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Breaking Down the Loan Process


It’s easy to get tunnel vision when you’re building a new home and it’s nearing completion. You can practically feel that beautiful wooden banister and picture your shoe collection in that marvelous walk-in closet. These visions keep you going when your home is being built, but before you pack up those shoes, you want to make sure you understand the loan process, especially how your permanent loan finalizes. 

APM offers both one-time close and two-time close construction loan options, allowing homebuyers to choose the structure that best fits their goals, timeline, and comfort level with market conditions.

With a two-time close construction loan, the first loan covers the cost of the land, building materials, labor, and required permits. Because this loan funds the construction phase, it is always a good idea to get pre-approved early to better understand your budget and borrowing power. APM Loan Advisors can help guide you through this process.

During construction, which typically takes 12 to 18 months, payments are usually interest-only and based on the funds that have been drawn. Construction loans function similarly to a line of credit, releasing funds in a series of draws as specific phases of the build are completed. Interest is calculated only on the amount used, and payments can often be made monthly or structured into the loan.

As construction nears completion, permanent financing becomes the focus. With a two-time close, you will qualify for your permanent mortgage toward the end of the build, typically 45 to 60 days before completion. With a one-time close, your permanent financing is already approved upfront, and the final steps are focused on inspections and receiving the certificate of occupancy.

Your APM Loan Advisor will help coordinate each stage of the process, ensuring a smooth transition from construction to long-term homeownership, regardless of which construction loan option you choose.

 

Collecting Documents and Credit Check

First, we’ll collect updated versions of the documents we collected when we did your construction loan. This will include bank statements and pay stubs, as well as any life, income, or employment changes. There may also be additional documentation that we ask for at this time.

You’ll want to keep your credit score high during the construction process and avoid any credit pitfalls. We’ll need to run a new credit report as part of the permanent financing application process.

Appraisal

A new appraisal isn’t always necessary, but it can be beneficial during a two-time closing. That’s because you might be able to adjust your permanent loan based on this appraisal. If your appraisal comes back higher than the original value, you can use the new appraisal value to adjust your loan amount. Both VA and conventional loans allow for cash-out refinancing, so you might even be able to tap your equity at this time. Your APM Loan Advisor will be happy to discuss these options with you to see if this is the right strategy for your situation.

Approving Your Loan

Once we’ve got your final appraisal, your loan will go through our underwriting department for final approval. You have a few options for your permanent mortgage, which will have been discussed when you applied for your construction loan. These include FHA, conventional, and VA loans. Each has its own advantages, as your APM Loan Advisor will have laid out. They’ll also review everything to ensure that what you thought you wanted back when you started still works for you.

In a way, this final loan is like a typical refinance, meaning that you’ll start paying your loan off like any other permanent mortgage. You can choose from 30-, 20-, 15-, and 10-year fixed-rate financing. 

Many borrowers choose to secure a specific program and lock their loan rate before construction even begins. These long-term locks can bring peace of mind, knowing you won’t have to pay a higher rate once construction is completed. And don’t worry—your loan officer will go over any changes in the market and discuss whether you want to keep the locked rate or select a new one if interest rates go down. We’ve got you covered!

Closing

Our goal is to have your final closing right after your final inspection, but the process can vary based on the builder and local requirements. You’ll need to be ready to pay your closing costs and sign the final paperwork. This will likely happen at a title company, so be sure you bring an up-to-date proof of identity with you, like your driver’s license or passport.

Certificate of Occupancy

This is one of the last pieces that comes into play when a home is being built. Ironically, in many cases, this isn’t even a physical certificate! It simply means your local government approved your home for occupancy and the home follows all the required building codes. Just because it isn’t a physical document doesn’t mean it isn’t important, however. You need the certificate of occupancy to legally move in once construction is complete, which means we need it before we can fund your loan!

Move In!

Once your loan is finalized, funding typically occurs the day after signing unless a different timeline is needed. From there, it is time to move into your new home and begin the next chapter of homeownership. At this stage, your loan transitions to a traditional mortgage, with monthly principal and interest payments beginning as outlined in your loan terms.

