Over 70% of physicians are now employed by a health care system or corporate entity, including publicly traded and private equity firms. Research to date shows that consolidation has increased health care prices with limited impact on quality or access to care. Yet the impact of consolidation is highly heterogeneous across market conditions. Research at CAHPR aims to inform policy by understanding this evolving landscape that has critical implications for competition, choice, access, and the structure of health care services.
Center for Advancing Health Policy through Research
Markets and Consolidation
While the health care industry has been consolidating for two decades, a number of trends are changing how physician markets are organized and how various stakeholders are impacted.
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Dr. Yashaswini Singh, Assistant Professor at Brown University, presented findings from a study on private equity (PE) in Maryland physician practices, mandated by Maryland’s 2024 legislation (HB 1388). The study analyzed PE trends, geographic penetration, affected communities, and PE-affiliated physicians' participation in payer networks and value-based programs. Erin Fuse Brown provided NASHP-based policy recommendations focused on enhancing oversight of healthcare transactions, protecting healthcare workers through stronger CPOM laws and limiting covenant restrictions, and increasing ownership transparency.
Recent News
Hospitals are discouraging infection testing to avoid Medicare penalties, a practice clinicians say jeopardizes patient safety and skews public reporting. As Brown University’s Andrew Ryan put it, “Basically, the measures are just really, really bad … this is honestly the worst” pay-for-performance program, underscoring deep flaws in how infection penalties are designed and enforced.
Republican lawmakers pressed for stricter oversight of nonprofit hospitals at a House hearing, arguing that many exploit tax exemptions while providing limited charity care. Witnesses, including Brown University’s Christopher Whaley, highlighted that current reporting structures obscure hospital-level community benefit, and urged stronger, more transparent requirements to ensure accountability.
In testimony before Congress, Brown University researcher Christopher Whaley revealed that many nonprofit hospitals reap massive financial benefits yet spend far less on community health than their tax exemptions are worth. With bipartisan concern mounting, Whaley urged reforms to ensure tax breaks translate into affordable, high-quality care for patients — not executive perks or stadium sponsorships.
This article reports on a Health Affairs study led by Brown University researchers analyzed over a decade of private equity acquisitions in opioid treatment programs across 43 states. The findings show that despite rapid growth in private equity ownership, there were no measurable improvements in methadone access, treatment expansion, or opioid-related mortality
A new Health Affairs study reveals that hundreds of urban hospitals have secured “Medicare administratively rural” status—unlocking benefits meant for rural communities. While CMS prepares to roll out its $50 billion Rural Health Transformation Program, the findings raise concerns about loopholes, misaligned incentives, and whether subsidizing facilities truly improves access for rural patients.
This article talks about a Health Affairs study led by researchers at CAHPR, University of Pittsburgh and the RAND Corporation on the current PE ownership of opioid treatment programs in the US. Despite acquiring large shares of the market, PE firms are not expanding access to methadone—leaving the treatment gap largely unchanged.
The Milbank Quarterly
How States Strengthened Their Health Care Markets in the 2025 Legislative Session
In the first half of 2025, states enacted numerous laws to strengthen their health care markets. These new laws address several recurring policy issues affecting states across the country, including skyrocketing health care costs, increased consolidation in the healthcare sector, and the heightened penetration of private equity in health care systems.
The proposed sale of two safety net hospitals — from private equity-backed Prospect Medical Holdings to the nonprofit Centurion Foundation — has been closely watched across the state. The Attorney General's updated terms for the sale reflect growing concern over the role of private equity in Rhode Island’s health care system.
Drugmakers are experimenting with direct-to-consumer sales in response to Trump’s push for lower drug prices, aiming to bypass traditional middlemen like PBMs. While the strategy could reshape how patients access medications, experts warn its impact on affordability, safety, and equity remains uncertain.
The article investigates how major drugmakers like Pfizer and Eli Lilly are paying telehealth companies millions of dollars to connect patients to providers, raising concerns about potential conflicts of interest and violations of anti-kickback laws. While both companies deny influencing prescriptions, lawmakers and experts worry these partnerships may steer patients toward expensive branded drugs and allow pharma firms to collect detailed patient data.
Managed Healthcare Executive
Private Equity in Healthcare: Colonoscopy Prices Soar While Care Remains the Same
This article covers a study in JAMA Health Forum finds that private equity-acquired gastroenterology practices significantly raised colonoscopy prices without any improvement in quality of care. The rise in costs was especially steep in highly consolidated markets, where prices surged by 6.7%. With no measurable gains in patient outcomes, the findings raise broader concerns about the impact of PE’s profit-driven model on healthcare affordability, transparency, and value.
This article argues that despite Massachusetts’ recent reforms after the collapse of Steward Health Care, a major loophole still allows private equity to control medical practices through shell companies and “friendly physician” arrangements. Drawing on the century-old corporate practice of medicine (CPOM) doctrine, the article calls for stronger legal restrictions like those recently passed in Oregon to protect patient care from financial interests.