Two of the country's largest companies, CVS Health and UnitedHealth Group both say they are positioning the U.S. for a shift away from fee-for-service healthcare and will thus save Americans money.
But is the growing size of the payer-providers good or bad for healthcare? Several experts on both sides of that debate weighed in to Fortune in a May 24 story:
— "While recognizing that we have shareholders and a lot of different stakeholders, my personal passion is, 'How do we improve the healthcare system?" said CVS Health CEO Karen Lynch.
— "Everything about the incentive structure that exists, when you have providers and insurers and pharmacy benefit managers coming together under one roof, to me spells 'conflict of interest,'" said Sara Sirota, a policy analyst at the antitrust advocacy nonprofit American Economic Liberties Project. "That's going to harm services and prices for patients."
— "We're bigger, we're more accessible. There's more technology," said Tony Lin, MD, CEO of Houston-based Kelsey-Seybold Clinic, which UnitedHealth subsidiary Optum bought in 2022, adding to its growing roster of physicians. The arrangement "gives us a little more juice."
— "The furious pace of consolidation in healthcare is resulting in higher prices and lower-quality care for patients," said U.S. Sen. Elizabeth Warren, D-Mass.
— "One does need a critical mass of patients to execute on this, [and] physicians collectively to be open and willing to innovate with us," said Margaret-Mary Wilson, MD, chief medical officer of UnitedHealth Group. The company's deals are not "flashy acquisitions" but about "bringing the pieces together to help drive value."
— "The incentives are not super strong for these companies to actually do a great job of lowering costs," said Dave Windley, a financial analyst for Jefferies.
— "I'm really proud of what we built — but that's not moving the needle for the country," said Mike Pykosz, CEO of primary care chain Oak Street Health, which CVS purchased in May for $10.6 billion. "CVS will allow us to grow, to reach more older adults — and to allow us to say we're actually helping to solve societal problems."
— "We've got some important imperfections in those risk-adjustment systems," said Mark McClellan, MD, PhD, a former CMS administrator and the leader of Washington, D.C.-based Duke-Margolis Center for Health Policy. "You have an incentive to identify more diagnoses and get paid more that way."
— "We find that many people who get care at Oak Street have sometimes not felt welcomed by the healthcare system — and we pride ourselves on really nice places where people can feel welcomed and supported," said Marisa Rogers, MD, executive medical director of Oak Street.
— "Insurers are arguing it gives doctors a chance to become part of integrated care and build more supportive systems," said former CMS administrator Donald Berwick. "I think the evidence is not there right now. [Physicians] want to work for patients, and now they find that working for financial interests … it's a toxic trend that we're going to pay dearly for."
— "It's kind of a throwback to the '50s, where the doctor used to come to the home," said Kyle Armbrester, CEO of home health company Signify Health, which CVS acquired in March for $8 billion. "We can bring [care] in a convenient, accessible, preventative way."
— "All of the evidence shows that it does not improve quality or patient experience, but it absolutely drives up prices," said Elizabeth Mitchell, CEO of the Purchaser Business Group on Health employee coalition.