Centene CEO Sarah London: AI Must Reach Medicaid, Not Just Money

Centene CEO Sarah London says 26 million Medicaid, marketplace and Medicare Advantage members are getting health care innovation last — and she wants AI to flip that order.

Speaking Monday at Fortune's Most Powerful Women Summit, London didn't mince words about where venture capital actually flows. "Most of the venture money in health care goes into where the money is, and the money isn't in Medicaid," she told Fortune senior writer Sheryl Estrada. "That means that underserved communities don't actually benefit from innovation first. Sometimes they never do."

Who is Sarah London — and why does her seat matter?

Centene is a $33 billion company headquartered in Missouri. It runs Medicaid plans in 29 states and also sells individual marketplace plans and Medicare Advantage. London took the CEO job four years ago at age 41, making her the youngest CEO in the Fortune 500.

She said she joined because she believed health care and technology had hit an inflection point. Centene's 26 million members, she noted, are "among the poorest, sickest members of the communities that we all live in."

That's the lens on her AI argument. If innovation follows money, and Centene's membership sits at the bottom of the payment stack, then AI built for that population is by definition AI built for people the market skips.

What does AI investment actually look like right now?

Not what London wants. Asked where AI could create the most value, she answered: "everywhere." But the deployment reality, in her view, is pointed in the wrong direction.

"The part that's really depressing right now is that where AI is being deployed at scale, and where there's a lot of investment happening right now, is in inflationary use cases," she said.

Translation for operators: most AI dollars today chase more revenue inside a fee-for-service system. Automating claims and paperwork saves money, sure. London called that valuable in its own right. But she argues it misses the bigger prize — a chance to "break the way the system works today" by democratizing care.

Where AI could actually change care delivery

London pointed to medical deserts — rural areas with so few hospitals they're hard to reach at all. There, she said, AI could make community health workers potentially as capable as a first round of emergency-room triage for non-acute problems.

"That puts community care back in the community," she said. "It puts individual care back in the hands of patients, and I think that is the thing that is going to fundamentally change how health care works."

She also sees patient agency as a cost lever. People are already using ChatGPT to research symptoms — London joked her own ChatGPT is "completely confused" because she asks about her whole family, including her "hypochondriac husband." Jokes aside, she said AI used the right way can make people smarter about their health than most realize.

"If we can create that level of agency and the ability for individuals to make the first couple of decisions themselves, that is actually how you bend the cost curve," she said.

What does this change for Centene — and for payers generally?

For now, Centene is using AI in administrative communications with members, London said. The goal is for interactive tools that eventually help patients take first steps on their own. She framed even the unglamorous administrative work as directly convertible into benefits: "Every dollar that we can save in the administration of health care, we can apply to benefits."

The so-what for practitioners: London is staking out a position where AI's value isn't measured in revenue cycle acceleration but in triage-grade capability pushed to community workers and decision tools pushed to patients. A $33 billion payer with 29 state Medicaid contracts saying that out loud is a signal about where demand for AI tools may shift next — toward the population venture capital has so far ignored.