How Optum Health's CEO Is Reading Federal Signals on Future of Medicare
Summary
Optum Health’s CEO, Krista Nelson, spoke about how Medicare is shifting from paying for the amount of care done to paying for the quality of care. The Centers for Medicare & Medicaid Services (CMS) is encouraging doctors and organizations to join programs where they share financial risks and rewards based on patient outcomes, a model known as value-based care.Key Facts
- CMS is pushing more Medicare patients into accountable care arrangements where providers are responsible for both cost and quality.
- Value-based care rewards providers for better health outcomes rather than the number of procedures.
- Starting in 2026, doctors in advanced payment models get higher Medicare fee updates (0.75% vs. 0.25%).
- Over 700,000 providers are involved in Medicare accountable care programs in 2026.
- CMS plans to expand these models and move away from traditional reporting systems toward value-based pathways.
- Optum Health is part of UnitedHealth Group, the largest U.S. health care company by revenue, serving over 120 million customers nationwide.
- Krista Nelson highlighted CMS’s goal for all Medicare-eligible people to have access to value-based care, not just through Medicare Advantage.
- Optum provides care across various settings, including primary care, specialty, surgical, behavioral, and home-based care.
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