When Your Health Insurer Owns Your Doctor's Office

My wife and I call our doctor's office "the health mall." We're patients at Atrius Health in Boston, part of Optum, part of UnitedHealth Group. Everything under one roof: primary care, specialties, imaging, labs, pharmacy. Walk out of your PCP visit and get bloodwork down the hall. It's great.

Here's the thing. My employer's health insurance is also managed by UnitedHealthcare. Same parent company on both sides of every transaction when I see my doctor. I didn't plan this. I just ended up as a case study in vertical integration.

And I'm happy with the care. That's what makes this uncomfortable to write about.

Because the research paints a different picture than my experience. Optum now employs or is affiliated with about 90,000 physicians, roughly 10% of the entire US physician workforce. A Health Affairs study from February found prices at surgery centers went up 11% after Optum bought them. A separate study found UnitedHealthcare pays its own Optum doctors 17% more than rival insurers pay those same doctors, raising concerns the company is gaming the ACA's medical loss ratio rules by shuffling money between its own subsidiaries. UnitedHealth called that study "flat-out wrong." The pattern keeps showing up in independent research anyway.

Meanwhile, UnitedHealth is cooperating with criminal and civil DOJ investigations into its Medicare Advantage billing. A Senate investigation reviewed 50,000 pages of internal documents and concluded the company turned risk adjustment into a profit strategy. Their stock has lost about half its value in the past year.

I wrote a few weeks ago about why your doctor doesn't really do preventive medicine and how the incentives are structurally broken. This is the next chapter. When your insurer owns your doctor's practice, the surgery center, the pharmacy benefit manager, the claims processor, and even a bank that lends to physicians at 35% interest, the concentration of power is remarkable. It doesn't automatically make your care worse. But it removes most of the forces that would keep things in check if it did.

I wrote a longer version with all the sources and more detail on my Substack: https://dadstrengthdaily.substack.com

Does anyone else here get care through an Optum-owned practice? I'm curious whether your experience matches mine: good care, total opacity about what's happening financially above you.

Disclaimer: I used Claude in researching and drafting this piece.