At APM, we work to make the construction loan process as streamlined and straightforward as possible from start to finish. If questions come up along the way, your APM Loan Advisor is always available to explain each step and provide guidance tailored to your situation.

To learn more about the full construction loan journey, explore our Construction 101 resources and connect with an APM Loan Advisor when you are ready to get started.



Some UK Entrepreneurs Plan To Flee As Government Fails In Supporting Innovation: Report


A recent report highlights the challenges the UK faces in supporting and retaining high-value entrepreneurs and the innovative firms they aim to grow.

A declaration by the London-based Entrepreneurs Network states that up to 21% of UK entrepreneurs plan to leave the UK because the Labour government fails to understand the dynamics of an innovation-driven economy.

Apparently, jurisdictions like Dubai, the US, and Singapore are more appealing. Each of these locations has supported policies that encourage capital formation and support business, including lower taxes.

The Entrepreneurs Survey states:

“..Founders almost universally agree that the current government does not understand the needs of entrepreneurs.”

And;

“Negative views of the current levels of taxation and regulation in the UK are widespread among founders.”

Concerns are prevalent about the difficulty in raising growth capital and the inability to hire talent to support a new firm.

While it may be easy to launch a startup, scaling the business is a different question, which is more challenging.

Only 22% believe the UK does a good job of incentivizing new business creation.

On a positive note, tax exemptions such as SEIS, EIS, and VCT are viewed favorably, yet more needs to be done by the government.

Leo Labeis, CEO and founder of REGnosys, says the gloomy report reflects a broader issue of lack of confidence by founders, as policy uncertainty is affecting sentiment.

“Recent industry data continues to position London as one of Europe’s leading start-up ecosystems, underpinned by its depth of capital, talent and financial infrastructure, particularly in fintech and high-growth sectors such as Regtech. Maintaining that position will depend on greater clarity and consistency in policy, alongside stronger support for founders seeking growth funding and looking to scale in the UK.”

He believes that if the right policy is put in place, the UK can retain its competitive edge

Meanwhile, the survey shows that as faith in Labour has declined, support for the Tories is on the rise.

Philip Salter, Founder of The Entrepreneurs Network, is quoted in Sifted as explaining that the current climate is making it harder to invest, hire, and innovate. This has long-term ramifications for the UK economy.

“Politicians across all political parties need to double down on their efforts to rebuild trust by focusing on the practical barriers entrepreneurs face day in and day out,” stated Salter.

An innovation-driven economy should be a policy goal of all politicians. Risk takers and entrepreneurs drive economic growth and wealth for all. Myopic policies that undermine new business creation, including high taxes and excessive regulations that act as a hidden tax on capital formation, harm the entire population of any country.

 

 



Here’s Why Nearly Half of Workers Say They Feel Like Impostors


Editor’s Note: This story originally appeared on MyPerfectResume.com.

Confidence has become a workplace requirement. Employees are expected to sound certain in meetings, project expertise on Slack, and present themselves as capable and composed, even when they are still learning, adjusting, or struggling.

But behind that polished exterior, many workers feel like they are performing. New national survey data from MyPerfectResume shows that nearly half of U.S. employees experience impostor syndrome at work, while a much larger share feel ongoing pressure to appear more confident or knowledgeable than they actually are.

The result is a growing gap between how workers feel internally and how they believe they must present themselves professionally, a phenomenon that can be described as confidence theater. This disconnect isn’t just uncomfortable. It has real consequences for career growth, visibility, and long-term confidence at work.

Key Findings

  • 43% of workers experience impostor feelings at work.
  • 66% feel pressure to appear more confident or knowledgeable than they actually are.
  • 65% say leaders at their company rarely or never talk openly about their own doubts or mistakes.
  • 74% cite pressure or comparison, including high expectations, peer comparison, or personal perfectionism, as a driver of self-doubt.
  • 24% point to a lack of feedback or recognition as a contributor.
  • 58% say self-doubt or impostor syndrome has negatively affected their career growth.

Nearly Half of Workers Feel Like Impostors

According to the survey, 43% of workers say they experience impostor feelings at work, a sense that their success is undeserved or that they will eventually be “found out,” despite their qualifications or performance.

