The youngest-ever female Fortune 500 CEO is reinventing the largest Medicaid insurer amid funding cuts and rising costs

• In today’s CEO Daily: Diane Brady profiles Centene CEO Sarah London.
• The big leadership story: CFOs plan AI-related layoffs—but not as many as you might think.
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Good morning. Sarah London, the youngest-ever female CEO to run a Fortune 500 company, isn’t leading from a place of comfort. As federal cuts and new regulations reshape U.S. health care, the chief executive of Centene, the country’s biggest Medicaid insurer, is redefining what it means to innovate in a constrained environment. Her playbook is less about bold spending and more about disciplined reinvention; she’s streamlining operations, shedding noncore businesses, and using predictive algorithms to help manage care for vulnerable populations. At a moment when “the country is getting poorer and sicker,” as she puts it, London’s version of innovation is all about using technology to keep the social safety net intact. (You can read my full story on her here.)

Centene grew revenue almost 20% last year amid drastic cuts to federal Medicaid spending that have inflicted pain on the bottom line and customers. That hasn’t stopped London from focusing on programs that tie affordable housing to health care or leveraging AI to identify and deliver a suite of services to members with high-risk pregnancies.

“There is an opportunity in this moment to innovate and deliver within the construct of these programs,” she told me. “We’re harnessing this moment to transform and simplify the organization, to lean into our mission and the levers that are going to fundamentally change how we power that mission.”

Companies that stand the test of time tend to draw on their strong foundation to lean into the future. They’re focused on what’s ahead without ignoring the value that comes with expertise, relationships and brand. Case in point: the pioneering giants on Fortune’s 2026 Most Innovative Companies list, out this morning. As many of you know, we’re holding a Fortune 500 Innovation Forum in Detroit on Nov. 16 and 17 to look at the next 250 years of American innovation. It’s part of a broader push to dig into the issues and opportunities around innovation, and to highlight the companies that are shaping what’s next. Get in touch with me or find out more here if you’re interested in joining us.

Contact CEO Daily via Diane Brady at diane.brady@fortune.com

This story was originally featured on Fortune.com