UNH · Forward model · Optum Health · Bear case
What has to happen in Optum Health
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Optum Health
Basis quarter$23.47B
Final quarter$21.41B
Implied CAGR−2%
Final revenue mix19%
Care delivery under value-based arrangements: revenue follows the number of patients the business is accountable for and the rate it is paid for them. It is shrinking on purpose while margin is rebuilt - 2026 Q2 revenue fell 5% year-over-year on about 700,000 fewer value-based-care patients, and the January outlook guides consumers served down to roughly 84 million.
Last four quarters
2025 Q3
$25.42B
Reported
2025 Q4
$25.07B
Reported
2026 Q1
$24.11B
Reported
2026 Q2
$23.47B
Reported
Value-based care (fully accountable patients)Primary and specialist careAmbulatory surgeryHome health (incl. Amedisys)HouseCalls
Subscribers
93.0M
93.0% of a 100.0M addressable base
93 million consumers served at 30 June 2026, recast for the Optum Financial realignment, against 95 million a year earlier.
Addressable subscribers
100.0M
the S-curve ceiling
100m is a round scaling base the driver requires. The number doing the work is the attach ceiling below it.
Net adds
0/qtr
ramping toward 0/qtr, throttled as the base approaches the TAM
Net-add ceiling
0/qtr
what supply can deliver at full rate
ARPU
$84.13/mo
drifting +0.4% per quarter, floor $0.00
$84.13 a month is $252.39 a quarter - 2Q26 revenue over consumers served. The rate has run $252-273 for six quarters.
Non-subscriber revenue
$0/qtr
growing 0.0% per quarter
Zero. Consumers served times the derived rate is the whole line; no separate non-consumer revenue is disclosed.
Optum Health
Latest: $21.41B (2031Q2E)
| Period | Value |
|---|---|
| 2023Q2 | $23.92B |
| 2023Q3 | $23.86B |
| 2023Q4 | $24.53B |
| 2024Q1 | $26.73B |
| 2024Q2 | $27.05B |
| 2024Q3 | $25.92B |
| 2024Q4 | $25.66B |
| 2025Q1 | $24.84B |
| 2025Q2 | $24.73B |
| 2025Q3 | $25.42B |
| 2025Q4 | $25.07B |
| 2026Q1 | $24.11B |
| 2026Q2 | $23.47B |
| 2026Q3E | $22.57B |
| 2026Q4E | $22.04B |
| 2027Q1E | $21.72B |
| 2027Q2E | $21.54B |
| 2027Q3E | $21.43B |
| 2027Q4E | $21.37B |
| 2028Q1E | $21.34B |
| 2028Q2E | $21.32B |
| 2028Q3E | $21.32B |
| 2028Q4E | $21.32B |
| 2029Q1E | $21.32B |
| 2029Q2E | $21.33B |
| 2029Q3E | $21.34B |
| 2029Q4E | $21.35B |
| 2030Q1E | $21.36B |
| 2030Q2E | $21.37B |
| 2030Q3E | $21.38B |
| 2030Q4E | $21.39B |
| 2031Q1E | $21.40B |
| 2031Q2E | $21.41B |
Assumptions & reasoning
- 3.18% is the guided full-year 2026 reported operating margin - $2,275M of operating earnings on the $91,000M revenue floor, 2.50% - plus 0.68pp of pro-rata D&A. Reported, not adjusted: the segment carries $405M of loss-contract amortisation in reported earnings that adjusted strips out, and the revenue guidance is on the reported basis too.
- Terminal 5.20% EBITDA is 4.52% operating, below the 5.1% the segment printed in 2026 Q2. Management has said nearly all of Optum Health's earnings land in the first half, with modest fourth-quarter losses, so the Q2 print is not a run rate and the base case does not assume it becomes one.
- Consumers served is a much looser measure than the true economic driver. Fully accountable patients - guided at about 4.1 million for 2026 - are disclosed only as an approximate annual figure, so the quarterly driver has to rest on consumers served and the derived rate per consumer is published as a trace so the looseness is visible.
- The metric was recast for the 1 January 2026 Optum Financial realignment: 31 December 2025 reads 95 million in the 4Q25 release and 92 million in the 1Q26 recast table. The 2026 basis is used. Revenue for 2023-2024 is as originally reported and still reconciles exactly, because each quarter's elimination line comes from the same release.
- Left aseasonal: the measured amplitude of 1.2% sits an order of magnitude inside its own 2.7-5.1% window spreads, and the series straddles both the realignment and the August 2025 Amedisys close.