Medicaid membership increased by 2% to 14.5 million due to the public health emergency, but the unwinding of continuous coverage requirements is expected to reduce membership. Centene is working to transition members to other coverage options.

Marketplace membership increased by 88% to 3.9 million members due to strong product positioning and overall market growth.

The company completed the divestitures of Operose Health Group and signed a definitive agreement to sell Circle Health Group, continuing the strategic shift away from international operations.

The SG&A expense ratio increased from 8.6% to 9.0% due to growth in the Marketplace business and Medicare distribution costs, partially offset by ongoing SG&A reduction initiatives.

The company completed key milestones in its Value Creation Plan, including divestitures, stock repurchases, operating model changes, and standardization of the pharmacy operating model.

The company is working to improve quality across the enterprise with a focus on enhanced patient experience and access to care, which lays the foundation for strong Medicare Star ratings in the future.

The company's profitability depends on accurately estimating and managing medical expenses, which is subject to various factors beyond their control, including healthcare regulations, utilization, and external events.

Medicare operations are subject to negative outcomes from program audits, sanctions, and failure to maintain or improve quality Star ratings, which could materially and adversely affect the business.

Government customers employ risk-adjustment models, which can result in retroactive adjustments that have a material adverse effect on the company's business.

The company competes with other MCOs, specialty companies, and non-traditional competitors, and some competitors have greater financial resources. Increased competition could adversely affect the company's ability to retain or increase members and providers.

The healthcare service industry is competitive, dynamic, and rapidly evolving. Failure to anticipate or appropriately adapt to changes in the industry could negatively impact the company's competitive position.

The company believes its local and collaborative approach with physicians and other providers gives it a competitive advantage in entering new markets.

The company's strategic approach is to continue to target initiatives to improve productivity, efficiencies and reduced organizational costs, as well as execute on capital deployment activities.

A number of health plans rely on state-operated systems or subcontractors to qualify, solicit, educate and assign eligible members into managed care plans. The effectiveness of these state operations and subcontractors can have a material effect on a health plan's enrollment.

The company's profitability depends, in large part, upon its ability to contract at competitive prices with hospitals, physicians, and other healthcare providers.

The company has employed an investment strategy designed to increase its capability to collect and analyze data and insights.

Data and reporting are delivered via a secure, user-friendly web-based provider portal. This is provided through the company's suite of technology platforms.

The company has invested in new technology to enhance its access to clinical data on gaps in care, committed to integrating its numerous quality platforms into a single unified workflow and developed advanced analytics to more efficiently and effectively target our member engagement efforts for maximal impact on access, quality and member satisfaction.

The company repurchased $1.6 billion of common stock in 2023 and has $5.2 billion remaining under the authorization.

The company expects to spend approximately $640 million in capital expenditures in 2024, primarily associated with system enhancements.

The company expects to receive net dividends of approximately $3.0 billion from regulated subsidiaries during 2024.

Implementation of the Sustainability Framework is overseen by the Board of Directors' Governance Committee and sustainability initiatives throughout the organization are driven by a cross-functional network of executive representatives.

Annually, the company issues a sustainability report, a Task Force on Climate-related Financial Disclosures (TCFD) Index report, and a Sustainability Accounting Standards Board (SASB) Index report.

The company's steadfast commitment to the health and social well-being of communities, fostering a healthy environment and a culture of sound and ethical corporate governance, extends far beyond individual programs or initiatives.

CMS estimates the total Medicaid program will grow from $787 billion in 2022 to $1.2 trillion by 2031. Based on these trends, the company believes a significant market opportunity exists for managed care organizations.

The Congressional Budget Office estimates the total Medicare market will grow from $973 billion in 2022 to $2.1 trillion by 2033.

The company operates in a highly competitive environment in an industry subject to ongoing significant changes, including business consolidations, new strategic alliances, market pressures and regulatory and legislative reform.