Across Optum Health, Optum Insight and Optum Rx, 2025 marked a pivot from years of rapid expansion to focusing on value-based care and operational consistency.
Here are seven ways Optum’s strategy shifted in 2025:
1. Refocusing on a core value-based care model.
Optum executives said on an Oct. 29 earnings call that the company is returning to its core value-based care model after drifting from its original mission.
CEO Patrick Conway, MD, said the strategy had “strayed from the initial intent of the model,” resulting in an oversized provider network, operational inconsistencies and an overreliance on affiliated physicians who were not fully aligned with value-based care. Optum Health posted flat year-over-year revenue in the most recent quarter, and leadership tied the results to the network growing too large, misalignment with value-based care policies, and product and service drift away from Optum’s clinically oriented VBC foundation.
After years of rapid footprint and affiliation growth, the shift signals a tightening of the model. Executives said Optum is prioritizing high-performing, engaged providers and moving toward employed or contractually dedicated physicians. Less-aligned providers are being removed from networks, and Optum expects further contraction in 2026 to restore consistency and margins.
2. Value-based care works, but is not yet at scale.
Optum’s value-based care infrastructure now covers more than 5 million patients in full-risk models and another 7 million in two-sided risk arrangements. At the Oracle Health and Life Sciences Summit, Dr. Conway said these models are producing measurable improvements in utilization and outcomes.
“[Hospitals’] avoidable ER visits go down double digit-plus quality and outcomes and experience improves in this peer reviewed literature we publish, so it can be successful,” Dr. Conway said. “It is successful, proven data and now we’re scaling that across the country.”
Even so, adoption remains limited. Dr. Conway said Optum is “not going fast enough,” noting that while roughly half of Medicare payments are now tied to value-based arrangements, commercial and Medicaid adoption still lags — despite Optum viewing the addressable market as “every American.”
3. Leadership shakeup.
UnitedHealth cycled through several senior leadership changes in 2025. In May, former CEO Stephen Hemsley returned to lead UnitedHealth Group after the company’s first major earnings miss in years and pledged a full review of forecasting and cost management across divisions, including Optum.
Within Optum:
- Patrick Conway, MD, replaced Amar Desai, MD, as CEO of Optum Health in June and also serves as CEO of Optum.
- Ben Eklo was named Optum CFO effective Nov. 1, replacing Roger Connor.
- Sandeep Dadlani was named CEO of Optum Insight, taking over the data/analytics business after previously serving as UHG’s digital and tech chief.
4. Acquisitions continue, but with more selectivity.
Optum remains active in dealmaking, particularly in care delivery, but 2025 acquisitions appear more targeted. This year, Optum acquired Holston Medical Group and FlexCare Infusion. Optum affiliate Atrius Health intends to acquire Acton Medical Associates, a primary care group in Massachusetts. Additionally, SCA Health acquired U.S. Digestive Health Management from Amulet Capital Partners earlier in 2025.
In August, UnitedHealth closed its long-delayed acquisition of home health and hospice provider Amedisys after settling Justice Department and state antitrust concerns and agreeing to divest clinics in 19 states. With Amedisys plus its earlier LHC Group acquisition, UnitedHealth is now positioned as the largest hospice provider in the country.
5. Regulatory scrutiny persists.
In August, UnitedHealth Group and Amedisys reached a proposed settlement with federal and state attorneys general over an antitrust challenge to their $3.3 billion merger, a deal the Justice Department argued would give Optum control over roughly 10% of the U.S. home health market when combined with its earlier acquisition of LHC Group.
6. New studies spotlight integration and market power
Several studies in 2025 raised fresh questions about Optum’s size and the implications of its vertical integration. A study published in November in Health Affairs found that UnitedHealthcare pays Optum-owned physician practices 17% more than rival insurers do, relative to payments made to non-Optum practices. In markets where UnitedHealthcare holds 25% or more market share, that difference jumps to 61%. The researchers raise the possibility that UnitedHealthcare may be inflating payments to Optum to meet ACA medical loss ratio requirements, thereby reducing rebate obligations and artificially achieving mandated thresholds.
“UnitedHealthcare pays Optum Health consistent with other providers in the market, which is essential for staying competitive. The study, funded by groups with known biases, cherry-picks data and is flat-out wrong,” UnitedHealth Group told Healthcare Dive.
Meanwhile, the Center for Health & Democracy’s “Sunlight Report,” funded by Arnold Ventures, estimated Optum employs or contracts with more than 90,000 physicians, roughly 10% of the U.S. physician workforce. The report also highlighted Optum’s reach in outpatient care, including 423 ASCs, more than 880 home health providers and 335 administrative entities.
7. Optum Rx: Reducing friction in pharmacy access.
Optum Rx took steps aimed at reducing provider and patient burden. In March, it announced it would eliminate up to 25% of reauthorization requirements, initially covering about 80 drugs and affecting more than 10% of its prior authorization volume. In late November, Optum Rx added 40 more drugs to the list, effective Jan. 1.
