That's not quite how the actual incentives work. Most commercial insurers (both for-profit and non-profit) are increasingly adopting the "payvider" business model pioneered by Kaiser Permanente. As health plans pressured network providers to cut rates, the providers responded with M&A activity (some financed by PE) to gain more negotiating power. In some regions there are only a couple large health systems left that dominate the local market. Like in the SF Bay Area, health plans are pretty much forced to have Sutter Health in their networks in order to maintain adequate coverage. So now the only lever that health plans have left to control costs for their customers (i.e. large employers) is to hire clinicians directly as employees and cut out the middleman. UnitedHealth Group has been particularly aggressive about this strategy but all of their major competitors are taking similar approaches.