When you pick a therapist, you think you’re choosing a person. Increasingly, you’re also choosing an owner. And the owner matters more than most people realize. I’ve written recently about why city workers deserve better insurance and about ghost networks, the directories full of therapists who don’t return calls because the listings are fiction. This piece is about the question that naturally follows: fine, so who should I actually see? And more specifically, who is behind the name on the website?
What’s happening to the market
Private equity has been buying behavioral health at a remarkable pace. In 2025 alone, PE firms completed 56 behavioral health deals, part of a record year in which they closed more than 1,000 healthcare deals overall [1]. Counting every kind of buyer, there were 180 behavioral health transactions last year, with mental health leading all subsectors at 111 deals [2]. By one JAMA Psychiatry analysis, private equity already owns about 6 percent of mental health facilities nationally, and more than 20 percent in several states [3].
You won’t see this in the branding. Ownership changes are often quiet on purpose. Deal advisors themselves report that PE-backed buyers increasingly decline to announce acquisitions to avoid regulatory and public attention [4]. The name on the door stays the same, the website gets nicer, the ads get everywhere. BetterHelp spent $29.6 million on podcast advertising in a single quarter and has ranked among the medium’s top advertisers for years, per the ad tracking firm Magellan AI [5]. No independent practice can compete with that spend. That’s the point of the spend.
Here in New York, this shows up as a specific experience. You search for therapy, and what surfaces first is not the group practice twenty blocks away. It’s a national platform, funded to look shiny, helpful, and local, that may connect you to a clinician anywhere.
Why ownership shapes your care
The business model is not complicated. A fund buys a practice, or combines many small practices into one company, with a plan to sell the whole thing in three to seven years at a higher price, the standard private equity holding period documented in the health policy literature [17]. In a therapy business, there are only a few ways to get there: more sessions per clinician, cheaper clinicians, automated or offshored intake, and harder bargaining with insurers. Every one of those choices ends up in the room with the client.
We don’t have to speculate about what that looks like. LifeStance, which describes itself in its securities filings as one of the nation’s largest providers of outpatient mental healthcare [18], paid $50 million to settle a shareholder lawsuit alleging it misled investors about how fast its clinicians were leaving [6]. Think about what that settlement means: therapist turnover was so central to the business that hiding it moved the stock price. BetterHelp was ordered by the FTC to pay $7.8 million over charges it shared sensitive mental health data, including health questionnaire answers, with Facebook, Snapchat, and other companies for advertising, after promising users it wouldn’t [7].
The middleman platforms deserve a mention too. Headway, valued at $2.3 billion, sits between tens of thousands of therapists and the insurance companies [8]. When UnitedHealth’s Optum cut its rates in late 2024, Headway and its competitor Alma passed the cuts straight through, up to 30 percent per session for some therapists, effective within weeks [9]. The therapists had no contract to renegotiate and no seat at the table, because the platform holds the insurance contract, not the therapist. And a platform is not a practice. The therapist on the other end works alone, as an independent contractor, with no benefits, no supervision, no colleagues down the hall. When your therapist has that kind of year, you feel it, whether you know the cause or not.
And here is the part most people never see. The insurers and the platforms are not on opposite sides of the table. Alma’s $130 million Series D round included both Optum Ventures and Cigna Ventures, the investment arms of UnitedHealth and Cigna [10]. Headway’s investors include Health Care Service Corporation, the parent of several Blue Cross Blue Shield plans [11]. UnitedHealth went further and simply bought Refresh Mental Health, then one of the largest outpatient mental health providers in the country, outright [12]. So when a payer negotiates rates with a platform, it is sometimes negotiating with a company it partly owns. That’s not a conspiracy. It’s an alignment of interests, and the interest being aligned is not the care.
