Optum is extending its influence in outpatient care with another high-profile acquisition. Its subsidiary, SCA Health, one of the nation’s largest ASC operators, acquired Exton, Pa.-based U.S. Digestive Health in early 2025.
Formed in 2019 through the consolidation of three regional gastroenterology groups with private equity backing, U.S. Digestive Health has grown into a major platform in the Northeast with more than 250 gastroenterology providers across 40 practice sites and 24 ASCs in Pennsylvania and Delaware.
Shakeel Ahmed, MD, CEO of St. Louis-based Atlas Surgical Group, told Becker’s the deal will be a “positive influence on outpatient care and the ASC market in general,” accelerating the migration of procedures to outpatient settings.
“While I lament the impending demise of private practice gastroenterology, I feel that these high-level mergers do help improve patient care and access,” he said. “By bringing a large GI practice under the Optum umbrella, SCA can leverage their care and offer their value-based contracts to the medical practices.”
The acquisition adds to a pattern of aggressive growth by Optum. As of July 17, UnitedHealth, Optum’s parent company, directly employs or contracts with more than 90,000 physicians, according to a new “Sunlight Report” by the Center for Health & Democracy, funded by Arnold Ventures. This accounts for about 10% of the entire U.S. physician workforce. Optum’s subsidiaries include 423 ASCs, more than 880 home health companies, and 335 administrative/support entities.
A study published in Health Affairs Scholar in July found that by 2023, Optum controlled 2.71% of the national primary care market by service volume, making it the largest payer-affiliated provider in this space.
Private equity activity in gastroenterology has slowed in deal frequency but grown in transaction size and momentum. GI PE deals fell by 50% between 2022 and 2023, dropping from 26 to 13. Still, large platforms such as GI Alliance, Gastro Health and United Digestive are expanding through add-on acquisitions and recapitalizations. GI Alliance’s $785 million investment with Apollo Global Management and Cardinal Health’s $2.8 billion majority stake in GI Alliance illustrate the scale of recent GI megadeals.
These consolidations are raising concerns about autonomy, costs and patient impact.
Not all physicians are optimistic. Alejandro Badia, MD, founder and CMO of Miami-based Badia Hand to Shoulder Center, told Becker’s that corporate acquisitions often come at the expense of clinician decision-making.
“The continued acquisition of medical practices by large corporations, whose focus is on profits and Wall Street, will continue to have a chilling effect on clinicians and ultimately, patients,” he said.
Surveys reflect these concerns. A 2023 NORC survey from the University of Chicago found that 61% of employed physicians reported moderate or no autonomy to make referrals outside their system. Nearly half (47%) said they adjust treatment options to reduce costs based on practice policies or incentives.
Benjamin Levy III, MD, gastroenterologist at University of Chicago Medicine, reinforced the dual edge of consolidation.
“Optum’s acquisition of U.S. Digestive Health is important because it’s an example of how companies … can quickly consolidate gastroenterology practices and integrate care within a health insurance ecosystem,” he said. “Unfortunately, physicians might lose some autonomy during the acquisition.”
Concerns also extend to the cost of care. A study from the National Bureau of Economic Research found that physician practices acquired by hospitals between 2008 and 2016 experienced a 15.1% price increase for physician services within two years of acquisition, with no measurable quality improvement.
“We have to anticipate that the cost of care will increase as market power is consolidated to those that control the care and the dollar,” Andrew Lovewell, CEO of Columbia (Mo.) Orthopaedic Group, told Becker’s.
On the policy front, President Donald Trump’s Aug. 13 repeal of Executive Order 14036 — a Biden-era directive scrutinizing consolidation across industries, including healthcare — could accelerate deals. While federal antitrust laws remain, the repeal removes one layer of oversight, giving health systems and consolidators more leeway to pursue mergers.
At the state level, however, regulators are tightening scrutiny. In 2025, Oregon enacted the country’s strictest limits on corporate and private equity ownership of medical groups, requiring physicians to retain majority control. Pennsylvania expanded its attorney general’s authority to review and potentially block healthcare M&A.
For independent, physician-led groups, consolidation raises both challenges and opportunities.
“Consolidation can bring resources, scale and leverage, but it also risks diminishing the physician’s voice and shifting the focus away from patient-centered care toward purely financial outcomes,” said Dr. Geogy Vennikandam, COO of GI Partners of Illinois.
In markets like Dallas-Fort Worth, gastroenterologists are already feeling the pressure. Gregory Brennan, MD, a gastroenterologist in Mansfield, Texas, told Becker’s.
“In the last one to two years … there have been several physician transactions with both primary care and specialty groups,” he said. “I think in general it is harder for smaller practices to keep up with consolidation and remain independent.”
Optum’s expansion in GI coincides with another blockbuster ASC transaction: Ascension’s $3.9 billion agreement to acquire AmSurg, which will boost its ASC portfolio from 58 to more than 300 centers nationwide.
Between payer-backed consolidators like Optum and health system-driven expansions like Ascension’s AmSurg deal, the ASC industry is entering a new phase. Scale, integration and financial leverage are shaping where procedures take place and the owners of those providing care.
