MMIT Payer Portrait: Sentara Healthcare

Sentara Healthcare is a Norfolk, Virginia-based nonprofit health system of 12 hospitals and more than 300 other sites of care. Its health insurance unit, Sentara Health Plans, Inc., is the third-largest insurer in Virginia, though it also serves employer groups in Ohio and North Carolina on a smaller scale. Many of Sentara’s products are offered under its Optima Health branding. UnitedHealth Group’s OptumRx and Optum Specialty Pharmacy manage Sentara’s pharmacy benefits.

Sentara is the largest Medicaid stakeholder in Virginia, operating the state’s largest Medicaid managed care plans. In the wake of Virginia’s 2019 Medicaid expansion, Sentara in April 2020 became the majority owner of Virginia Commonwealth University Health System’s Virginia Premier Health Plan, then the second-largest Medicaid MCO in the state. Virginia has seen managed Medicaid growth of nearly 500,000 members since the advent of expansion and the enrollment shifts caused by the COVID-19 pandemic. Also in 2020, Sentara unveiled a deal to merge with Greensboro, North Carolina-based Cone Health, a system of five hospitals in that state, but the deal fell through in June 2021.

Sentara told AIS Health’s Health Plan Weekly (HPW) in April 2022 that it is preparing for the end of the COVID-19 public health emergency (PHE) and the reinstatement of Medicaid eligibility redeterminations, which will shrink Medicaid rolls nationwide. “For members who lose their Medicaid eligibility, we will offer coverage though our individual and family exchange products to ensure that they have the same access to quality providers within our integrated delivery network,” Patti Darnley, senior vice president of government programs with Sentara Health Plans, told HPW. “This will allow members, in many cases, to continue their relationships with their care managers,” she added. The PHE is currently set to expire in October but will likely be extended through at least January 2023. Sentara also enhanced its behavioral health benefits and screening procedures as a result of the pandemic.

SOURCE: AIS’s Directory of Health Plans as of August 2022; MMIT Analytics as of 3Q 2022.

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