UnitedHealthcare’s acquisition of nearly 300 ASCs over the last decade wasn’t associated with reduced procedure volume, fewer physicians, changes to patient mix or worse quality of care, according to a study published in the September issue of Health Affairs.
The finding lands as regulators have grown increasingly vocal about the risks of insurer-provider vertical integration. The Department of Justice, the Federal Trade Commission and HHS have said such consolidation could let a dominant insurer steer patients toward the ASCs it owns or use its position to raise prices and reduce competition, concerns that fueled a 2024 federal inquiry into corporate ownership trends in healthcare and, more recently, a Senate bill aimed at breaking up vertically integrated insurers.
Researchers from Brown University, Columbia University, RAND Corp. and Cornell University used 100% of Medicare fee-for-service claims data from 2013 to 2021 and a difference-in-differences design to isolate the effect of UnitedHealthcare’s ownership on ASCs that performed arthroscopy and colonoscopy procedures.
Key findings:
- No statistically significant change in the number of procedures, physicians or patients at ASCs after UnitedHealthcare acquired them.
- No change in patient mix, including age, sex, race, dual Medicare-Medicaid eligibility or composite health risk scores, suggesting no evidence of patient selection or cherry-picking on the part of the insurer.
- A small but statistically significant decline in colonoscopy complication rates beginning in the second year after ownership change, equivalent to a 0.04-standard-deviation improvement. Complication rates for arthroscopy ticked up slightly but not significantly.
“UnitedHealthcare ownership did not lead to deterioration in quality during this period,” the authors wrote.
The results echo two earlier studies the authors cite that found little evidence of changed referral patterns or performance at Optum-acquired physician practices. But the same research group flagged a separate finding worth watching: UnitedHealthcare negotiated meaningfully lower facility fees than rival insurers, including at ASCs it owns, a pattern the authors said still warrants monitoring as insurer-ASC consolidation continues to draw regulatory attention.
The authors were careful to note limits on how far the “no harm” finding can be generalized. Most UnitedHealthcare ASC acquisitions happened after 2017, meaning the study captures only short-to-medium-term effects, and it covers just two procedure types in the Medicare fee-for-service population.
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