What Centivo does

Centivo is a primary-care-centered health plan administrator founded in 2017 and headquartered in Buffalo, NY, serving self-funded employers in the mid-market segment (typically 50-3,000 employees) across 14 U.S. states. The company designs health plans that eliminate deductibles, offer free or low-cost primary care visits, and route members through curated provider networks built around quality and cost standards. Distribution is exclusively through benefits brokers and consultants, with implementations typically taking 60-90 days from contract to go-live.

The product platform combines a self-funded plan administration backbone with the Centivo Care virtual primary care practice (one of the first virtual care practices to achieve NCQA Patient-Centered Medical Home recognition), a member portal and mobile app (my.centivo.com), and a provider portal integrated via Availity for eligibility, claims, and referral management. In May 2024, Centivo acquired Eden Health to bring virtual primary care clinical capabilities in-house, and in February 2025 launched a partnership product with Premise Health for employers and unions.

Centivo's revenue model is built on administrative fees charged to self-funded employers, who additionally bear actual claims costs under the self-funded arrangement. The company has raised over $200 million cumulatively from investors including Morgan Health (JPMorgan Chase), B Capital Group, Maverick Ventures, Bain Capital Ventures, Bessemer Venture Partners, F-Prime Capital, MemorialCare Innovation Fund, Define Ventures, and Cone Health Ventures. Customers span mid-market regional employers (regional grocery, automotive dealerships, manufacturers) and Fortune 500 companies. Reported operational performance includes 15-30% employer savings versus fully-insured benchmarks, average employee out-of-pocket of $409 versus $1,650 industry average, 32% fewer ER visits and 10% fewer inpatient admissions versus benchmark, and a 96% customer satisfaction score for Centivo Care.

Name

Centivo

Legal name

Centivo Corporation

Website

https://centivo.com

Company type

Private

Founded year

2017

Operating status

Operating

Headcount range

251–500 employees

Short description

Centivo is a primary-care-centered health plan administrator serving self-funded employers with 50-3,000 employees across 14 U.S. states, distributing exclusively through benefits brokers and consultants and offering plans with free primary care, no deductibles, and an NCQA-recognized virtual primary care platform.

Ownership category

akta.pro rank

Product category

Self-Funded Health Plan Administration

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292)

SIC

Hospital & Medical Service Plans (6324)

akta.pro primary industry

Self-Funded (ERISA) Employer Plans (HLAEAAAC)

akta.pro secondary industry

Level-Funded Employer Plans (HLAEAAAE)

Keywords

• Self-funded health plans
• Health plan administration
• Virtual primary care
• Employer health benefits
• Benefits broker platform

Headquarters

HQ city

Buffalo

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure

Revenue model

1. Self-Funded Health Plan Administration: Centivo administers self-funded health plans for employers, handling plan administration, network management, and care coordination. Revenue comes from administrative fees charged to self-funded employers.
2. Level Funded Plans: Level funding solution offering predictability of fully insured plans with upsides of self-funded ones, targeting employers not ready for full self-funding.
3. Virtual Primary Care Services: Centivo Care virtual primary care practice integrated into health plans, providing coordinated virtual care with potential shared savings opportunities.

Pricing tiers

Go-to-market motion2 records

Distribution channels3 records

Marketing channels6 records

Core offering

Centivo designs and administers primary-care-centered self-funded health plans for employers with 50-3,000 employees across 14 U.S. states, sold exclusively through benefits brokers and consultants. The plans feature free primary care visits, no deductibles on Partnership Plans, low predictable copays, and integrate the Centivo Care virtual primary care practice alongside curated provider networks of directly contracted high-value health systems. Level-funded plans are offered as a transitional hybrid product for employers not yet ready for full self-funding.

Product overview

Centivo offers a unified health plan platform centered on primary care for self-funded employers. The core product is the Centivo Health Plans offering, which integrates the Centivo Care virtual primary care practice, the Centivo Network of value-based providers, and member-facing digital tools (mobile app and member portal). The company also provides level-funded plan options as a transitional offering. In 2024, Centivo expanded its capabilities through the acquisition of Eden Health, whose virtual-first medical and mental health technology is now integrated into the Centivo Care platform.

Differentiator

Problem solved

Functional benefit

Brands

• Centivo Care: A virtual primary care practice offering personalized primary care with free appointments, integrated behavioral health, and care coordination. One of the first virtual care practices to achieve Patient-Centered Medical Home accreditation from the National Committee for Quality Assurance.

Products and services

• Centivo Health Plans (Self-Funded Partnership Plans) Primary-care-centered self-funded health plans for employers with 50-3,000 employees, featuring free primary care visits, no deductibles on Partnership Plans, low predictable copays, curated provider networks, and integrated virtual primary care. Sold exclusively through benefits brokers and consultants.
• Centivo Care (Virtual Primary Care) Virtual primary care practice offering no-cost virtual appointments, behavioral health, medication management, and care coordination. One of the first virtual care practices to achieve NCQA Patient-Centered Medical Home recognition, with a 96% customer satisfaction score.
• Centivo Member Portal (my.centivo.com) Member-facing digital platform for finding doctors, viewing coverage and costs, accessing pharmacy benefits, managing referrals, viewing claims and spending, and contacting Member Care.
• Centivo Mobile App Mobile application enabling plan members to search for doctors, access digital ID cards, view claims and spending, and contact Member Care on mobile devices.
• Centivo Provider Portal Provider-facing portal delivered through Availity integration for eligibility verification, claims submission, claim status inquiries, and referral management.
• Centivo Network (Curated Provider Network) Proprietary value-based provider network featuring direct contracts with high-value health systems selected for quality and cost standards, supplemented by independent primary care practices, virtual care options, and national network partners such as Cigna, HPS Network, and PHCS Network for out-of-area coverage.
• Level Funded Health Plans Hybrid health plan product combining the predictability of fully insured plans with the cost advantages of self-funding, designed as a transitional option for employers not ready for full self-funding.

