What Farmers Already Know About Vertical Integration and the Uncanny Similarity to What’s Happening in the Mental Health Industr

By Dr. Elizabeth Carr, Founder, Kentlands Psychotherapy

This article explores how corporate consolidation in agriculture mirrors the forces shaping independent mental health practice today.

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What if the future of private practice looks a lot like what’s already happened to America’s family farms?

I recently watched a 60 Minutes segment on corporate consolidation in American agriculture. The piece documented how farmer owners, who until relatively recently in American history have been independent businesses, theoretically free to run their own operations, have gradually lost control over the fundamental means of their own production. John Deere software locks prevent farmers from repairing their own equipment without dealer authorization. A handful of corporations control the seed supply, the fertilizer market, and the distribution channels that get crops to consumers. The farmer who tries to operate outside this ecosystem faces structural disadvantages that compound with each passing year. Independence is now largely theoretical.

As I listened to their story, I couldn’t help but think about the January 2026 Ways and Means Congressional hearings where AOC grilled insurance company executives about their own corporate efforts at vertical integration of the healthcare industry using the “Kate Case Study” as an example.

[For more background Watch: Hearing on Health Insurance Affordability]

This, in turn, had me thinking about some of the recent corporate excursions into my own industry, mental health care, but looking at those movements specifically through this vertical integration lens.

The Means of Production in Mental Health

In mental health, the “means of production” aren’t tractors and seed. They’re client acquisition, credentialing, billing infrastructure, and clinician recruitment and retention.

We independent clinicians and group practice owners may not think of ourselves as farmers. But our means of production are being consolidated in much the same way. And we’re being squeezed from every direction.

Client Acquisition Challenges
Consider how client acquisition has changed. A decade ago, a Psychology Today profile and a basic web presence could often reliably fill a private practice caseload. Today, a solo practitioner’s website competes on Google against BetterHelp, Talkspace, Cerebral, and Teladoc, platforms spending millions on search advertising and SEO optimization. Psychology Today itself has evolved from a practitioner directory into a marketplace where platform-optimized listings compete for the same real estate that once belonged exclusively to independent clinicians. The independent practitioner who responds rationally by increasing their own marketing spend on PPC campaigns, SEO consultants, multiple directory subscriptions is likely finding themselves on a treadmill with rising costs and diminishing returns. We are, in effect, paying a tax to compete in a race structurally designed for us to lose.

The Credentialing Trap and Vertical Integration

The most structurally significant development, I believe however, is the vertical integration of insurance companies into care delivery platforms.

We all know insurance credentialing has become notoriously lengthy, complex, and administratively burdensome. Delays in this process have caused substantial financial repercussions for some practice owners. Insurance network participation demands ongoing administrative maintenance. This burden functions as a structural barrier that makes independent insurance-based practice increasingly difficult to sustain.

The same insurance companies creating that friction are now investing in telehealth and middleman credentialing platforms that offer clinicians a frictionless alternative. Platforms like Alma and Headway handle credentialing, billing, and client acquisition for clinicians who join their networks. This structural incentive has engineered a platform dependency analogous to John Deere making independent equipment repair impossible through software locks, then offering dealer service contracts as the solution.

The Parallels with Roundup Ready Seed
The Roundup Ready seed model offers an even sharper parallel. Monsanto created a product that solved the problem of weed management. It worked, adoption spread quickly, and farming systems reorganized around it. Then the dependency became difficult to unwind.

Why? One problem is that saving seed from your Roundup Ready crop for next year’s use is prohibited. These seeds carry a patented gene, making the farmer who tries to return to traditional seed-saving practices vulnerable to intellectual property litigation even when acting in good faith.

Furthermore, the weed problem that Round Up solved, ultimately resulted in the evolution of Roundup-resistant superweeds that require more Roundup (weed killing product) to control them.

Moreover, neighboring farmers who had never chosen to use the product have found the patented gene seeds in their field through cross-pollination, inheriting the same legal exposure without having made the choice.

The Similar Pattern is Emerging in Mental Health
When a clinician joins platforms like Alma or Headway to solve the very real problem of credentialing, billing, and risk of claw backs. The barriers drop immediately. Revenue begins to flow. But over time, something else happens: the practice stops building its own essential infrastructures.

Competency and Infrastructure Atrophy
That’s the “superweed.” The longer you rely on the platform, the more your independent marketing muscles atrophy. Website development, referral relationships, community presence can all weaken. And rebuilding them later is much harder than maintaining them.

Who Owns Your Business?
There’s also a question of ownership. In the Roundup model, the seed carries a patented gene. In platform-based care, the client relationship in many ways belongs to the platform. It is mediated through infrastructure you don’t control. Access, visibility, and terms that can shift. Exclusive reliance of these infrastructural support can give the illusion of entrepreneurship when the relationship is more like other gig economy roles, where the scheduling and dress code freedom can give an illusion of greater independence then may actually exist.

