Centivo

Centivo is a health plan administrator that builds and runs self-funded health plans for U.S. employers, with a plan design organized around a primary care relationship. Members select a primary care physician who acts as care coordinator, managing referrals and follow-up after specialist visits, with the stated aim of reducing fragmented care, specialist visits, imaging and emergency room use. The plan design features $0 primary care, no deductibles (plan design may vary by client), low and predictable copays, and low-cost generics, alongside an integrated PCMH-recognized virtual primary care practice.

Centivo handles plan administration, network construction and care coordination. Employers pay for actual claims rather than a fixed premium, with stop-loss insurance covering catastrophic claims, an arrangement the company positions as accessible to mid-market employers as well as large ones. Its network is curated around providers meeting price and quality standards, and unit costs are negotiated directly through health system partnerships. Member-facing tools include a mobile app, a member resources site and a Member Care function; providers use a dedicated portal for eligibility verification and claims submission.

Business model

Centivo acts as the administrator of self-funded employer health plans, assembling the provider network, plan administration and care coordination while the employer funds claims directly and stop-loss insurance covers catastrophic risk.

Revenue derives from serving as the health plan administrator for self-funded employer clients rather than from collecting insurance premiums.

Traction

The company reports average annual employee out-of-pocket costs of $409 versus a cited industry average of $1,650, and employer savings of roughly 15-30% relative to traditional fully-insured plans.