At the same time, two-thirds of employees say they feel pressure to appear more confident or knowledgeable than they actually are.

This environment encourages employees to manage impressions rather than openly ask questions, admit uncertainty, or take learning risks. Over time, that pressure can amplify self-doubt, especially in fast-paced roles or workplaces where success is highly visible and comparisons are constant.

Self-Doubt Is Driven by Workplace Conditions, Not Personal Ability

When asked what fuels their self-doubt, workers overwhelmingly point to structural and cultural pressures, not a lack of skill or competence. Nearly three-quarters of employees cite pressure or comparison as a driver of self-doubt, including:

  • Comparing themselves to high-achieving peers (26%)
  • Personal perfectionism (26%)
  • High expectations from management (22%)

Additional contributors to feeling like a fraud at work include:

  • Lack of feedback or recognition (24%)
  • Rapidly changing technology or job demands (17%)

Only 25% of workers say they don’t experience self-doubt at work, reinforcing how widespread these pressures have become.

Rather than being a personal flaw, signs of impostor syndrome often emerge in environments where expectations are high, feedback is limited, and confidence is treated as a baseline requirement rather than a skill that develops over time.

How Impostor Syndrome Shows Up on the Job

Self-doubt rarely leads employees to completely disengage. Instead, it changes how they behave at work, often in ways that increase stress or reduce visibility.

The most common responses include:

  • Overworking or minimizing themselves (56%), such as working extra hours, fixating on perfection, or downplaying achievements
  • Internal doubt and constant comparison (45%), including second-guessing decisions or replaying mistakes
  • Pulling back or becoming less visible (33%), avoiding new responsibilities, or staying quiet in meetings
  • Seeking reassurance from colleagues or managers (19%)

While some of these behaviors may appear dedicated or cautious on the surface, they can quietly stall growth over time, especially when employees avoid visibility or opportunities out of fear of exposure.

The Career Impact Is Real & Measurable

Impostor syndrome doesn’t stay contained as a feeling. It directly affects career trajectories.

  • 58% of workers say self-doubt or impostor feelings have negatively affected their career growth.
  • 7% say they have turned down major career opportunities as a result.

These findings highlight a hidden cost of confidence theater: capable employees may opt out of promotions, stretch assignments, or leadership opportunities, not because they aren’t qualified, but because they don’t feel ready to perform at a higher level.

Leadership Silence Keeps the Cycle Going

One of the strongest patterns in the data is the rarity with which leaders model vulnerability.

  • 65% of workers say leaders rarely or never talk openly about their own doubts or mistakes.
  • Only 35% say leaders discuss these topics even occasionally.

When leaders present confidence as effortless and unbroken, it reinforces the idea that uncertainty is a weakness to hide. Employees learn quickly that confidence is expected, while doubt is private, if it’s acknowledged at all.

This silence can unintentionally normalize impostor feelings, leading employees to believe they are the only ones struggling.

Why Confidence Theater Persists

Confidence theater thrives in workplaces that prioritize performance signals over learning signals. Titles, visibility, speed, and certainty are rewarded, while curiosity, experimentation, and questions are often undervalued.

In these environments, employees don’t stop doubting themselves; they just get better at hiding it. Over time, that performance gap can erode trust, increase burnout, and limit growth across teams, especially for early-career workers, career changers, and those in rapidly evolving roles.

Together, these findings suggest that impostor syndrome isn’t just an internal struggle. It’s closely tied to how workplaces reward confidence, certainty, and visibility, often without leaving room for learning, doubt, or growth in public.

Methodology

The findings presented in this report are based on a nationally representative survey conducted by MyPerfectResume using Pollfish in December 2025.

The survey collected responses from 1,000 U.S. adults currently employed full-time. Respondents answered a mix of single-selection and multiple-choice questions about impostor syndrome, self-doubt, workplace culture, leadership behavior, and career confidence.

The survey sample consisted of 56% female and 44% male respondents. Age distribution included 25% aged 65 or older, 53% aged 35–64, and 22% aged 18–34. Regarding education, 61% reported having at least some college education, while 40% had a high school diploma or less.

