Lots of talk and lots of research these days about private equity in healthcare, so I am so pleased to bring you Yashaswini Singh, PhD, who is one of the authors of a lot of that research. Dr. Yashaswini Singh has been spending the last several years trying to understand the corporate transformation of medicine and the tension between medicine as a profession and healthcare as a business.
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She says the key concern here has always been that business obligations to shareholders might not always align with physician obligations to their patients.
In this episode, we are gonna tie up (or roll up, if you will) the recurring themes about private equity in healthcare that are just kind of flying around all over the place right about now.
So, this show, it is a little longer than normal maybe; but I decided not to edit it so much because if you do decide to listen to the whole shebang, you certainly can check the box that you got at least the nuts and bolts of the situation.
And look, it must be said right outta the gate here that not all private equity paths to profitability are inherently wrong, and that matters because healthcare is increasingly becoming much more capital intensive. Money is required.
The problem starts happening, though, when money becomes the mission in ways that are detrimental to patients’ health. It becomes a win-lose.
I’m interviewing, actually, Ben Schwartz, MD, MBA (coming up); and he talked about how it’s a very different view 10 feet from the bedside than 10,000 feet from it. But yeah, this is healthcare that we are talking about; and dollars that are made are made from the sick and from the old or from the disabled.
You get the wrong types of folks in leadership or decision-making roles, and even the most originally patient-first strategy can devolve into a really humanitarian disaster. And I might not be exaggerating when I say that, depending on what’s being done and to whom.
So, again, today I am talking with Yashaswini Singh; and we talk about typical private equity paths to profitability and how that might impact plan sponsors, patients (for sure), and also physicians and other clinicians.
And speaking of benefit consultants or plan sponsors, I just wanted to point out that if weirdly, suddenly plan costs go up 15% to 25% in some local market, might wanna check who just bought up and rolled up all of the physician practices in that area.
It certainly could be a local or maybe not local hospital system, but sometimes it’s not. Private equity, after all, has invested over $1 trillion in U.S. healthcare in the past decade; and currently there is just such a lack of transparency relative to who owns what and what they’re doing until, of course, the downstream effects are deeply pervasive.
To that end, Adam Brown, MD, MBA, wrote an article (he was on Relentless Health Value in 2023 [EP416]); but the title of that article is “Private Equity’s Growing Role in Disability Care Demands Urgent Oversight—Patients Are Not Lines on a Balance Sheet.”
Dr. Brown wrote, “Private equity is not inherently bad.” Hey, I just said that. “[It’s] not inherently bad. When firms are responsible and transparent, they can fuel innovation, expand access, and help modernize outdated systems. But when left unchecked, firms’ incentives are often misaligned with the core mission of healthcare: to care for people. This argument is not speculative.”
In the show today, I really like how Dr. Yashaswini Singh puts it. She says, “You’ve seen one private equity strategy, you’ve seen one private equity strategy.”
And because of that diversity in how PE operates, it’s slippery to get a handle on. It’s hard to grasp what may have already happened or is underway, and what’s gonna happen in the future is sort of hard to predict sometimes.
But it is becoming increasingly clear that there are certain playbooks, certain strategies that tend to be deployed by private equity. And some of them are much better than others, which is why getting a handle on these patterns in these playbooks is a really important conversation to be had, especially for you lot in this tribe who are some of the key decision makers in this country when it comes to buying or providing healthcare or setting policies.
Because if we know these playbooks, the knowledge is power when it comes to discerning the good kind of stuff from the really dangerous things. We need all of us to be working to try to make sure that the value accruing to the patient is the North Star, as Steve Schutzer, MD, puts it and which I keep quoting.
So, knowing these strategies and their typical impact equips you, me, us, all of us, the listeners to be on the alert and not get caught, you know, flat-footed after you, we, all of us, someone has already signed the contract. Because the impact of private equity is for real, and many of us don’t understand the mouse type in the contract and the elephant-size impact that it will have on all of our lives and patients’ lives until it’s too late.
Yashaswini Singh, PhD, is an economist by training, my guest today. She works as an assistant professor at Brown University at the School of Public Health.
Also mentioned in this episode are Brown University School of Public Health; Ben Schwartz, MD, MBA; Adam Brown, MD, MBA; Steve Schutzer, MD; Eric Bricker, MD; Tom X. Lee, MD; Ge Bai, PhD, CPA; Chris Crawford; Rushika Fernandopulle, MD; and Peter Hayes.
You can learn more at Brown University School of Public Health. You can also follow Yashaswini on LinkedIn.
Yashaswini Singh, PhD, MPA, is a healthcare economist and assistant professor of health services, policy, and practice at Brown University. Her areas of interest and expertise include consolidation, vertical integration, and private equity in healthcare markets. Her research examines how acquisitions of physician practices by private equity funds change physician practice patterns and the downstream effects on healthcare spending, access, quality, and the clinical workforce.
Dr. Singh’s research has been published in high-impact peer-reviewed journals, including Health Affairs, The New England Journal of Medicine, and Journal of the American Medical Association; featured in national media outlets; and is frequently cited in policy discourse. She received the Outstanding Dissertation Award from AcademyHealth in 2024, the Richard B. Salomon Faculty Research Award from Brown University in 2024, an international research award from the International Health Economics Association in 2023, and a teaching award from Johns Hopkins University in 2021.
Dr. Singh holds a PhD from Johns Hopkins University, a graduate degree in international finance from Columbia University, and a bachelor’s degree in mathematics and economics from Bryn Mawr College. In addition to her academic career, she has extensive private sector experience working in the antitrust and competition practice of National Economic Research Associates (NERA) Economic Consulting.
05:53 What is the tension between business and medicine?
07:05 What is the impact of private equity on healthcare?
08:46 How does healthcare change when private equity invests in medical facilities?
10:54 What are the intuitive impacts of private equity in healthcare?
12:28 What are the less intuitive effects of private equity on healthcare?
13:36 EP472 with Eric Bricker, MD.
14:15 What are the misconceptions about private equity investors acquiring healthcare facilities?
16:17 The Steward saga.
16:24 The death of Hahnemann Hospital in Philadelphia.
19:27 Are there any positive outcomes to private equity investment in healthcare?
21:17 EP445 with Tom X. Lee, MD.
22:45 EP420 with Ge Bai, PhD, CPA.
22:47 EP465 with Chris Crawford.
22:49 EP460 with Rushika Fernandopulle, MD.
22:55 Is there ever a need for private investment in healthcare?
25:40 How do the changes private equity firms create affect patients?
27:20 Study in Health Affairs on physician turnover rates following private equity acquisitions.
29:30 How can private equity disrupt physician employment as well?
34:13 What remedies might there be for consolidation in healthcare and private equity investing in medicine?
Recent past interviews:
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Dr Kenny Cole, Dr Eric Bricker, Dr Christine Hale, Nikki King, James Gelfand (Part 2), James Gelfand (Part 1), Matt McQuide, Stacey Richter (EP467), Vivian Ho, Chris Crawford (EP465), Al Lewis