UnitedHealth's headquarters in Minnetonka, Minnesota. Credit: UnitedHealth
Optum — an arm of UnitedHealth — employed about 6,170 of the 239,138 primary care physicians who billed Medicare in 2023, or 4% of the total, according to a new Health Affairs Scholar paper.
Affiliates of UnitedHealth and other large insurers employed about 6.8% of the physicians who billed Medicare.
Elevance Health — the parent of Anthem Blue Cross — employed 1.5% of the total, Humana employed 1%, CVS Health's Aetna unit employed 0.3% and Cigna employed 0.1%.
Related: Private investors pumping billions into primary care
Loren Adler, a Brookings Institution researcher, led the team that wrote the article.The team came up with the figures by analyzing Medicare program data. The authors did not look at figures for physicians who bill commercial health plans, but they likely reflect most primary care physicians in the United States, because Medicare program managers have estimated that 98% of U.S. physicians take Medicare.
The backdrop: A "vertical integration" deal involves efforts by one or more vendors to combine with one or more of their suppliers.
Defenders of vertical integration involving health insurers and health care providers have argued that at least some of the deals may improve the cost and quality of care in at least some markets. In 2018, for example, Ken Pokalsky, a vice president with the Business Council of New York State, wrote to the U.S. Justice Department Antitrust Division to support the CVS acquisition of Aetna. Pokalsky predicted that the deal would help CVS and Aetna hold down premiums, improve preventive care and improve primary care.
But Sen. Elizabeth Warren, D-Mass, suggested in January in a public letter to Elon Musk, who then was overseeing efforts by the administration of President Donald Trump to streamline the federal government, that the government should consider breaking up UnitedHealth because of its dominant size and breadth.
The researchers' views: The Adler team did not look in the new paper at the impact of vertical integration on the cost, availability or quality of primary care.
In May 2023, Adler told members of the House Energy and Commerce Committee's Health Subcommittee that vertical integration in health care could have both positive and negative effects.
Adler and his colleagues do recommend in the new paper that policymakers and other researchers look into the impact of vertical integration on the primary care market.
Vertical integration could "give insurers an advantage over competing health plans by steering patients toward their own services or making it harder for other insurers to contract with their physician groups," the authors wrote. "Additionally, payer acquisitions can directly reduce competition in local physician markets, potentially leading to higher prices or less choice for patients."
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