US Health Insurers' Vertical Integration Raises Regulatory Concerns

The vertical integration of health insurance in the US is extensive, with major insurers controlling significant parts of the healthcare supply chain. This includes pharmacy benefit managers (PBMs), physician practices, clinics, home health services, and ambulatory surgery centers.

Some see this integration as a way to facilitate data sharing, care coordination, and efficient patient-treatment matching, while others point out opportunities for regulatory evasion and hidden profits through 'tunneling.'

The charts and spreadsheet provided illustrate the extent of vertical integration among five major health insurers: CVS-Aetna, Elevance, Humana, Kaiser, and UnitedHealth Group. These companies account for 69% of Medicare Advantage enrollment and 46% of commercial insurance enrollment.