Quantifiable outcome

• 15-30% employer savings vs traditional fully-insured plans
• +5 more outcomes

Named customers5 records

Segments4 records

Ideal customer profiles2 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration3 records

Feature4 records

Partnerships

Seven partnerships are on record, tiered core and supporting.

• Premise HealthcoreStrategic or Co-development Partner · 26 February 2025Partnership to create a new primary care-centered health plan for employers and unions. Combined Centivo's health plan technology with Premise Health's primary care capabilities to deliver comprehensive healthcare benefits.
• MercycoreStrategic or Co-development Partner · 22 October 2024Collaboration to bring Centivo's curated health plan to St. Louis. Mercy provides the healthcare provider network while Centivo provides the plan administration and design.
• Eden HealthcoreStrategic or Co-development Partner · 20 May 2024Acquired Eden Health, a virtual-first medical provider, to expand primary care health plans across the U.S. The deal integrated Eden's clinical services and technology, enhancing virtual primary care offerings and broadening patient access. This acquisition built on Centivo's capability to deliver integrated virtual care.
• CignasupportingTechnology or IntegrationSome Centivo plans use Cigna networks for provider access, particularly for out-of-area coverage and national network options.
• HPS NetworksupportingTechnology or IntegrationHPS Network covers Eastern Wisconsin, with additional provider access outside the HPS service area for plan members.
• PHCS NetworksupportingTechnology or IntegrationMulti-network arrangement for plan members needing broader provider access.
• AvailitysupportingTechnology or IntegrationProvider portal integration for eligibility verification, claims submission, and referral management through Availity's real-time health information network.

Scale indicators13 records

Recent moves6 records

Expansion highlights6 records

Emerging players

• Aledade: Aledade partners with independent primary care physicians to build value-based care arrangements, primarily serving Medicare ACOs but increasingly extending into commercial/employer markets. Shares Centivo's primary-care-centered thesis but operates in a different payer segment.

Direct peers

• Premise Health: Premise Health operates employer-sponsored primary care clinics and wellness centers. Premise is both a Centivo partner (for a primary-care-centered health plan launched February 2025) and a competitor in the employer primary care market.
• Marathon Health: Marathon Health provides on-site and near-site primary care to self-funded employers through its employer-sponsored health center network. Comparable to Centivo Care's primary-care-centered model, though Marathon focuses on employer-owned clinics rather than virtual-first care.
• Collective Health: Collective Health is a leading technology-driven health benefits administrator focused on self-funded employers. Like Centivo, it targets mid-market and large employers seeking modern plan administration with curated networks and better member experience, competing head-to-head in the broker channel.
• HealthComp Holdings: HealthComp is a third-party administrator of self-funded health plans for employers of all sizes. It competes in the same self-funded TPA market as Centivo, offering plan administration, claims processing, and care management services to employer clients.
• apree health: Formed by the merger of Vera Whole Health and Castlight Health, apree health combines primary care clinics with a health navigation platform, serving self-funded employers — directly comparable to Centivo's primary-care-centered model with integrated virtual care.
• Surest (UnitedHealth Group): Surest (formerly Bind) is UnitedHealth Group's modern, copay-based health plan for self-funded employers. It competes directly with Centivo's no-deductible, predictable-copay design and shares a similar target market of self-funded mid-market and large employers.

Broad incumbents

• Cigna Healthcare: Cigna is a major carrier offering self-funded employer plans and broad national networks. Cigna is also a partial Centivo partner (some Centivo plans use Cigna networks for out-of-area coverage), making it both competitor and infrastructure provider.
• Elevance Health (Anthem): Elevance Health (Anthem) is a major US health insurer with significant self-funded/ASO business across Blue Cross Blue Shield plans. It competes with Centivo in the self-funded employer market with broader networks and Blue brand trust, particularly in Centivo's existing 14 states.
• UnitedHealthcare (UnitedHealth Group): UnitedHealthcare is the largest US health insurer, offering self-funded ASO products, broad national networks, and increasingly Optum-integrated primary care and virtual care. It is the dominant incumbent Centivo competes against in the broker channel.

Market position

Strengths4 records

Weaknesses4 records

Competitive moat5 records

Key risks6 records

Key highlights6 records

Customer concentration

• Facebookfacebook.com/CentivoHealth
• LinkedInlinkedin.com/company/centivo
• Xx.com/Centivo_Health

Compliance6 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles13 records

Subsidiaries1 record

Funding overview

Funding rounds7 records

Investors20 records

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A1 record

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Centivo