The research on private equity in healthcare more broadly points the same direction. A study in JAMA found a 25 percent increase in hospital-acquired adverse events, like falls and bloodstream infections, after private equity acquisition [13]. A 2025 JAMA Psychiatry study of psychiatric hospitals found PE-owned facilities ran significantly thinner nurse and social worker staffing, though the quality measures it could check were not worse [14]. To be fair, the evidence is mixed across settings. A BMJ systematic review of two decades of research found private equity ownership most consistently associated with higher costs to patients and payers, with mixed to harmful impacts on quality [19]. And outpatient therapy outcomes specifically are barely studied. I’d argue that’s part of the problem. The incentive structure is documented. The staffing effects are documented. The outcome data is a question the industry has not been eager to answer.
The corner market test
Here’s the simplest way I know to think about it. There’s a difference between your corner market, where the owner is behind the counter or at least in the building, and a chain, where decisions about your neighborhood get made somewhere else by people who will never stand in it.
The corner market owner eats their own inventory. They see the same customers for years. If something is wrong, they fix it because their name is on it and their life is in it. The chain isn’t evil. It’s just answering to something other than you. But I want to be honest about where the comparison breaks, because the break is the point. At the chain, you at least get the same can of beans. Groceries are groceries. Therapy has no same can of beans. The product is the relationship, the person sitting with you, how much room they have to think about you between sessions, whether they’ll still be there in six months. Ownership doesn’t change where you get therapy. It changes what therapy you get.
If you want to know how this movie ends, look at the pharmacy counter. We let the chains buy the corner drugstores. The pharmacists ended up understaffed and overloaded enough that thousands staged walkouts in 2023 over conditions they said were unsafe [15]. The line got long, the counter got slow, and the person behind it stopped having time to know you. And then the model failed anyway. Rite Aid closed its last stores in 2025, and CVS and Walgreens are closing locations by the thousand, long after the independents they replaced had disappeared [16]. The extraction came first, the collapse came after, and the neighborhood ended up with neither. Therapy is at the beginning of that arc, and the stakes are your inner life.
The obvious question
I run a group practice with more than 100 clinicians, so let me address the obvious question: isn’t Humantold big too? Size isn’t the issue. Ownership is. I’m a clinical social worker. My partner in this practice is a clinician. We built this over twenty years, seeing clients ourselves, and we have no fund behind us and no exit clock running. Like most practices our size, we use an administrative organization to run the business side, the billing, the scheduling, the credentialing. The question is never whether a practice has business structure. It’s who that structure answers to. Ours answers to the clinicians who own the practice. A platform’s answers to the fund. And let me be precise about the claim, because it’s easy to overstate. Clinician ownership does not guarantee good care, and outside investment does not guarantee bad care.
There are excellent therapists working at every kind of organization, and there are mediocre
independent practices. The argument is about incentives, accountability, and who ultimately controls clinical decisions. A clinician-owned practice answers to a clinical standard, because the owners have to face their colleagues and their clients. A fund answers to an exit timeline. Both can employ good therapists. Only one is structurally built around what happens in the room.
What you can do
First, a word about affordability, because arguments like this one can drift into lecturing people about choices they don’t have. For many people, what their insurance covers decides where care happens, full stop. If a platform is the door your coverage opens and you walked through it, you did nothing wrong, and if the care is helping you, that matters more than anything in this essay. The critique here is aimed at a system that too often makes the extracted option the covered option, not at anyone doing their best inside it. That system is worth fighting, which is why I’ve written about insurance in the first place. And it’s worth knowing that many local, clinician-owned practices, solo and group, do work with insurance. The choice is more available than the ad spend makes it look. If you do have a choice, ask who owns the practice. It’s a fair question and a revealing one, and there are three easy ways to get the answer. Ask directly, at the first call or the first session. Read the about page and see whether the founders are clinicians or whether the story is about growth and funding. And search the practice name alongside the words “private equity” or “backed by.” Ownership changes are quiet on purpose, but they’re rarely secret.
What you’re looking for is simple. Is it owned by clinicians? Are the owners in the building, seeing clients, supervising, present? Is it local to your city, so your premium dollars and your fees stay in your economy instead of flowing to a fund somewhere else?