This dynamic has real-world consequences that practice owners rarely anticipate. In a recent episode of Your Group Practice Podcast, practice investor Dan King and Maya Topitzer of Breksey described a clinician who attempted to sell his practice, only to have the deal collapse when due diligence revealed he didn’t own any of his insurance contracts. Headway did. The asset he thought he was selling didn’t exist under his business name.

We Are All Impacted
And just like cross-pollination in agriculture, even clinicians who never join these platforms are still affected. Market expectations change. Referral patterns shift. The ecosystem reorganizes around these larger platforms’ presence.

The yield advantages are real. But so is the dependency.

Insurance Company Vertical Integration Example

Now insurance companies are no longer just payers. They are increasingly becoming providers.

Cigna owns Evernorth, which owns Evernorth Behavioral Health, which directly employs clinicians who deliver care. So, Cigna is simultaneously the entity that decides whether to cover your care, sets the reimbursement rate, and delivers the care itself. The conflict of interest is structural and unresolvable. The same corporate parent benefits financially from denying coverage and from providing care at the lowest possible cost per episode.

UnitedHealth Group owns Optum, which owns behavioral health delivery organizations, employs clinicians directly, operates outpatient mental health clinics, and manages pharmacy benefits. UnitedHealth both adjudicates claims and delivers the services being claimed. This is textbook vertical integration example of a corporation owning the supplier, the distributor, and the retailer simultaneously.

Anthem/Elevance owns Carelon Behavioral Health, formerly known as Beacon Health Options, manages behavioral health benefits for millions of members while the parent company also insures those same members.

The Talent Retention Squeeze

Platforms didn’t just compete with group practices. They dismantled the core value proposition, e.g., we handle credentialing and billing so you don’t have to, and we provide these services and a referral stream in exchange for a share of your revenue. That proposition made sense when credentialing was complicated and independent billing was difficult.

Platforms have systematically unbundled that value proposition. A mid-career clinician with established credentials can now port them to Alma or Headway with relative ease, retain a larger percentage of their session fees, and nominally access client acquisition support through the platform. The administrative barriers that once made group practice membership necessary have been substantially lowered by the platforms competing for clinicians and clients.

The Notable Impact on Insurance-Based Practices
Insurance-based group practices are particularly experiencing talent erosion from their most productive cohort: mid-career clinicians who have the credentials, the clinical confidence, and now the technological infrastructure to consider independence. Talent erosion is the human equivalent of topsoil loss: slow, hard to see until it’s severe, and extremely difficult to reverse. These practices are finding it increasingly difficult to recruit fully licensed clinical staff. With the bulk of their clinicians needing the most investment via oversight, mentoring, and supervision while also generating the lowest revenue. Often these folks are leaving soon after obtaining their license as the value proposition of the group practice position shifts making turnover an additional increasing burden to today’s practice leadership.

What This Means for Practice Owners

The farming analogy is clarifying because it has played out over decades and the outcome is more visible. Many of the farmers who have navigated corporate consolidation most successfully were not those who tried to compete with corporate agriculture on its own terms for scale, price, and distribution efficiency. Instead, they were those who found positions the corporate model structurally cannot occupy: direct-to-consumer relationships, they developed niche, organic, and other specialty products, created community-rooted identities, and differentiated so genuinely that consumers would have sought them out rather than defaulting to the norm.

How David Responds to Goliath
The parallel for mental health practice owners is direct. The practices most vulnerable to platform capture are those whose value proposition to both clients and clinicians was primarily administrative and logistical. This is the ground that platforms have commoditized best.

The practices with the strongest positions are those offering something VC platforms cannot replicate at scale: offering a niche treatment focus, accessible/human vs more cumbersome/automated admin support, and specialized and doctoral-level clinical services, while also creating a professional culture worth belonging to and emphasizing of your trusted community-based reputation.

This analysis is essential if we are to understand the ground that is shifting under us. We may have operated successfully for years yet today many of us are discovering that our competitive position has been based on pre-VC platform market conditions that no longer hold. The COVID-era mental health boom, when demand was so high and alternatives so scarce that virtually any practice could fill a caseload, masked growing structural vulnerabilities that the current market is now exposing.

The Question Worth Asking

What should I be doing now to respond to this changing industry landscape?

Farmers who understood what was happening to their industry early enough had options. Those who pivoted accordingly have survived, while those who recognized the dependency only after it was fully established have largely gone under. The mental health field is in the early phase of this consolidation curve which means practice owners who see the structural dynamics clearly still have some time to make meaningful choices about how to position themselves, what to build, and what to protect.

The question I keep returning to is this: When we look back at this period in ten years, will we recognize it as the moment our profession’s independent practice infrastructure was consolidated into a handful of corporate platforms? And will we wish we had paid more attention to and learned from, what the farmers already knew?

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Dr. Elizabeth Carr is the founder and Clinical Director of Kentlands Psychotherapy, a fee-for-service group practice in Gaithersburg, Maryland. This piece is a companion to her earlier article, Strategic Positioning During Industry Upheaval. She writes about the mental health sector, practice leadership, and industry dynamics.