Payer Contracting

Provider-payer contracting tensions intensified this week as hospitals continue to push back on Medicare Advantage economics, with a North Carolina hospital dropping BCBS and UnitedHealthcare MA plans as “financially and operationally unsustainable,” while policy momentum builds around the House Medicare Advantage Improvement Act and CMS’s withdrawal of a 2027 special enrollment rule tied to MA network breakups. At the same time, VBC activity is still moving forward through CMS Innovation Center models, with provider enablement and digital health firms joining the CMS ACCESS Model for outcomes-based specialty care participation, signaling that organizations are trying to pair payer-contract discipline with more measurable, model-based revenue opportunities. For ACOs and health systems, the pattern is clear: MA network adequacy, administrative burden, and rate pressure are becoming core contracting flashpoints even as CMS and market actors keep pushing outcomes-based arrangements as the preferred alternative to volume-based payment (AHA on MA Improvement Act