I’ve had a lot of time to think about Centene over the weekend. I’ve talked about most of this in pieces before, but when you put it all together, the picture doesn’t look good.
Well-run companies are building their own technology, automation and AI skills because those things will run the business in the future. UnitedHealthcare said on its July 16 earnings call that AI is already used across its administrative work and in nearly every provider and member interaction. It is even automating complex claims that once required people to review them. UnitedHealth is investing about $1.5 billion in AI and wants 80% of prior authorizations processed in real time by the end of 2027. Like them or not, they built much of that capability through Optum and they own it.
Centene is going the other way. It is pushing out thousands of people who understand its systems, data, business rules, and history. Then it is reportedly paying Cognizant between $500 million and $1 billion to use TriZetto for claims, billing, and customer service. At the same time, cut-rate SOW tech jobs are showing up for work that looks a lot like what former Centene employees were doing. The jobs didn’t disappear. They were moved somewhere cheaper, with less ownership and less accountability.
Centene’s Q2 filing says it expects to spend $355–$405 million on severance and contract exits, plus another $85–$115 million on outside companies helping with “enterprise optimization.” That doesn’t include the full reported Cognizant deal. This isn’t cutting costs as much as moving them from employees to vendors.
Here’s the scary part. Centene already has the highest ACA prior-authorization denial rate among major insurers at 25%. In Medicare Advantage, 93% of its appealed denials were overturned. Those numbers suggest the decisions already need work. Now Centene wants to automate more of them through a system run by someone else.
What happens when that system is wrong thousands of times? Who checks the rules? Who stops it? Who can reverse the decisions? Who inside Centene will know enough to push back when Cognizant says everything is working as designed?
UnitedHealthcare has publicly said doctors will still be involved when care is denied and that its call centers will never be fully automated. What has Centene promised? Who will make sure it happens after so many of the people who understand the work are gone?
A Cognizant TriZetto business also had a data breach affecting roughly 3.4 million people. It was not necessarily the same TriZetto platform Centene may use, but it is still a fair reason to ask hard questions about security and giving one vendor this much control.
The board and leadership changes add another piece. Lauren Tyler, who has experience in audit, investor relations, HR and private equity, joined the board in June. Paul Diaz, a healthcare private-equity leader and former CEO of Kindred and Myriad, joined in July. That same day, former WellCare CEO and Centene executive Ken Burdick left the board. Now Drew Asher is leaving the CFO job. Maybe none of this is connected. But add the buyouts, layoffs, new leadership structure, board changes, Cognizant deal, and replacement SOW jobs, and it sure looks connected.
Reporters and analysts have plenty to cover with earnings, membership and medical costs. But somebody should also be asking what the full Cognizant deal includes, how many Centene jobs are being replaced by vendor jobs, who will own the rules and data, what all of this will really cost, and how Centene gets out if TriZetto doesn’t work.
There are still missing pieces. If you’re seeing public SOW postings, job titles, rates, vendor names, work moving offshore or teams being replaced, share what you know. No names or confidential information. Just help fill in the picture.
- This isn’t simplification. Centene may be handing over its ability to run itself, one SOW at a time.*