Optum Health posted adjusted earnings of $1.3 billion in first-quarter 2026, ahead of analyst expectations, driven by what leaders called a return to “disciplined, integrated value-based care,” in an April 21 earnings call.
The result follows significant restructuring across Optum’s care delivery portfolio.
“We are really encouraged by what we are seeing in the first quarter, which is a direct reflection of intentional actions that we have taken over the past few months to improve core performance,” Krista Nelson, CEO of Optum, said in the call.
Optum Health’s leadership described a deliberate reset away from an overstretched value-based care portfolio.
“A key part of the progress is OptumHealth’s return to a disciplined, integrated value-based care model,” Patrick Conway, MD, CEO of Optum Health, said.
The company serves over 20 million people across its care models, including more than 4 million in fully value-based arrangements.
An operational data point came from the West Region, where more intensive clinical navigation targeting hospital admissions, skilled nursing facility placements and ED encounters produced sharp results. Clinical reviews increased more than 50%, and skilled nursing facility admissions dropped approximately 35% in the first month versus prior year, executives said in the call. New scheduling standards are now live across nearly 70% of OptumHealth’s clinical settings, driving a 12% year-over-year increase in patient-facing hours.
Ms. Nelson cited two drivers behind first-quarter outperformance: favorable prior period reserve development in markets where clinical management has been most intensive and operational improvements in scheduling and cost management. Across the full enterprise, net prior period reserve development came in at just over $500 million, according to CFO Wayne DeVeydt.
United Health remains on track to invest nearly $1.5 billion in AI in 2026. Tools include ambient AI for clinicians, digital scheduling, and Optum Insight’s Optum Real platform, which has processed half a billion transactions year-to-date. A new prior authorization tool is live with several clients, showing a 96% approval rate. Chief Digital Officer Sandeep Dadlani projected a conservative 2-to-1 return on AI investments, “many paying back within the next 12 to 18 months.”
Despite the strong quarter, full-year adjusted EPS guidance was raised only modestly, to greater than $18.25.
“It is early in the year, and we are taking a prudent approach to make sure that we see another quarter of medical mature,” Ms. Nelson said.
Medicaid remains a drag with negative margins expected through 2026, and contract renegotiations covering arrangements that could generate over $100 million in premium deficiency reserves remain ongoing.
“This management team believes we are a long way from performing to our full potential, and we are committed to getting to that potential quarter after quarter,” United Health Group CEO Andrew Witty said. The long-term margin target for Optum Health remains 6% to 8%.
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