several noncore operations.

The rebuilt operating model leans on data: London says every claim runs through 75 fraud, waste, and abuse algorithms daily and predictive algorithms flag members likely to have high-risk births (self-reported in the interview). Centene runs work programs in more than 17 states, and in May 2024 she announced at Fortune Brainstorm Health a partnership to build $900 million of affordable housing in eight states to improve health outcomes. A One-CenTeam initiative is meant to make the insurer a catalyst for healthier communities.

The results are mixed. Fortune reports 2025 revenue grew almost 20% to $194.8 billion, but Centene posted a $6.7 billion net loss on a write-down tied to the One Big Beautiful Bill Act, which cuts federal Medicaid spending by more than $900 billion over ten years. In July 2025, after data showed its ACA plans enrolling fewer and sicker people, London withdrew earnings guidance and shares fell 40% in a day to an eight-year low.

She told Fortune it is 'hard not to feel like pulling guidance and cutting the stock in half is a failure,' and described a 'new normal' of compounding pressures on the system. Analysts do not expect the federal cuts to hit Centene's top line massively, and London argues the reforms underscore the need for a holistic, high-tech approach to caring for vulnerable populations.

2025 revenue rose almost 20% to $194.8 billion, but Centene posted a $6.7 billion net loss and shares fell 40% in a day after it pulled 2025 guidance.

More than half of Centene's revenue comes from Medicaid, where it is the largest US insurer, so a $900 billion federal cut lands on its core business.

Neidorff's acquisition-led growth left, in London's words, plenty of mission but too little operating discipline; noncore sales and integration were the correction.

Centene serves a higher proportion of sicker patients than many insurers, making data-driven prevention of expensive events the main cost lever.

The guidance withdrawal showed the old playbook — growth on subsidized ACA enrollment — had stopped working as enrollment shrank and acuity rose.

In a policy-driven business, an operating model rebuilt around data — divesting noncore units, automating oversight, preventing high-cost events — is a hedge to build before funding turns, not after.

As of the March 2026 interview the reset was still running under pressure: the administration had announced new Medicare and Medicaid fraud crackdowns in February, on top of funding cuts and expired ACA tax credits already in effect. London argues there was 'quite a bit of bipartisan support' for making the sector more efficient and frames the moment as underscoring the need for holistic, technology-enabled care. The piece reports no post-reset profit figures; the latest verified results are the $194.8 billion revenue, the $6.7 billion loss, and the July 2025 guidance withdrawal.