When Optum acquired Surgical Care Affiliates in 2017 for $2.3 billion, it was a bet that the future of healthcare was outpatient.
Nearly a decade later, that bet has produced the country’s largest ASC operator and a network of roughly 90,000 physicians. Its care delivery enterprise, however, now is pushing toward a deliberate pullback, a multibillion-dollar restructuring charge and a recalibration toward quality over quantity.
What follows is a timeline of how Optum built it and where it goes from here:
Origins and early identity
Surgical Care Affiliates was founded in 1982 by Joel Gordon in Nashville, Tenn. Mr. Gordon had previously founded General Care Corp., a hospital company sold to HCA in 1980, and partnered with Andrew Miller and Jack Massey, a co-founder of HCA and American venture capitalist, to launch SCA.
The company built its identity around the physician-partnership model with joint ownership of ASCs with physicians and health systems rather than outright acquisition. That structure distinguished it from later, more acquisition-driven competitors. SCA’s portfolio was weighted toward musculoskeletal, ophthalmology and gastroenterology cases. Andrew Hayek served as CEO from 2008 to 2018, leading the company through a public offering, significant facility growth and ultimately its acquisition by Optum.
Before the merger with Optum, SCA reported $1.3 billion in revenue and $148.7 million in EBITDA at the end of fiscal year 2016.
January 2017: The Optum acquisition
Optum announced plans to acquire SCA in January 2017. Under the agreement, Optum would acquire SCA’s outstanding common stock for $57 per share, with UnitedHealth Group common stock funding between 51% and 80% of the acquisition. Optum acquired SCA in 2017 for $2.3 billion. SCA became part of OptumCare, Optum’s primary and urgent care delivery services business.
At the time, Mr. Hayek framed the deal as a partnership play: “Joining with OptumCare will enable us to better support and empower independent physicians, helping them provide high-quality care for their patients while making healthcare more affordable.”
The combination of the nation’s largest payer and its largest pure-play ASC company reflected how much the healthcare delivery system had moved from inpatient to outpatient.
2017-2021: Steady ASC growth under Optum
After the acquisition closed in January 2017, SCA steadily grew its ASC portfolio. In 2019 alone, the company added 25 ASCs. CEO Tony Kilgore, who replaced Mr. Hayek in January 2018, told Becker’s the Optum relationship was enabling SCA to advance value-based care initiatives, particularly its connectivity to primary care.
By mid-2019, Optum had 56,000 affiliated, contracted and employed physicians and was on track to add 10,000 more that year. UnitedHealth executives publicly projected OptumCare would grow from a $16 billion business to a $100 billion business, with plans to purchase more surgery centers, primary care, and urgent care practices.
May 2022: Rebranding to SCA Health
Surgical Care Affiliates rebranded to SCA Health in May 2022, updated its logo to signal forward growth momentum, and added a new tagline: “The future of specialty care.” The move was explicitly a signal of strategic expansion beyond ASC management.
SCA Health positioned itself as a company that “pioneered the managed service organization model aligning physicians around the transition to value-based care” and now aimed to become a leader in specialty care more broadly. At rebrand, SCA supported a network of more than 260 surgical facilities and 8,500 physicians, and was supporting physician practices through Optum Specialty Practices.
The company had also launched the SCA Physician Development Institute the prior year, which is an educational platform focused on the business side of medicine, with a specific focus on outpatient migration of orthopedic procedures.
2022-2023: Physician strategy takes center stage
Then-CEO Caitlin Zulla told Becker’s the rebranding represented a transition to “support physician specialists more holistically across the specialty care continuum,” rather than being an ASC company “singularly focused on partnering with surgeons in their ASCs.”
In the year following the rebrand, SCA Health added over 60 surgical facilities and 700 physicians to its network. SCA also launched Specialist Management Solutions, linking users with local surgeons and facilities where they could save up to 50% on the cost of care.
Meanwhile, Optum was aggressively building out its physician portfolio. Key deals included Houston-based Kelsey-Seybold for $2 billion, Dallas-based Healthcare Associates of Texas for $300 million, Auburndale, Mass.-based Atrius Health for $236 million, and Middletown, N.Y.-based Crystal Run Healthcare, all within roughly one year.
Optum added nearly 20,000 physicians in 2023 alone, making it the largest employer of physicians in the country, with more than 70,000 affiliated physicians.
2024: Portfolio at scale
By 2024, SCA Health had a portfolio of 320 ASCs, second only to USPI’s 480-plus. Optum was pursuing health system partnerships that outsourced administrative functions, including revenue cycle management, IT, informatics and care management, rather than ownership of inpatient facilities. SCA Health’s ASC strategy reflected this wider lens.
As of late 2024, UnitedHealth’s subsidiaries included 423 ASCs and approximately 90,000 physicians across its provider network.
The growth attracted regulatory and academic scrutiny. A study published in Health Affairs found that Optum’s acquisition of ASCs was associated with an 11% increase in prices charged to competing commercial insurers, with an average price increase of $239 per procedure. Price increases were steepest in markets where acquired ASCs already held high horizontal market share and where Optum-owned physician practices and ASCs were co-located — rising by more than $370 per procedure in highly vertically integrated markets. SCA Health pushed back on the findings, saying the study “relies on narrow datasets and limited markets and does not reflect the accessible, affordable care ambulatory surgery centers provide.”
2025: Specialty deepening and GI expansion
In early 2025, SCA Health acquired U.S. Digestive Health, adding roughly 24 ASCs and 250 GI physicians across Pennsylvania and Delaware, expanding SCA’s gastroenterology network to more than 40 locations in the mid-Atlantic.
As of 2025, SCA Health operates more than 320 ASCs nationwide, supports approximately 9,200 physicians, and treats more than 1.43 million patients annually. The company controls about 5% of the U.S. ASC market, behind USPI and Surgery Partners. SCA’s 2025 strategy is focused on musculoskeletal service line expansion via its OrthoAlliance platform and higher-acuity outpatient cases.
2025-2026: Recalibration
The rapid expansion that defined Optum’s first decade of care delivery growth gave way to a deliberate pullback. Optum Health spent 2025 scaling back from its prior expansion, trimming its affiliated provider network by nearly 20% and reducing risk-based membership by around 15% through dropped PPO contracts, market exits and abandoned risk-sharing deals where viable terms couldn’t be reached.
UnitedHealth Group described the effort internally as “re-baselining operations at Optum,” bringing in new leaders to refocus and strengthen the company’s commitment to integrated value-based care. The company also took a $2.8 billion charge in the fourth quarter of 2025, covering restructuring costs alongside lingering Change Healthcare cyberattack expenses and portfolio divestitures.
Executives said Optum is prioritizing high-performing, engaged providers and moving toward employed or contractually dedicated physicians, meaning less-aligned providers removed from networks, with further contraction expected in 2026 to restore consistency and margins.
SCA Health, however, remained a growth vehicle. By early 2026, SCA Health operated more than 370 specialty clinical care locations, 400-plus physician practice clinics and roughly 9,700 physicians. Optum Health’s value-based care membership is expected to decline another 10% in 2026 before recovering, though the unit is projecting approximately 9% operating earnings growth as it works toward a target profit margin of 6% to 8%.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.