These HORRIBLE Financial Decisions Aged Like MILK…



These HORRIBLE financial decisions aged like MILK… and some of them are still costing people thousands. From $800 car payments and $26,000 on Uber Eats to shopping addictions, high-interest store credit cards, drained savings accounts, and lifestyle creep that spiraled into debt — these viral money confessions are painful.

Across social media and Tiktok, people are going viral for finally admitting the financial mistakes that quietly ruined their budgets, wrecked their credit scores, and kept them paycheck to paycheck — even while making more money than ever. Brand new SUVs that instantly felt like regret. Grocery bills exploding past $2,000 a month. Influencer spending habits funded by Afterpay and Affirm. Credit cards with 30% APR. Savings accounts controlled by family. Decisions that felt smart in the moment… but aged worse than spoiled milk.

The scary part? Most of these weren’t reckless on the surface. They looked normal. Responsible. “Deserved.” But emotional spending, car loans, lifestyle inflation, and bad financial boundaries have consequences that compound.

If you’ve ever wondered why your income went up but your money didn’t… if you’ve ever justified a big purchase and felt it later… or if you’re trying to avoid debt, protect your credit, and build real financial freedom — this conversation matters.

Because some financial decisions don’t just age.
They quietly drain you.

Chapters / timestamps
0:00 Shopping addiction + dopamine spending
1:00 Why the “cart life” steals time + money
3:39 Tips to break the shopping cycle
5:33 Influencers selling a lifestyle you can’t afford
7:33 “We make more but still struggle” + grocery shock
8:56 The car payment trap + why $800 isn’t “normal”
11:04 High income, still paycheck to paycheck
14:35 Car buying without emotion (real affordability)
16:24 $26,000 Uber Eats confession
18:38 Store cards that wreck your credit
23:53 “My mom has my credit held hostage”
27:14 Authorized user vs. identity/credit misuse
31:23 Paid-off car → new Suburban regret
33:39 Freedom vs. flex: choosing the smarter car
36:16 The lesson: stop repeating other people’s regrets

just some cool words:)
financial mistakes, bad money habits, shopping addiction, emotional spending, lifestyle inflation, car payment too high, $800 car payment, broke with good income, paycheck to paycheck, credit score problems, credit card debt, budgeting tips, personal finance reactions, viral money stories, overspending, financial regret, car loan trap, money discipline, how to stop shopping, financial literacy #debt #money #finance

👇👇👇 What’s the money decision you regret the most—and what did it cost you long-term?

source

Here’s How Oil Stock Volatility Is Affecting This Leading Solar Energy Company


Observe energy stocks — both clean and fossil — long enough, and you’ll learn that periods of oil-market volatility are often accompanied by renewed enthusiasm for renewables.

The Invesco Solar ETF (TAN 0.20%) is an effective tool for making that point, as recent history has confirmed. Military conflict in Iran is contributing to skyrocketing oil prices, pushing this exchange-traded fund (ETF) up 12% year to date. The fund’s 2026 price action is a sequel to what was seen in 2022, when it surged 29% in the six months following Russia’s invasion of Ukraine.

This stock is hot, but if oil prices decline, it could cool off. Image source: Getty Images.

As for individual stocks, SolarEdge Technologies (SEDG +3.30%) is strutting its stuff amid elevated oil-market volatility. Shares of the maker of residential solar inverters are up more than 36% over the past month. That’s another sequel, as the stock surged in the months immediately following Russia’s push into Ukraine. Now it’s time to decide whether SolarEdge is flying too close to the Sun.

This solar stock may be getting ahead of itself

There’s wisdom in the old Wall Street saying, “Don’t fight the tape.” That said, let’s consider what some sell-side analysts are saying about SolarEdge. Yes, the stock has been upgraded twice this month — first on March 10 by Bank of America, and again on March 20 by Jefferies — but those upgrades were from “underperform” to their analysts’ equivalents of “hold” or “neutral.”

Jefferies didn’t even raise its price target, which remains at $49. Bank of America did, boosting its call on SolarEdge to $40. However, both are well below the March 20 closing price of $51.73. That may be a sign that the stock needs a cooling-off period after its recent scintillating pace.

