BIG HEALTH CARE'S BIG TEST

More than ever before, insurance giants like UnitedHealth and CVS Health say that their enormous scale and scope make them the best candidates to fix America's health care system. After another wave of mergers, are they ready to live up to that promise?

- Maria Aspan & Erika Fry

IN APRIL, THE CORPORATE BEHEMOTH that started life as the Consumer Value Store celebrated its 60th birthday with a costume party. Karen Lynch, the CEO of what is now CVS Health, asked her top executives to attend a town hall dressed in 1960s fashion. Some opted for tie-dye, some opted out. Lynch herself enthusiastically embraced the brief, donning the white go-go boots and pillbox hat of a Mad Men-era flight attendant.

But while Lynch was cosplaying as a woman with little professional power, she was celebrating the latest acquisition in her career as a health care mogul. She joined CVS in 2018 when the pharmacy chain paid $70 billion to buy Aetna, the insurance giant that now covers about 37 million Americans. Since becoming CEO of the combined company in 2021, Lynch has spent another $19 billion on primary care and home health care businesses, betting that CVS can profit by directly owning doctors' groups.

By her side at that birthday party was Mike Pykosz, CEO of primary care company Oak Street Health. The Chicago based business specializes in treating Medicare-eligible and thus highly profitable-patients; Lynch was in the process of bringing Oak Street and its 600 physicians and other providers under CVS's ever-expanding umbrella. A few weeks later, CVS closed the deal. And Lynch, who now runs the sixth-biggest company on the Fortune 500, saw the number of people whose health and lives are affected by her decisions expand again, to more than 110 million.

"I always think, sitting in this chair, 'How would I want to be treated? How would I want my family members to be treated?"" Lynch tells Fortune, reflecting on CVS's influence eight days after her Oak Street purchase closed. "You're not going to get it right all the time," she acknowledges. "But how do we get better?"