The Optum Playbook: What Every Healthcare Leader Should Know About Vertical Integration

Investor Insight Meter: Each addition includes an Investor Insight Meter to help you gauge strategic momentum at a glance.

5 / 5 – Extreme Strategic Momentum

UnitedHealth Group is accelerating its AI strategy while simultaneously defending its vertical integration model amid regulatory scrutiny. Competitors are quietly doubling down on post-acute care and specialty service acquisitions — areas where UnitedHealth is also expanding.

The strategic signals suggest intensifying competition in home health, pharmacy, and digital transformation — with Optum positioned as both the standard setter and the regulatory target.

Executive Signals

UnitedHealth Group

Elevance Health

Humana

Cigna

UnitedHealth Group (UHG)

• Scaled up AI deployment across Optum: Prior auths, claims automation, clinical summaries.

• Launched NavigateNOW, a virtual-first plan for employer groups in over 25 markets, integrating 24/7 Optum care teams with $0 copays and wellness incentives.

• Optum Rx eliminated reauthorization requirements for ~80 chronic condition drugs.

• Actively pursuing Amedisys acquisition (home health), now under DOJ scrutiny.

Elevance Health

• Acquired Paragon Healthcare (infusion services) for >$1B (March 2024).

• Announced $2.7B acquisition of CareBridge, focused on home-based chronic care (expected close: Q2 2025).

• CEO confirmed intention to expand Carelon platform using these assets.

Humana

• Acquired Intrepid to add 30+ new CenterWell Home Health branches.

• Took over 23 former Walmart Health sites to expand CenterWell and Conviva senior primary care clinics.

• Despite Q4 net loss, affirmed CenterWell strategy as long-term growth driver.

Cigna

• Divested Medicare Advantage, CareAllies, and Part D businesses to HCSC for $3.3B.

• Focus now squarely on Evernorth Health Services and employer-based offerings.

Risks to Watch

• Regulatory Blowback on UHG: DOJ lawsuit to block the Amedisys acquisition underscores heightened antitrust scrutiny — particularly on Optum’s consolidation of providers and payer functions.

• Rising Medical Cost Ratios: All four players reported higher medical cost ratios in 2024. These trends may pressure margins and accelerate divestitures or strategic shifts, especially for Cigna and CVS Health.

• Tech-First Plan Risks: Virtual-first models like NavigateNOW are promising — but consumer satisfaction, coordination quality, and long-term outcomes remain under-evaluated.

• Capital Deployment Hesitancy: Both Cigna and CVS Health leaned toward divestitures and stock buybacks rather than acquisitions, possibly signaling caution amid macroeconomic headwinds or a reset of strategic priorities.

CVS Health is consolidating — integrating Signify Health and Oak Street Health while divesting MSSP business to Wellvana. Likely to target value-based enablement and primary care optimization.

Elevance is aggressively assembling post-acute capabilities (infusion, home health) through Carelon — mirroring UHG's Optum strategy but possibly with less regulatory heat.

Humana is doubling down on CenterWell as both a care delivery and brand platform — setting the stage for vertical integration at smaller scale and targeting senior care.

Cigna’s exit from Medicare Advantage and CareAllies leaves a gap in post-acute and chronic care management capabilities — possibly making them a future buyer in behavioral health or tech partnerships.

Health System Executives

• Referral risk is real: Expect more aggressive payer integration into delivery. If you're not planning partnerships or defenses, your referral base may erode.

• New alliances are forming: Non-UNH players are expanding into home health, infusion, and chronic care management — potential partners or competitors.

• Tech is moving fast: 

  • AI tools (e.g., clinical summaries for nurses, personalized navigation) are becoming differentiators

  • Trust and transparency remain essential.

Startup Founders and Strategists

• Follow the dollars: Chronic care at home, specialty pharmacy, care team tools, and virtual navigation are where major buyers are placing bets.

• Exit strategy alignment matters: If you're targeting Optum, consider your exit timeline and whether Elevance, Humana, or CVS is a better alignment in the near term.

• Data interoperability is now table stakes: Integrations with EHRs, payers, and care management systems will be crucial to gaining traction.

Investors and Board Members

• Watch for margin compression in regional health systems: Integrated giants like Optum can price strategically to take share — and blur traditional benchmarks.

• Regulatory scrutiny may not slow momentum: Optum has faced FTC pushback and kept moving. Be wary of assuming regulatory friction equals deal-blocking risk.

• Look beyond headlines: The vertical integration trend includes subtle acquisitions and operational moves — not just blockbuster deals. Strategic patterns matter.

Copyright Notice:

^{© 2025 Red Ocean / Blue Ocean. All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form without prior written permission. Subscribers are welcome to share brief excerpts (with attribution and a link), but full articles may not be copied, distributed, or reused without written permission.}