SolarEdge Technologies Stock Quote

Today’s Change

(3.30%) $1.54

Current Price

$48.27

Perhaps adding to the case for this stock having gotten ahead of itself is the European market. Conflicts involving major oil-producing countries have a way of rejuvenating interest in clean energy.

Still, as Jefferies points out, the continent’s embrace of solar and other renewables increased following the start of the Russia-Ukraine war, implying there’s limited room for comparable growth on the back of the Iran conflict. Bank of America went so far as to note that SolarEdge’s end markets, including Europe, are soft. That’s not what prospective buyers want to hear after the shares jumped so high over the past month.

Oil can take away as quickly as it gives

Regarding SolarEdge, another old investing adage is worth remembering: “History doesn’t always repeat, but it often rhymes.” Whether it’s mere rhyming or clear repeating, oil can take away from investors as quickly as it blesses them; it’s a volatile commodity. If the Strait of Hormuz were to open today (I’m not saying it will), crude prices would likely tumble; that could claim other victims, including solar equities, along the way.

This is history some SolarEdge shareholders have already lived. Following an impressive run for much of 2022, the stock was the worst performer in the S&P 500 the following year, leading to its expulsion from the index. Maybe things won’t go that way for the stock if oil prices falter over the near term, but it’s a risky bet to make.

This Viral Graphic Is Changing How We Understand the ‘Autism Spectrum’



This 39-point visual map moves beyond “mild” or “severe” labels to reveal the true complexity of the autism spectrum.

How Trump’s EO could redraw QM’s safe harbor lines



Part of a recent executive order from President Trump that calls for potential changes to the qualified mortgage definition and its safe harbor could increase competition for certain types of loans, depending on how and if it progresses.

Processing Content

Changes that the broader mortgage credit order calls for include having the Consumer Financial Protection Bureau look into “tailoring” the ability-to-repay rule and QM for “smaller banks.” It goes on to parenthetically suggest this could include a broader safe harbor for portfolio loans.

The order additionally calls for exempting or modifying “small-mortgage loans” from qualified mortgage points-and-fees limits, and removing “unnecessary and burdensome elements” from ATR and QM underwriting requirements for banks.

Some experts’ analysis of what this could mean follow:

New breaks for small mortgages

Expanding the QM points-and-fees limit for small-mortgage loans — a topic also addressed in drafts of the 21st Century ROAD to Housing Act — could make it easier to extend credit to more borrowers buying modest homes.

It could help less sizable banks manage the higher costs of making small loans by allowing them to charge higher rates above the standard cap without incurring additional non-QM liability.

However, since lifting the QM points-and-fees-limit would allow for a higher interest rate, its impact on the cost of the loan to the consumer could be limited.

“We might pick up a couple more loans on the margin, but I don’t think it entirely solves the problem when it comes to the cost to originate,” said Ron Haynie, senior vice president of mortgage finance policy at the Independent Community Bankers of America.

Other rules have provided leniency for less-sizable loans because they may face more difficulty meeting the points-and-fees caps, but exempting them from the limits entirely could take this a step further. 

It’s not clear how small a mortgage would need to be to qualify. In some other contexts they’ve been up to $100,000 or $150,000.

Other QM exceptions already in place

The broader extension of the safe harbor in line with references to tailoring QM and ATR requirements for smaller banks has precedents that could inform the path it takes. 

These include:

  • A more expansive portfolio loan exemption for less sizable “small creditors” also predates the 2018 legislation. The definition of smaller creditors has been set at $2.785 billion in assets and no more than 2,000 first-lien mortgages for 2026.

Portfolio loan possibilities

With the executive order suggesting a broader safe harbor for portfolio loans, one result could be that more sizable “smaller” banks making these mortgages may become eligible for breaks from non-QM liability than have been in the past.

The first part of the EO refers to the “smaller bank” universe referred to as going up to $100 billion while also noting that “community banks” with less than $30 billion in assets are “especially affected” by mortgage-related regulatory burdens.

Giving a larger range of banks a way to remove non-QM liability could cut some risk-based costs for making for nontraditional loans even if with the removal of points-and-fee cap opening up the possibility of raising the mortgage’s rate.

