Commentary: Primary care takeovers by Amazon, CVS, Optum threaten clinician autonomy, healthcare costs

Corporate takeovers of primary care practices by the likes of Amazon and CVS Health are a threat to health equity, healthcare costs and clinician autonomy, researchers wrote in a recent New England Journal of Medicine commentary.

On the flip side, the deals could boost convenient access to care for people with good insurance, IT and capital investment for physicians, and administrative support and work-life balance for clinicians, the authors said in the Jan. 7 article.

Between 2010 and 2021, private investment in primary care grew more than a thousandfold, from $15 million to $16 billion, the researchers noted. A likely influence is the expanding Medicare Advantage market.

They pointed to Amazon's proposed $3.9 billion deal for One Medical and CVS' planned $8 billion acquisition of Signify Health. Other big players they cited were Walmart, Optum, Humana, Agilon Health and Oak Street Health.

"Primary care has evolved from family doctors visiting patients by horse and buggy, to professional physician groups, to integration into larger health systems," wrote Soleil Shah of Stanford (Calif.) University School of Medicine, Hayden Rooke-Ley of Stanford Law School, and Erin Fuse Brown of Georgia State University College of Law in Atlanta.

"Now, corporate investors are moving aggressively into this field, drawn by financial opportunities created by the shift to value-based care, with major ramifications for the decades ahead. It is critical that neither the historical creed of medicine nor patients' trust in primary care physicians be sacrificed along the way."

Their recommended solutions include more aggressive antitrust actions, CMS curbing gaming of the risk-coding system for Medicare Advantage reimbursement, more scrutiny of corporate-owned primary care practices' referral and coding behaviors, and limitations on noncompete and nondisclosure agreements to give clinicians more authority over their practice.

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