United Health now controls 1 in 10 physicians

Steph Weber reports for Medscape that UnitedHealthcare’s owner, UnitedHealth Group now controls–either owns or otherwise works with–one in ten physicians. Concerns are mounting about corporate control of health care. Treating physicians are no longer in full charge of patient care as insurers increasingly overrule their treating decisions.

Legally, insurers are not allowed to interfere in the practice of medicine. But, what does that really mean? It apparently does not prevent insurers from telling physicians how much time to spend with their patients or who to refer them to if they need to see a specialist–anti-competitive behavior. It also does not stop insurers from providing financial incentives to their physicians to withhold or otherwise delay costly care.

UnitedHealth now controls around 90,000 of the 950,000 physicians in the US. It is adding multispecialty physician groups in large numbers. These physicians all work for Optum Health, a subsidiary of UnitedHealth.

UnitedHealth’s ownership or control of these physicians is endangering people’s health. There’s no good independent data to evaluate the consequences of UnitedHealth’s ownership of these physicians. Based on the horror stories reported in the press–from insurer use of AI to conduct massive denials of care without regard to particular patient needs, to inappropriate withholding of payment to hospitals and “ghost” networks–UnitedHealth is interfering in the practice of medicine to the detriment of its enrollees.

Some experts suggest that there could be some good in what UnitedHealth is doing. But without data to conduct independent assessments and with mountains of horror stories, these experts are likely dreaming. Insurer control of physicians means putting profits ahead of patient needs, with potentially horrific consequences.

One recent study published in JAMA finds that private equity ownership of physician groups has driven up health care prices. That study looked at dermatology, gastroenterology, and ophthalmology practices. Several other studies have had similar findings, including one on private equity ownership of dental practices. Nursing homes, emergency medicine, urology and cardiology practices are all being taken over by private equity and corporations.

The Biden administration has focused some attention on anti-trust issues, but it seems that the anti-trust train left the station a long time ago and undoing the damage that has already been wrought would be a very heavy lift. Moreover, when insurers hire physicians, rather than acquiring them, they are not subject to anti-trust laws.

The dangers to patient health from the corporatization of healthcare are potentially massive, with costly care particularly hard to come by. Insurer ownership or control of physician practices is hurting physicians as well. They may no longer be able to practice the medicine they think is in their patients’ interest.

Recently, UnitedHealth and Humana have been sued for using AI algorithms to deny patient care, overruling treating physicians, and overlooking the particular needs of their enrollees in Medicare Advantage plans.

Here’s more from Just Care:

• UnitedHealth deprives members of critical rehabilitation care
• CMS can’t oversee AI denials in Medicare Advantage
• Private equity profiting wildly on home care at the expense of older adults
• Private equity buying up orthopedics practices
• 2023: Five things to think about when choosing between traditional Medicare and a Medicare Advantage plan