Washington, D.C. — In response to news that Aetna, a health insurer owned by CVS Health, will cut reimbursement rates for mental health clinicians who use Alma, a practice management company, the American Economic Liberties Project released the following statement. 

“By slashing reimbursement rates 30% to 40%, Aetna is making it untenable for therapists who use Alma to continue accepting Aetna health plans, which many patients rely on to access and afford mental health care and have little say in choosing when selected through work,” said Emma Freer, Senior Fellow for Health Care at the American Economic Liberties Project. “This announcement underscores the urgent need for Congress to pass the bipartisan Break Up Big Medicine Act so that CVS Health and other insurance conglomerates cannot wield their market power to squeeze independent therapists out of business amid a severe behavioral health workforce shortage.” 

Aetna is the third-largest health insurer in the U.S. and appears to use its market power to demand untenably low reimbursement rates from independent providers in exchange for network inclusion. Aetna is owned by CVS Health, a vertically-integrated healthcare conglomerate whose other subsidiaries include CVS Caremark, the nation’s largest pharmacy benefit manager; CVS Pharmacy, the nation’s largest retail pharmacy operator; and Oak Street Health, a primary care provider for Medicare enrollees. CVS Health reported $1.8 billion in profit in 2025.

Like Aetna, Alma is a corporate middleman that contributes to the Big Medicine problem. It is a for-profit practice management company that over 24,000 mental health clinicians across all 50 states use to bill insurers. Its original investors included Cigna Ventures and Optum Ventures, subsidiaries of the Big Medicine healthcare conglomerates Cigna Group and UnitedHealth Group, respectively. Spring Health, a venture-backed mental health platform that offers employee assistance programs, recently completed its acquisition of Alma for an undisclosed amount.

For-profit practice management companies raise several concerns among therapists, including patient privacy protections, undisclosed ownership by insurers and other corporate entities, and hidden fees. They mirror middlemen in other healthcare sectors – including management services organizations (MSOs) and dental services organizations (DSOs) – that circumvent state laws meant to prevent the corporate ownership or control of healthcare providers. 

In addition to breaking up Big Medicine, policymakers should ensure structural reforms encompass practice management companies. Specifically, they should: 

• Strengthen state prohibitions on the corporate practice of medicine, using Oregon’s 2025 law as a model. 
• Enact a federal ban on the corporate practice of medicine.

Economic Liberties has advocated for such structural reforms since 2024, in both white papers and the popular press. In early 2025, Economic Liberties launched the Break Up Big Medicine initiative to bring together independent healthcare professionals, patient advocates, employers, and policy experts who support structural reforms across the healthcare industry. 

Learn more about the Break Up Big Medicine initiative here.

Learn more about Economic Liberties here.