A handful of major healthcare organizations are redrawing the physician landscape through aggressive acquisitions, vertical integration and high-stakes partnerships.
These moves are affecting competition, in some cases rousing antitrust scrutiny from legislators and the Justice Department.
Here are four developments to know:
Cardinal Health’s accelerating physician group buyouts
Dublin, Ohio-based Cardinal Health, long known as a pharmaceutical and medical products distributor, has rapidly expanded into physician services with three billion-dollar acquisitions in the past two years. The strategy reflects a broader industry push toward physician-led, vertically integrated care platforms. According to VMG Health, pharmaceutical companies are increasingly acquiring physician groups and management services organizations to build national, specialty-focused networks.
Cardinal Health’s most notable deal was its 2024 majority acquisition of GI Alliance, one of the country’s largest gastroenterology groups.
The deal sparked criticism from Sen. Elizabeth Warren, who urged the FTC to investigate, noting Cardinal Health already controls 28% of the U.S. prescription drug wholesale market. She said the acquisition could restrict competition by incentivizing physician practices to rely on Cardinal’s supply chain rather than rival wholesalers.
Cardinal Health has continued to double down on specialty care. In August, it announced plans to acquire Solaris Health, a leading urology MSO, for $1.9 billion in cash. Earlier in the year, it acquired Urology America and Potomac Urology.
Cardinal Health is also restructuring its strategy. In its July 2025 earnings report, the company announced the launch of The Specialty Alliance, a national multispecialty MSO platform. The platform now encompasses its newly acquired platforms.
Sanford Health’s regional consolidation spree
Sioux Falls, S.D.-based Sanford Health is undergoing one of the most ambitious expansion efforts in rural healthcare, inking four major deals in the last year that significantly broaden its physician network.
Sanford, the nation’s largest rural health system, with 56 hospitals and nearly 300 clinics, has absorbed independent practices, regional competitors and full health systems. This year, it acquired Black Hills Plastic Surgery and Creekside Medical Clinic, both in Rapid City.
In January, Sanford finalized a merger with Marshfield Clinic Health System.. In November 2024, it acquired Black Hills Surgical Hospital and Black Hills Orthopedic and Spine Center, securing full ownership after purchasing both the physician-owned and corporate stakes. The move intensifies Sanford’s rivalry with Monument Health, according to Sioux Falls Live.
A contentious academic partnership in Minnesota
A new $1 billion agreement between Fairview Health Services and University of Minnesota Physicians has drawn sharp objections from the University of Minnesota, which argues the deal threatens its academic mission and was negotiated without its consultation.
The 10-year partnership, set to launch Jan. 1, 2027, replaces the current M Health Fairview clinical enterprise and includes a $1 billion capital commitment to support academic health infrastructure and sustain key hospital operations.
University leaders called the agreement a “hostile takeover” of the medical school. In a statement to Becker’s, the university said the deal “oversteps” the authority of Fairview and M Physicians and limits the institution’s ability to educate medical students or conduct research. Leaders also criticized the closed-door nature of negotiations, warning it erodes public trust.
Fairview President and CEO James Hereford defended the agreement, saying it prioritizes patient access, provider support and the long-term stability of Minnesota’s academic health system.
Optum’s outsized influence on the physician workforce
UnitedHealth Group’s Optum remains one of the most disruptive forces in physician employment, directly employing or contracting with more than 90,000 physicians, or roughly 10% of the U.S. physician workforce, according to the Center for Health & Democracy’s “Sunlight Report,” funded by Arnold Ventures.
Optum’s subsidiaries extend deep into outpatient care, including 423 ASCs, more than 880 home health providers and 335 administrative entities.
Optum continues to acquire physician groups, many without public announcements. Recent deals include Atrius Health’s planned acquisition of Acton Medical Associates in Massachusetts, the acquisition of Holston Medical Group in Tennessee, and the purchase of FlexCare Infusion, an Oklahoma City–based ambulatory infusion network.
Optum’s ASC subsidiary, SCA Health, also made a major 2025 acquisition: the quiet purchase of U.S. Digestive Health, one of the largest gastroenterology groups in the country, which includes more than 149 physicians and 24 ASCs across Pennsylvania and Delaware.
Regulatory scrutiny is intensifying. In August, UnitedHealth Group and Amedisys reached a proposed settlement with federal and state attorneys general over an antitrust challenge to their $3.3 billion merger, a deal the DOJ argued would give Optum control over roughly 10% of the U.S. home health market when combined with its earlier acquisition of LHC Group.
A recent Health Affairs study added new concerns. Researchers found UnitedHealthcare pays Optum-owned practices 17% more than what competitor insurers pay those same practices and 61% more in markets where UHC holds at least 25% market share. By raising payments to its own physicians while depressing reimbursement to independent practices, the study says UHC could create competitive pressure that pushes rivals toward consolidation under Optum.
The study also raises questions about whether inflated payments help UHC meet Affordable Care Act medical loss ratio requirements by artificially directing more dollars toward “care,” thereby reducing rebate obligations to consumers.
Following a recent dip in earnings, however, UnitedHealth executives devised a course correction to return to the company’s original value-based care model, which Optum CEO Patrick Conway, MD, said the company had drifted from. Optum plans to narrow its provider network in 2026, removing less-aligned physicians and prioritizing providers who are fully committed to its care model.
