Optum is recalibrating as it sheds providers, tightens its network and doubles down on AI and ASCs.
Here’s a breakdown of what’s new with Optum and SCA Health.
Scaling back to move forward
In a recent Becker’s Healthcare podcast, Optum’s CEO Krista Nelson outlined her vision for the care delivery giant following years of rapid expansion.
Optum Health, the care delivery arm of UnitedHealth Group and parent of ASC chain SCA Health, previously employed or had contractual ties with roughly 90,000 physicians. The unit spent 2025 scaling back from that 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.
Ms. Nelson, who previously served as Optum Health’s COO and CEO of UnitedHealthcare’s Medicaid business, said the unit’s core capabilities of primary and specialty care, behavioral health, home health, hospice, palliative care and ASCs remain strong, even as performance across markets has been uneven.
“You should expect Optum Health on the other side of this to more consistently deliver market-leading integrated value-based care,” she said, pointing to a tighter network anchored in employer groups and supported by technology and operational improvements.
The road back to profitability
Optum Health’s contraction isn’t over yet. Value-based care membership is expected to decline another 10% in 2026 before recovering, though the unit is projecting approximately 9% operating earnings growth this year as it works toward a target profit margin of 6% to 8%.
The financial pressure has been significant. Company leadership has acknowledged an $11 billion headwind over three years tied to federal risk model changes, elevated medical cost trends and challenges absorbing new members from other Medicare Advantage plans.
Ms. Nelson pointed to Houston as a proof of concept for what the trimmed-down model can look like at scale. There, Optum Health serves close to 1 million patients across more than 50 clinical settings, operates a 4.5-star Medicare Advantage plan and reports total cost of care 15% to 30% below alternatives, with strong patient satisfaction and low provider turnover. Internally, the company says its MA patients in value-based arrangements have 21% fewer hospital admissions overall, with reductions of 35% for patients with hypertension and 44% for those with COPD.
Leadership changes at the top
Beyond Ms. Nelson’s appointment, Optum also named Tom Roos — who has served as chief accounting officer since 2015 — as CFO at Optum Insight. UnitedHealth Group also named Dennis Stankiewicz as CAO, effective March 2.
Mr. Stankiewicz will continue as corporate controller, a role he has held since April 2023. He will also receive an annual salary of $550,000, an annual cash bonus target of 85% of salary, and annual and long-term stock-based awards.
Betting big on AI
In February, Optum launched Value Connect, an AI-powered platform designed to help payers and providers operationalize value-based care by unifying clinical, operational and financial data within a single system. The platform draws on more than 1,600 models, including Optum’s generative AI capabilities, to flag patients needing intervention and route next steps directly into care team workflows, replacing manual processes like spreadsheets and handoffs.
Value Connect is the latest in a string of recent AI product launches. Recently, Optum released two AI-driven prior authorization tools: Digital Auth Complete, a provider-facing product built in collaboration with Humata Health that went live in January, and InterQual Auth Accelerator, a payer-facing clinical review tool that began piloting with two large health plans in late 2025 and is expected to go fully live with its first payer by April. Other recent additions include Optum Real, a real-time claims validation platform, and Crimson A, a predictive analytics tool for OR scheduling.
The launches reflect a significant companywide bet on AI. UnitedHealth Group said it has deployed more than 2,000 engineers on AI initiatives and integrated over 1,000 use cases across its business.
SCA Health’s health system playbook
SCA Health, Optum’s ASC arm, is one of the largest ASC operators in the country with more than 370 specialty clinical care locations, 400-plus physician practice clinics and roughly 9,700 physicians. As of late 2024, Optum’s subsidiaries include 423 ASCs, according to a “Sunlight Report” from the Center for Health & Democracy, funded by Arnold Ventures.
Health system partnerships are central to SCA’s growth strategy. The company works with more than 60 health systems nationwide, and about half of its ASC facilities include a health system partner. As reimbursement pressure mounts and more procedures migrate to lower-cost settings, SCA positions itself as a partner that can help systems extend their outpatient networks without shouldering the full operational burden alone.
“Health systems excel at acute care, and our partnerships are strengthened by the ambulatory expertise we bring,” said Matthew Humbarger, group vice president of payer engagement and strategy at SCA Health. “We work closely with systems to identify opportunities to expand access and shift appropriate procedures into the ASC setting.”
Rethinking anesthesia for the long haul
With anesthesia shortages persisting and outpatient cases growing more complex, SCA Health is taking a long-term view on staffing and care delivery, leaning on top-of-license practice, closer clinical alignment and data-driven operational management.
At Owensboro (Ky.) Surgery Center, that shift is already underway. CEO Marti Gaw, BSN, RN, told Becker’s the center moved from an anesthesiologist-supervised model to a CRNA-only structure, planned to avoid care disruptions and shore up emergency support.
“Our ability to make this shift was rooted in the experience and professionalism of our CRNA staff,” she said. “CRNAs are empowered to operate at the top of their license and are deeply involved in ongoing clinical education and preparedness initiatives.”
Regional Vice President of Operations Stephanie Perna said SCA expects top-of-license practice to keep expanding across anesthesia roles, and that rising outpatient volume and higher-acuity cases are reshaping how centers screen patients.
“We have incorporated in-person assessments for patients with borderline ASA risk to ensure safe access to ASC care,” she said.
Operational oversight is tightening alongside those workforce changes. Group Vice President of Operational Strategy and Innovation Lindsey Lowder said SCA uses Tableau dashboards to track anesthesia-linked metrics including first-case, on-time starts, PACU length-of-stay, OR utilization, medication use and cancellations, broken down by cause, physician and service line. Pre-op texts and emails have also been added to reduce last-minute confusion and day-of cancellations.
Looking ahead, SCA is expanding direct employment of anesthesia providers to stabilize staffing and strengthen accountability.
“This strategic shift strengthens coordination and alignment with center operations, ultimately leading to smoother workflows and better patient experiences,” Ms. Lowder said.
Scrutiny from lawmakers, health systems and researchers
Optum’s expansion hasn’t gone uncontested, however. On multiple fronts, the company is facing legal challenges, legislative pressure and unflattering academic scrutiny.
MultiCare Health System, based in Tacoma, Wash., is suing Optum and Change Healthcare, alleging Change owes the system at least $1.2 million in outstanding claims. This is the latest fallout from the 2024 Change Healthcare cyberattack, which continues to generate legal and financial consequences across the industry.
In Minnesota, the state House passed a bill on a 107-27 vote to grant lawmakers access to an unredacted Optum report on the state’s Medicaid program, where Optum has been conducting a prepayment audit of more than 80,000 claims across 14 high-risk service categories as the state grapples with a widening fraud crisis.
On the research front, 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.”
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