Cigna made a $67B bet on vertical integration with Express Scripts, and six years later they are still trying to digest it. Big acquisition creates complexity, complexity requires restructuring, restructuring means layoffs, layoffs damage culture, damaged culture slows integration, slow integration triggers more restructuring. Breaking this cycle requires either a pause (unlikely) or technology that bypasses organizational resistance (the AI bet).
16-year CEO tenure, C-suite reshuffling needed 6 years post-merger to consolidate authority
Rebate-free model shift shows adaptability, but data breach went undetected for over a year
Evernorth data pipeline enables AI, but Glassdoor cites finger-pointing culture and silos
$67B merger still being integrated, legacy PBM model constrained until 2028 transition
3+ years of layoffs, declining Glassdoor, office politics over performance
Services-based model with 15.5% ROE, relatively capital-light vs vertically integrated peers
AI tools (80%+ satisfaction) accelerate flow, but micromanagement and merger complexity slow it
"Cigna is essentially performing open-heart surgery while running a marathon."
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