Self-employed borrower implications

QM’s definition is generally aimed at reducing liability for loans with standard pricing, underwriting and features. So loans outside its bounds are generally taken out by gig workers and business owners, some of which have been served by non-QM specialists. 

That means companies making those loans could face some new competition if certain institutions get an QM exemption due to the executive order.

“This could give an edge to whichever banks it applies to in the self-employed space,” said Richard Horn, former senior counsel and special adviser for the CFPB. He is currently a co-managing partner at law firm Garris Horn.

While an extension of the QM safe harbor against liability provides some protection for nontraditional loans, it’s not necessarily bulletproof, he warned.

“There’s nothing to prevent a consumer from challenging the QM status of any loan,” Horn said.

Much depends on definitions

Many provisions in the executive order around a QM safe harbor are subject to interpretation, such as whether it gets extended fully or makes exceptions for any of its elements such as product features.

Key definitions “are left to regulators,” Kara Ward, an attorney at Baker Donelson, wrote in her analysis of the executive order.

Another important determinant of the outcome is what the boundaries of portfolio loan are, which hasn’t been consistently defined in other contexts.

Certain performing non-QM loans that become “seasoned” after being held in portfolio for at least three years do get a safe harbor after that time. So the executive order seems to suggest a broader definition than that. 

If the portfolio loan definition were to be pegged to a three-year hold period, the question arises as to whether these loans keep or lose their QM safe harbor if sold after that time. 

In some contexts involving the three-year hold, loans do retain their safe harbor after that time even if sold. In some cases a portfolio or seasoned loan safe harbor is only retained if it’s sold to a similarly eligible institution.

The broader view for the CFPB

Since a lot of the order’s language about changing ATR, QM and many other things is broad and potentially could go far beyond portfolio loans, there’s a possibility the seasoned loan definition and other things could be impacted too, changing the entire landscape.

“The statute gives the CFPB a ton of discretion,” Horn said.

That said, the line between what the bureau can do and where Congress should be involved has been questioned in court. Some advocates of deregulation might view that discretion in a new light if they back these attempts to loosen CFPB rules. Consumer advocates might too, Horn said.

A far-reaching change to ATR and QM could face some resistance because the rules around sizing up consumers’ ability to repay were considered a cornerstone of mortgage underwriting reform after the Great Financial Crisis. 

Another potential hurdle when it comes to how or whether the proposed extension of safe harbor moves forward is how fast a downsized CFPB might move on drawing up a potential change. It could be a reason to sustain some bureau operations in order to get the EO fulfilled.

“It would be hard to undertake this massive reform effort if you’ve staged a reduction in force that affects 90% of the staff. So this could have the effect of preventing the complete shutdown of the CFPB,” said Horn. “It might not mean supervision and enforcement are operating as normal, but at least it could keep the Office of Regulations open.”



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The youngest-ever female CEO of a Fortune 500 company is fighting Trump’s cuts to keep Medicaid strong



Sarah London operates on the front lines of the toughest terrain in U.S. health care. She’s the CEO of Centene, an insurance giant providing government-sponsored plans at a time when funding is tight, costs are rising, and policy shifts create intense uncertainty.

While the St. Louis–based managed care insurer saw revenue grow almost 20% last year, to $194.8 billion, it posted a net loss of $6.7 billion. That was largely driven by a write-down that reflected the new reality for health care companies under the One Big Beautiful Bill Act championed by President Trump. Along with cutting federal Medicaid spending by more than $900 billion over 10 years, the law raises costs and reduces eligibility for people enrolled in Affordable Care Act (ACA) Marketplace plans.

Those changes are shaking up Centene’s core businesses. More than half of Centene’s revenue comes from Medicaid—it’s the country’s biggest Medicaid insurer—with the rest roughly divided between Medicare and Marketplace plans. While analysts don’t expect federal cuts to have a massive impact on Centene’s top line, they’re a sign of the challenges London faces.

Faced with new data that showed its ACA plans were enrolling both fewer and sicker people, London decided to withdraw earnings guidance last July, causing Centene’s share price to fall 40% in a single day, to an eight-year low.

