Running public healthcare programs has always been complicated. However, in recent years it has become utterly unforgiving. State and federal agencies are expected to manage massive populations, comply with ever-changing regulations, respond fast to policy changes, and still deliver flawless services.
Behind the scenes, this work depends on systems that can handle scale without breaking, and on teams that understand healthcare and government operations pretty well. This is the environment Acentra Health operates in.
The company exists almost entirely in the background of public healthcare. It supports programs most people barely think about until they need them. Medicaid systems, utilization reviews, care coordination, appeals processing, provider enrollment – these functions are critical. However, they are also complex and often invisible.
When they work, beneficiaries get care on time and providers get paid accurately. Contrarily, when they fail, delays and confusion quickly ripple across the system.
Acentra Health was formed in 2023 through the combination of two organizations with long histories in this space. One of them was CNSI, known for building large-scale health IT systems. The other one was Kepro, a clinical and care management service provider.
The merger brought together two sides of the same problem, technology and clinical operations, under one roof. The newly built company didn’t dream of reinventing public healthcare. It wanted to make systems that made support way more reliable and manageable.
Today, Acentra Health supports public sector clients in all 50 states. Its teams work with federal and state agencies that collectively serve more than 140 million people. That work includes processing billions of claims and encounters each year, conducting millions of utilization reviews, completing hundreds of thousands of clinical assessments, and so on.
The scale alone calls for strict measures. Neither the systems can go down, nor do processes refuse repetition. Moreover, decisions must stand up to audits and legal review.
Much of Acentra’s work revolves around the operational backbone of public healthcare programs. Its technology platform, evoBrix X™, can handle high-volume transactions. Such transactions may include claims processing, eligibility management, assessments, and financial reporting.
“Public healthcare systems barely get credit for flashy offers. Practically, they get judged on whether people receive care on time, providers are paid correctly, and programs hold up under dynamic compliance standards. Our responsibility is to make sure the systems behind those outcomes are accountable and long-lasting.” – Todd Stottlemyer, CEO
Notably, the platform is configurable. It allows programs to adapt to different policy rules and timelines without rebuilding systems from scratch. This flexibility is crucial in government environments, because there, requirements change but continuity remains non-negotiable.
Technology, however, is only part of the equation. Public healthcare programs also depend on clinical judgment. Utilization management, care coordination, appeals, etc need experienced professionals, who understand medical necessity and regulatory standards.
Acentra employs thousands of clinicians, nurses, and case managers who perform these functions effectively. Their work is supported by structured tools and standardized workflows. However, at the same time, it is driven by human review.
Care coordination is a good example of how Acentra blends systems with services. Many beneficiaries in public programs have multiple conditions. Naturally, they interact with several providers. Now, if there’s lack of coordination, care turns fragmented and costly.
Acentra’s teams help identify individuals who need closer monitoring. In addition, it connects them with appropriate services, and tracks progress over time.
The company pays enough attention to member experience. Generally, people find public healthcare programs a bit difficult to explore and handle. Acentra supports agencies with digital tools that give beneficiaries better access to information about coverage, claims, services, etc.
Members can check status updates through web portals and mobile applications. They can also find providers, and understand benefits. Importantly, these tools are built using national interoperability standards. Hence, data remains protected and consistent.
Acentra Health also caters to providers. Many times, enrollment and credentialing delays disrupt care delivery. Moreover, those reduce network capacity. Acentra offers provider engagement services. Such services help streamline the mentioned processes through digital workflows and automated checks.
It’s worth mentioning that Acentra invests in modern infrastructure. It’s among the first organizations to migrate a Medicaid Management Information System to the cloud. It works with hyperscale providers to make reliability and scalability better.
Consequently, agencies can process transactions more efficiently. Moreover, they achieve better visibility into system performance. Importantly, when making these changes, Acentra adheres to the strict security and compliance requirements related to sensitive health data.
Recently, Acentra has begun applying artificial intelligence in specific, controlled ways. Instead of replacing decision-making, these tools support staff by reducing repetitive work. For example, MedScribe, a generative AI application. It assists nurses in drafting Medicare appeal response letters.
The tool helps structure documentation quickly. However, clinicians still retain responsibility for review and final approval. Consequently, healthcare teams can save enough time because they don’t need to carry out complicated, extensive paperworks.
However, Acentra’s USP is not a single product or service. The company stands out because of the way it fits its pieces together. It’s a well-planned, complete cycle. Here, technology supports operations and operations, in turn, inform technology. Moving forward, clinical expertise builds workflows. This integrated approach helps understand public healthcare functions better.
Behind everything, there’s a strong, dedicated leadership. Todd Stottlemyer, Acentra Health’s Chief Executive Officer, prefers nurturing a solution-focused mindset in the organization.
The company’s direction admired stability and accountability. It never encourages imprudent experimentation.
In a nutshell, Acentra Health represents a trusty partner for CIOs and program leaders in government healthcare. It understands the stakes. And that’s why, the organization never chases those big innovation headlines. Instead, it prioritizes ensuring that essential programs run predictably and adapt responsibly. It continues to serve the people who depend on them. In public healthcare that’s crucial because here, consistent performance is often the most prominent indicator of success.