You already know how to do this. You do it when you choose the corner market. And you
already know what it costs to get it wrong. You’ve stood in that pharmacy line. The same
instinct applies here, and the stakes are higher.
Sources:
- Private Equity Stakeholder Project, “Private Equity Healthcare Deals: 2025 in Review,”
February 2026. https://pestakeholder.org/reports/pe-healthcare-deals-2025-in-review/
- Mertz Taggart, “Q4 2025 Behavioral Health M&A Report,” February 2026.
https://www.mertztaggart.com/post/q4-2025-behavioral-health-m-a-report
- Zhu et al., JAMA Psychiatry, reported in Psychiatric News, “Private Equity’s Inroads Into
Mental Health Bring Concern,” 2025. https://psychiatryonline.org/doi/full/10.1176/appi.pn.2025.03.3.38
- Behavioral Health Business, “Why Some Behavioral Health M&A Is Flying Under the
Radar in 2025,” July 2025. Why Some Behavioral Health M&A Is Flying Under the Radar in 2025 - Behavioral Health Business
- Magellan AI Podcast Advertising Benchmark Report, Q2 2023, via RAIN News.
https://rainnews.com/magellan-benchmark-report-q2-2023/
- Bloomberg Law, “LifeStance Investors Win Approval of $50 Million Settlement,” January
- LifeStance Investors Win Approval of $50 Million Settlement (1)
- Federal Trade Commission, “FTC Gives Final Approval to Order Banning BetterHelp from
Sharing Sensitive Health Data for Advertising, Requiring It to Pay $7.8 Million,” July 2023.
- Headway, “$100 Million Series D Funding” press release, July 2024.
- ClearHealthCosts, “2 digital mental health platforms cut pay rates for therapists with
UnitedHealth’s Optum, stirring anger,” November 2024.
- Fierce Healthcare, “Cigna, Optum back Alma’s $130M round,” August 2022.
Alma nabs $130M to scale platform for mental health providers
- Sacra, Headway funding and investor profile. https://sacra.com/c/headway/
- Behavioral Health Business, “UnitedHealth Group’s Optum Acquires Refresh Mental Health,” March 2022. UnitedHealth Group’s Optum Acquires Refresh Mental Health [Updated]
- Kannan S, Bruch JD, Song Z. “Changes in Hospital Adverse Events and Patient
Outcomes Associated With Private Equity Acquisition.” JAMA. 2023;330(24):2365-
- doi:10.1001/jama.2023.23147
- Shields MC, Yang Y, Busch SH. “Private Equity Among US Psychiatric Hospitals.” JAMA Psychiatry. 2025;82(7):701-708. doi:10.1001/jamapsychiatry.2025.0689
- PBS NewsHour / Associated Press, “Why pharmacy workers are going on strike amid store closures,” October 2023. PBS News Hour | Why pharmacy workers are going on strike amid store closures | Season 2023 | PBS
- CNN via ABC7, “Rite Aid closes all remaining stores,” October 2025; Axios, “Walgreens to close 1,200 stores,” October 2024. https://abc7.com/post/rite-aid-closes-remaining-
stores-more-60-years-business/17937848/ and https://www.axios.com/2024/10/15/walgreens-store-closings-wba-store-closures
- Offodile et al., “Private Equity Investments in Health Care: An Overview of Hospital and
Health System Leveraged Buyouts, 2003-17,” Health Affairs, 2021 (documents the
three-to-seven-year exit orientation). https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.01535
- LifeStance Health Group, Form 8-K earnings releases, SEC filings (“one of the nation’s
largest providers of outpatient mental healthcare”). https://investor.lifestance.com/
- Borsa A, Bejarano G, Ellen M, Bruch JD. “Evaluating trends in private equity ownership
and impacts on health outcomes, costs, and quality: systematic review.” BMJ.
2023;382:e075244. doi:10.1136/bmj-2023-075244