The Ledger

1.09 billion dollars: that is the profit Centene posted this morning, a swing from a 253 million dollar loss a year ago, after the country’s largest Medicaid managed-care insurer got its medical costs under control faster than Wall Street expected. Centene Corporation reported second quarter 2026 total revenue of 53.58 billion dollars, up 10 percent year over year and well above analyst estimates near 47.5 billion dollars, with GAAP diluted earnings per share of 2.19 dollars and adjusted diluted earnings per share of 2.51 dollars against a Wall Street consensus near 89 cents to 1.07 dollars. The swing came from Centene’s health benefits ratio, the share of premium dollars spent on medical care, falling to 89.6 percent from 93.0 percent a year earlier, which the company attributed to repriced marketplace plans, Medicaid rate increases and a favorable resolution of 2025 Medicare Advantage items. Centene raised its full year 2026 adjusted diluted earnings per share guidance to more than 4.80 dollars, up from more than 3.40 dollars, and total revenue guidance to 193.5 to 197.5 billion dollars; shares rose as much as 2 percent after the report. The results carried a warning sign: total at-risk membership fell to 25.9 million from more than 28 million a year ago, driven mostly by Marketplace enrollment under the Ambetter brand collapsing to 3.5 million from 5.8 million, which the company ties to Congress and the White House declining to extend enhanced Affordable Care Act tax credits, pushing premiums higher for exchange shoppers. Confidence: High on the reported figures and guidance, since they come directly from Centene’s own SEC filing; Medium on membership trends through year end, since they depend on unresolved subsidy policy. Sources: Centene Corporation Reports Second Quarter 2026 Results, U.S. Securities and Exchange Commission 8-K exhibit, Centene Reports $1 Billion Profit As Health Insurer’s Costs Ease, Forbes.

1.45 billion dollars: that is what a scientific-instruments and device maker paid to more than double its recurring medical device revenue overnight. Novanta Inc. announced July 27, 2026 that it completed its acquisition of Riverpoint Medical from private equity firm Arlington Capital Partners, paying 1.2 billion dollars in cash at closing plus a 250 million dollar milestone payment due in the first quarter of 2027, a total transaction value of up to 1.45 billion dollars, or roughly 19 times Riverpoint’s estimated 2026 adjusted EBITDA before synergies. Riverpoint makes minimally invasive surgical consumables, including surgical fibers used in sports medicine, trauma and cardiovascular procedures; Novanta said the deal roughly doubles its recurring medical consumables revenue to about 300 million dollars, pushes medical end markets to 60 percent of total company revenue, and should add 0.18 to 0.25 dollars to 2027 adjusted earnings per share. Confidence: High, since the deal terms and closing come directly from Novanta’s own announcement. Source: Novanta Completes Acquisition of Riverpoint Medical, Business Wire.

272.1 million dollars: that is all the disclosed spending on medical outpatient building deals in the second quarter, down from 927 million dollars in the first quarter, as capital-market caution reaches one of healthcare real estate’s steadiest corners. LevinPro HC, the research platform published by Irving Levin Associates, reported July 28, 2026 that medical outpatient building merger and acquisition activity fell to 51 publicly announced transactions in the second quarter of 2026, down 26 percent from 69 deals in the first quarter and down from 65 deals in the second quarter of 2025; disclosed dollar volume fell from 927 million dollars across 34 priced deals in the first quarter to 272.1 million dollars across just 13 priced deals in the second quarter. Montecito Medical Real Estate was the most active buyer with 13 deals totaling more than 539,000 square feet, and Lincoln Property Company closed the quarter’s single largest disclosed transaction, three properties totaling more than 291,000 square feet across California, Colorado and Texas; Georgia, Texas and Florida were the most active states. LevinPro HC associate editor Avery Swett attributed the slowdown to “caution in the capital markets and the current interest rate environment.” Confidence: High, since the deal counts and dollar figures come directly from LevinPro HC’s own published report. Source: Medical Outpatient Building M&A Activity Decreases 26% in Q2:26, According to Data from LevinPro HC, GlobeNewswire.

