Optum Acquires Refresh Mental Health in a major shift within the behavioral health landscape. As the health services arm of UnitedHealth Group, Optum’s acquisition of the rapidly growing outpatient provider, first reported by Axios Pro’s Sarah Pringle, marks a significant development in the national behavioral health market. This move underscores Optum’s commitment to expanding access to value-based, integrated care.
The deal, which does not have a publicly disclosed sale price, sees private equity firm Kelso & Co. selling Jacksonville Beach-based Refresh Mental Health to Optum. When Kelso acquired Refresh in December 2020, the company had roughly $40 million in EBITDA and was valued at approximately $700 million. In just under four years, Refresh has grown from 200 locations in 28 states to an impressive 300 locations in 37 states—solidifying its place as one of the largest outpatient mental health providers in the U.S.
A High-Growth Journey: From Founding to Acquisition
Refresh Mental Health’s story is one of calculated growth, strategic partnerships, and mission-driven expansion. The company was launched in 2017 by Lindsay Goldberg, a private equity firm with a strong track record of building sustainable, family-centered enterprises. Working closely with Steve Gold (now CEO) and his father Mark Gold (a Lindsay Goldberg affiliate partner), Refresh quickly established itself as a leader in delivering outpatient mental health services with an emphasis on local clinical autonomy, scalable infrastructure, and diversified payer relationships.
By the time Kelso & Co. entered the picture in late 2020, Refresh had built a strong foundation across dozens of states. Kelso’s involvement helped propel further expansion, adding 100 new sites and expanding into nine additional states in less than four years. With a reputation for quality care and local provider support, Refresh became one of the top targets for acquisition in a highly fragmented and competitive market. Now, as Optum acquires Refresh Mental Health, the company’s trajectory enters a new phase—one that could have national implications.
A Strategic Fit: Why Optum Chose Refresh
The acquisition is about more than just scale. Optum’s decision to acquire Refresh Mental Health is rooted in its broader strategy to close the gap between physical and behavioral health care. In a statement to Behavioral Health Business, an Optum spokesperson said:
“Optum and Refresh Mental Health are excited to expand effective behavioral care to patients through a more coordinated health system. Together, we will be able to drive deeper integration between medical and behavioral health care and advance personalized care to patients through value-based care.”
This statement underscores Optum’s goal of transitioning mental health care from a traditionally fee-for-service model to a more coordinated, outcomes-driven system. As a subsidiary of UnitedHealth Group—the nation’s largest insurer—Optum is uniquely positioned to operationalize this vision through its payer relationships, technology infrastructure, and clinical network.
The move is also aligned with the long-term vision shared by Dr. Katherine Hobbs Knutson, CEO of Optum Behavioral Care and SVP of UnitedHealth Group, who has advocated for stronger alignment between mental and physical health. At industry conferences, Knutson has emphasized the need to integrate behavioral health services not only at the clinical level but also within health plan benefits and delivery system design.
Industry Disruption: The Rise of National Behavioral Health Platforms
The Optum acquires Refresh Mental Health transaction positions Optum as a national powerhouse in the outpatient mental health sector, rivaling the scale and visibility of Lifestance Health Group Inc. (Nasdaq: LFST). Lifestance, founded in the same year as Refresh, has grown to over 500 locations in 32 states and went public in June 2021. Like Refresh, Lifestance has championed a model that blends clinical autonomy with centralized operational support, allowing providers to focus on care while the business scales efficiently.
But while both companies are national in scope, Optum’s backing gives Refresh a distinct advantage: access to robust health plan integration and long-term investments in care coordination. Lifestance CEO Michael Lester has also emphasized the importance of integrated care, announcing during the company’s 2021 earnings call that Lifestance is operating 10 integrated care programs, including partnerships with Medicare Advantage plans and dialysis providers.
“This is not just a goal,” Lester said. “We are innovating in this space today and are at the forefront of integrated care in the mental health industry.”
Still, Lester acknowledged that it could take several more years before full integration becomes the industry norm. With this latest development, Optum acquires Refresh Mental Health at a time when being able to offer both vision and operational muscle around integration may prove to be a decisive market advantage.
The Broader Context: Fragmentation, Access, and Value-Based Models
The outpatient behavioral health industry remains one of the most fragmented in health care. Thousands of independent providers operate under varying state regulations, with inconsistent reimbursement models and limited clinical coordination. The result has been an uneven patient experience and significant barriers to access—especially in rural and underserved areas.
Historically, most behavioral health reimbursement has come through fee-for-service models that incentivize volume over outcomes. Optum’s acquisition of Refresh—and its stated commitment to value-based care—could accelerate a long-overdue shift toward outcome-based reimbursement, personalized treatment pathways, and technology-driven care coordination.
As the largest insurer in the country, UnitedHealth Group has both the incentive and the resources to lead this transition. By embedding Refresh into its Optum Behavioral Care platform, the company has the opportunity to pilot innovative payment models, streamline provider workflows, and offer integrated care packages that address both physical and mental health needs.
What This Means for the Future of Mental Health Care
The fact that Optum acquires Refresh Mental Health is a signal to the entire health care ecosystem that behavioral health is no longer a peripheral service—it’s a central pillar of population health. This acquisition demonstrates that national insurers are increasingly willing to invest in outpatient platforms that offer quality, scalable, and coordinated care.
Over the next few years, we can expect further consolidation in the behavioral health space, with more partnerships between payers and providers, deeper investments in clinical infrastructure, and stronger incentives for data-driven, integrated care models. For patients, this could mean better access to services, fewer administrative hurdles, and more cohesive treatment plans that reflect the reality that mental health is inseparable from physical health.
For competitors, this is a moment of reckoning. Lifestance and others will need to match the scale, sophistication, and strategic alignment that Refresh now enjoys as part of Optum. And for policymakers, regulators, and payers, the deal is a case study in what happens when behavioral health is finally treated as a core health service worthy of systemic investment and innovation.
Conclusion: The Future Is Integrated
The outpatient mental health industry is evolving—and fast. As Optum acquires Refresh Mental Health, the spotlight now turns to how this acquisition will play out in the real world. Will it lead to more consistent care models, better access, and a higher standard of behavioral health nationwide? Or will it create new complexities in an already overburdened system?
What’s clear is that this deal is not just about acquiring more clinics—it’s about redefining how behavioral health care is delivered in America. With Optum’s resources and Refresh’s nationwide footprint, the promise of truly integrated care just got a step closer to becoming reality.
