Why the Rise of Health Care Conglomerates Is Bad for Patients

By Wayne Persky

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In a powerful JAMA opinion article, former U.S. Department of Justice antitrust officials Jonathan Kanter and Martin Gaynor warn that a new form of consolidation, what they call the “platformization” of health care, is creating monopoly-like power in the U.S. medical system, and that it may be time for antitrust enforcement to step in (Kanter and Gaynor, 2025, April 9).1

The essay highlights how today's health care behemoths, companies like UnitedHealth and CVS Health, are no longer just insurers or pharmacy managers. Instead, they’ve merged vertically and horizontally to include physician practices, pharmacies, hospitals, data analytics, and more, functioning as multi-sided platforms that control access to healthcare at nearly every level.

While this trend has enormous implications for the entire health care system, it’s particularly relevant for patients who have chronic, underdiagnosed, or poorly understood conditions, such as microscopic colitis (MC).

The authors argue that rather than resulting in better care, lower cost, greater access, and improved outcomes; the consolidation has led to higher prices, fewer independent options, reduced innovations, and murky choices in the decision-making process regarding healthcare access and coverage. Because of these consolidations in healthcare services, many patients face:

• Delays in diagnosis
• ​Restricted access to specialists
  
• Confusing drug coverage decisions, especially for nonstandard treatments such as budesonide, bile acid sequestrants, or Biologics​

Healthcare conglomerates try to control every step involved in healthcare.

When care delivery, prescription management, and insurance decisions are all controlled by a single parent company, patients with special needs, such as MC patients, may find themselves lost in a profit driven system that prioritizes system efficiency over patient care.​

In these consolidated systems, MC patients are especially vulnerable, since they rely on the diagnostic skills of gastroenterologists who understand MC and don't simply dismiss chronic, watery diarrhea as a temporary episode of diarrhea. And the fact that MC can only be diagnosed by examining biopsy samples under a microscope can be overlooked in a system designed to streamline costs. Only certain specific medications are useful for treating MC, and they may not even be on the formulary in vertically integrated pharmacy benefit plans.

Healthcare wait times are already too long.

Wait times for people seeking healthcare that requires special procedures (such as colonoscopies) are already too long in many situations, and as healthcare systems become more concentrated, small practices and community gastroenterologists may be "acquired" or "shut out", further limiting the number of clinicians able (or willing) to diagnose and properly manage conditions such as MC.

Platform-style health conglomerates can:

• Create barriers to entry for independent physicians and pharmacies,
  
• Increase conflicts of interest, such as when one corporate entity decides both what is prescribed and what is covered.
  
• Undermine patient trust by making healthcare decisions confusing, or driven by cost-cutting.

And this could easily lead to:

• Reduced access to non-formulary medications
  
• Higher out-of-pocket costs (for colonoscopy prep, diagnostics, or non-standard therapies)
  
• Difficulty getting second opinions or individualized care outside the “network”

These plans seem fine until patients actually try to use them.

A drop in the stock price of UnitedHealth Group (UHG) in early 2025. illustrates how insurance company profitability declines when patients actually use the services offered. And it exposes the inherent conflict of interest in Medicare Advantage's capitation plan (capitation is a payment system where a healthcare provider or group receives a fixed amount of money for each patient they are responsible for, per unit of time (like a month or year), regardless of how much care those patients actually need).

As an online Medpage Today article puts it: “Insurers are rewarded when care is avoided, delayed, or denied (Brown, 2025, April 29).”2 This is highly relevant to the platformization argument — large conglomerates are incentivized to restrict care to maximize profits, a trait they share with big tech’s control over access and content.

The "tactics" discussed in the article (prior authorizations, narrow networks, delays, cloudy appeal processes) show how conglomerates create friction in care delivery — exactly what the original JAMA viewpoint warned would happen when corporate consolidation overrides health system function. These practices are not just theoretical risks of consolidation, they're actively being used as cost-control strategies.

UHG’s acquisition of over 250 subsidiaries in a year further underscores the “platformization” of healthcare — one entity absorbing clinics, data firms, insurers, pharmacy benefit managers (PBMs), and physician groups under a single vertically integrated arrangement.​

The overall scheme turns Medicare Advantage into a “Trojan horse”.

The article provides a stark example of how public tax dollars are funneled into private profit — not to deliver more care, but to deliver less, as pointed out in the original JAMA article.

So how is CMS responding?

The Centers for Medicare and Medicaid Services (CMS) recently recalculated how Medicare Advantage's star ratings are calculated, the government is pumping additional billions of dollars of taxpayer money into the plan, and comments from politicians in positions of authority suggest that future regulatory decisions may continue to support this consolidation crisis rather than making any attempt to restrain it.

The bottom line is:

For patients with chronic, complex, or underrecognized conditions, such as MC, the rise of health care mega-platforms presents real risks. Decisions about diagnosis, treatment access, and even what’s covered can be made behind corporate walls, far removed from the individual needs of patients. Unfortunately, most of us have already felt the negative effects of this trend.​

The message from Kanter and Gaynor is clear: if policymakers don’t act soon, the same market dysfunction we’ve seen in big tech could soon define big health care, making an already fragmented system even harder to navigate for those who need it most, and creating a frustrating illusion — the more healthcare technology and capability improves, the less those who need healthcare the most, are able to access quality healthcare. How can access to healthcare be acceptable, let alone optimal,, when these conglomerates treat access to care as a liability, rather than a mission?

References

1. Kanter, J. and Gaynor, M. (2025, April 9). The Rise of Health Care Platforms JAMA, Published online. Retrieved from https://jamanetwork.com/journals/jama/article-abstract/2832535

2. Brown, N. A. (2025, April 29). What UnitedHealth's Stock Drop Reveals About Medicare Advantage. Medpage Today, Retreived from https://www.medpagetoday.com/opinion/prescriptionsforabrokensystem/115336