What Cognizant gets wrong in Healthcare
Cognizant is the largest healthcare IT services firm in the world by headcount. Scale creates a specific problem: the engagement model optimizes for contract management, not clinical outcomes. A 500-person managed services contract with a major health system is a revenue stream to be maintained, not a system to be improved.
Cognizant's healthcare IT delivery model is offshore-heavy for a domain where domain knowledge is the critical constraint. Clinical workflow engineers who understand the difference between an ADT-A01 and an ADT-A04 message are not commodities — and they are not the engineers Cognizant deploys on healthcare engagements.
The managed services trap in healthcare IT is particularly damaging. When your Epic environment is running on a Cognizant managed services contract, every change request becomes a change order, every integration requires a new statement of work, and the internal capability to manage your own systems atrophies over time. The dependency grows as the capability shrinks.
What we deploy instead
We do not offer managed services. We build systems and transfer them — with full source code, full documentation, and the internal capability for your team to operate them. The engagement ends when the system is production-ready, not when the contract expires.
Our healthcare engineering teams are sized for the work, not the contract. A FHIR integration engagement runs 8-12 weeks with a 6-10 person team, all domain-qualified.
HIPAA and HITRUST built into the architecture from day one — enforced automatically by ALICE at every commit.
Fixed-price engagements. Production system in 8-20 weeks. No discovery phase. No change orders.
Domain-qualified engineers with healthcare experience. The senior engineer who scopes the engagement is the senior engineer who delivers it.
Full source code and documentation transferred at close. No licensing. No managed services dependency.
The compliance difference
HIPAA, HITRUST, and SOC 2 compliance — Cognizant provides compliance documentation as a service. We build compliance into the system architecture so it does not need to be managed separately.
What switching from Cognizant looks like
Healthcare technology engagement: 8-16 weeks for a defined deliverable. Fixed price. Full IP transfer at close. No ongoing managed services dependency — your team runs the system we build.
Architecture review and scope definition. We review existing deliverables and identify gaps.
Scope locked, team assembled, first sprint underway. Working code from week two.
First production milestone — a working integration or system component, not a document.
Full IP transfer. Source code, documentation, operational runbooks. Your team runs the system.
Failed Vendor Recovery Playbook
Step-by-step framework for recovering from a failed Cognizant engagement — from emergency stabilisation through full re-platforming. 4-phase playbook covering stabilise, assess, transition, and normalise.