Where health insurance payers control primary care

In parts of the nation, health insurers and payers may be some of the main controllers of primary care.

A new study posits that Optum, the “health solution and care delivery” subsidiary of UnitedHealth Group, has grown to control payer-operated health care practices that account for 2.71% of the primary care market across the nation.

That may not sound like much, but the percentage of market share can be much higher at the local level, and some locations could have populations into the hundreds of thousands, or even millions of people.

“Overall, 15.1% of the U.S. population resided in counties where payers controlled more than 10% of the primary care market in 2023, with 10.1% living in counties where Optum alone exceeded this threshold,” said the study said. It appeared to be the first estimate of the extent of health insurer ownership of physician practices nationally and down to the county level.

What’s more: Payer control has increased nationally in recent years. In 2016, just 0.78% of physicians and other clinicians worked for payer-operated practices. Specific to Optum, its share of the primary care market rose from 0.55% in 2016 to 2.71% in 2016.

This slideshow lists 16 markets with the greatest concentrations of health insurer control of primary care. All data come from “The changing landscape of primary care: an analysis of payer-primary care integration.” The new study was published in Health Affairs Scholar.