The percentage of payer-operated physician practices has grown significantly since 2016, according to a study published in July in Health Affairs Scholar.
The study used corporate filings, mergers and acquisitions databases and insurer directories to identify medical groups operated by Optum, Humana, Elevance, Aetna-CVS Health and Cigna from 2016 to 2023, and calculates each payer’s share of the Medicare primary care market nationally and by county.
Here are five things to know:
1. Payer-operated practices account for 4.2% of Medicare primary care services in 2023, up from 0.78% in 2016.
2. Optum alone controlled 2.71% of the national market by service volume, making it the dominant payer-affiliated provider in primary care.
3. Payer-operated practices provided 5.73% of Medicare Advantage primary care services nationally, compared to 1.84% in traditional Medicare.
4. Amid national growth, the expansion of payer-owned practices has been uneven across the U.S. Counties with above-average MA penetration saw payer ownership rates of 5.5%, while those with below-average penetration had just 1.5%.
5. According to the study, payer ownership was lower in counties with highly concentrated hospital systems and employer-sponsored insurance markets.
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