“It’s hard not to feel like pulling guidance and cutting the stock in half is a failure,” London told Fortune in a recent interview. “We’ve watched a new normal unfold in terms of how many different pressures there are on the system and the magnitude of the change we’re facing.”

London is pushing to get ahead of that change. She’s been transforming Centene’s portfolio, technology, and culture since becoming CEO four years ago, at the age of 41, making her the youngest woman to lead a Fortune 500 company (a distinction she still holds).

Under London, Centene is using data and technology to better manage a business that cares for a higher proportion of sicker patients than many other insurers do. She has also launched a One-CenTeam initiative to make Centene a catalyst in creating healthier communities. In May 2024, at the Fortune Brainstorm Health conference, for example, London announced plans to partner in building $900 million of affordable housing in eight states to help boost health outcomes.

Other Centene initiatives spotlight preventive health measures that could help members avoid expensive medical problems—and leave Centene with a healthier bottom line

Mission-driven

After graduating with a history and literature degree from Harvard, London spent two years in the film industry before deciding she wanted to make a bigger social impact. She did stints at Harvard, supporting health, education, and equity initiatives, and at nonprofit Health Leads, building out its model of community-based care, before earning an MBA at the University of Chicago. Her goal: to move from storytelling to systems thinking, using data to drive change.

That mission drew her to Humedica, a pioneer in leveraging big data in public health. “Sarah sort of cold-called me in 2011,” recalls former CEO Michael Weintraub. “It wasn’t, ‘Hi, hello.’ It was, ‘I researched your company; this is what I work on. I’ve heard about your team; this is who I want to work with.’ We made a decision to hire her that day.”

London rose through the ranks at Humedica, which became part of UnitedHealth Group’s Optum, before joining Centene in 2020. She got the top job there in 2022 after longtime CEO Michael Neidorff stepped down shortly before his death.

Neidorff had built Centene from a regional Medicaid plan in St. Louis with about $40 million in annual revenues to the nation’s largest Medicaid managed care organization. With that growth came a lot of acquisitions and bloat. “The mission orientation was there from the get-go—that’s our superpower—but there hadn’t been as much focus on operating discipline,” says London, who subsequently sold off several noncore operations.

What distinguishes London’s leadership is an ability to connect the dots, says Karen Salfity, whom London brought in from Optum to create a more consistent strategy and member experience. “Sarah can look at a very complex situation, understand the various factors, and then create an assessment … with just enough heart that you know she cares deeply,” says Salfity, who has known London for 15 years. “The only thing that’s really changed is the scale at which she is able to do it.”

A new normal

London knows all too well that a lot of factors in health care are outside her control, not least of which is the Trump administration’s push to radically modernize and streamline federal programs. In February, the administration announced new steps to crack down on alleged fraud in Medicare and Medicaid, on top of the funding cuts and expired ACA tax credits that have already taken effect.

London is not as disheartened as one might think. “You could take a step back and come away with the conclusion that these [programs] are under attack,” she says. But she notes that there was “quite a bit of bipartisan support” for making the sector more efficient.

“I have yet to meet a politician who does not believe that affordable, high-quality health care is something very important to be able to provide for their citizens and voters.”

She sees the current reforms as underscoring the need to take a holistic, high-tech approach to caring for vulnerable populations. Indeed, some of Centene’s systems anticipated the changes that the administration has enacted. “We have work programs in more than 17 states; we partner with nonprofits and provide job training to Medicaid members,” London says. “We run every single claim through 75 algorithms every day to look for fraud, waste, and abuse.”

“Health care is wildly overdue for a digital revolution,” she argues, pointing to an array of tech initiatives that Centene has implemented. Those range from designing supplemental food benefits where there are food deserts—”because we know that if you don’t have access to food, medication adherence goes down”—to predictive algorithms identifying members likely to have high-risk births and mobilizing resources to support them. As London notes, “41% of all babies born in the U.S. are born onto Medicaid”; it’s crucial that the program keeps those children healthy so they can “go and get jobs and contribute to economic mobility and all the things we want as part of the American Dream.”

London knows how tough it is to deliver on that dream. “The country is getting poorer and sicker,” she says. “The dollars are not infinite. At the finite boundaries, you have to make decisions about what you are going to fund and what you are not.”