A Brookings Institution analysis published Sept. 3 maps how deeply the five largest U.S. health insurers — covering 126 million Americans — have expanded into owning the physician practices, ASCs, pharmacies and PBMs they also pay for care through. Researchers used 2025 SEC filings, IRS Form 990s and state insurance-subsidiary schedules to trace the money.
Five things ASC leaders should know:
1. UnitedHealth Group’s Optum Health division — which owns SCA Health, one of the country’s largest ASC operators — generated $100.5 billion in 2025 revenue, 63% of it from UnitedHealthcare’s own health plans.
2. UnitedHealth Group posted $443.6 billion in total 2025 revenue and now operates more than 2,000 subsidiary entities across insurance, care delivery and pharmacy.
3. CVS Health’s Aetna generated $141.5 billion in insurance revenue, while its Caremark PBM took in $181.1 billion — $45.6 billion of that from related CVS entities.
4. Elevance Health’s health services arm, Carelon, drew 75% of its $28.3 billion in revenue from Elevance’s own affiliates rather than outside customers.
5. The researchers warned the internal financial flows create “abundant opportunities to game regulations, hide profits through tunneling, and foreclose markets to rivals” — a dynamic ASC operators increasingly cite when insurer-owned networks steer referrals toward their own sites of care.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