3 days: that is all the runway left for Miami’s academic health system and the nation’s largest insurer before hundreds of thousands of patients go out of network. As of July 28, 2026, UHealth, the University of Miami’s health system, and UnitedHealthcare remain without a new contract, with the July 31 deadline this issue has tracked since July 22 unchanged; UHealth’s negotiation page, last updated July 22, says “UnitedHealthcare has not yet agreed to terms that protect patients’ care” and notes 94 percent of its UnitedHealthcare denial appeals are overturned, while UnitedHealthcare points to its roughly 9 billion dollar quarterly profit and says its offer would bring UHealth’s rates in line with peer South Florida hospitals. Miss the deadline, and UHealth’s hospitals, clinics and physicians, anchored by the Bascom Palmer Eye Institute, go out of network August 1 for UnitedHealthcare’s commercial, Affordable Care Act exchange and Medicaid plans; a separate carve out keeps UnitedHealthcare’s Medicare Advantage Preferred Care Network members in network through August 31 regardless of the outcome. Confidence: High on the deadline and each side’s public position, since both come from the parties’ own pages; Low on whether a deal is struck in time. Sources: UHealth and UnitedHealthcare Negotiation, University of Miami Health System, Network Negotiations with Miami Health System (UHealth), UnitedHealthcare.

FRONTIER SCAN. 2 billion dollars: that is the strategic capital a Tennessee safety-net hospital would get over 15 years by becoming a wholly owned subsidiary of a South Carolina nonprofit system three times its size. Erlanger Health System, which operates Chattanooga’s only Level I trauma center and its children’s hospital, signed a non-binding letter of intent July 22, 2026 to join Prisma Health, one of the Southeast’s largest nonprofit health systems; the deal would bring 2 billion dollars in strategic capital investment over 15 years for facilities, technology and expanded specialty care, while Prisma establishes an East Tennessee regional headquarters in Chattanooga and Erlanger keeps a local governing board for up to nine years plus two seats on Prisma’s 11 member corporate board. Erlanger’s own board has already backed the deal, which still needs approval from Erlanger’s independent oversight monitor board, the Hamilton County Commission and state and federal regulators over a 120 day due diligence period; Erlanger chief executive Jim Coleman called it “transformative,” while Prisma chief executive Mark O’Halla said the goal is expanding access “away from hospital campuses.” This scan adds HCI Innovation Group (hcinnovationgroup.com), whose finance and mergers-and-acquisitions vertical carried detailed early coverage of the deal structure, to our source stack for tracking the wider wave of financially stretched safety-net systems seeking capital-rich nonprofit partners. Confidence: High on the deal terms, since they come directly from both organizations’ own joint announcement; Low on final approval, since the transaction still requires multiple regulatory and board signoffs. Sources: Erlanger Health System Signs Letter of Intent to Partner with Prisma Health, Prisma Health, Erlanger Signs Letter Of Intent To Join With Prisma Health, Of Greenville, S.C., Chattanoogan.com.

THE DEAL SHEET

Target	Acquirer/Investor	Vertical	Value	Source
Riverpoint Medical	Novanta Inc.	Medical devices, minimally invasive surgical consumables	$1.2 billion cash plus $250 million milestone, up to $1.45 billion total; closed July 27	Novanta Completes Acquisition of Riverpoint Medical, Business Wire
Erlanger Health System	Prisma Health (non-binding letter of intent)	Hospital system consolidation, nonprofit affiliation	$2 billion strategic capital over 15 years; 120-day due diligence period	Erlanger Health System Signs Letter of Intent to Partner with Prisma Health, Prisma Health
Three medical office buildings (California, Colorado, Texas)	Lincoln Property Company	Medical office building real estate	Undisclosed; largest single disclosed MOB transaction of Q2 2026	Medical Outpatient Building M&A Activity Decreases 26% in Q2:26, GlobeNewswire

Centene reported today. Boston Scientific, Teladoc Health and Humana report tomorrow, July 29, followed by Cigna July 30, and Privia Health, agilon health, Oscar Health and Clover Health cluster in early August.