Dive Brief:
- CommonSpirit and Humana have reached a new nationwide Medicare Advantage contract keeping Humana members in-network with the massive health system for the next three years.
- The agreement also reestablishes the companies’ relationship in Colorado and Texas, where some Humana members lost in-network access to CommonSpirit facilities at the start of 2025 after regional contracts lapsed.
- The agreement caps off nearly a year of negotiations between the two companies.
Dive Insight:
Following a contract dispute, Humana dropped CommonSpirit from its MA plans in parts of Colorado and Texas on Jan. 1, 2025. The companies have largely been mum about what prevented them from reaching a new contract. However, CommonSpirit said publicly at the time that fair agreements allow the provider to keep up with the rising cost of care, implying the schism may have been over reimbursement rates.
Both Humana and CommonSpirit declined to provide details on the terms of the new contract. However, CommonSpirit said it was beneficial to hammer out one national contract with Humana, instead of negotiating separate contracts.
“It is more efficient for CommonSpirit to have one contract for our entire footprint, which ultimately helps reduce administrative burden and keeps costs down,” Harpreet Cheema, CommonSpirit’s senior vice president of payer strategy and analytics, said in an emailed statement.
The nationwide contract allows CommonSpirit to retain access to a growing pool of patients covered by Humana — and the revenue they represent. The insurer, the second-largest in MA, ended January with about 7 million members in the privatized Medicare program after experiencing sharp growth during the open enrollment period for 2026.
As for Humana, its members will be able to receive in-network care at one of the largest nonprofit health systems in the U.S. CommonSpirit operates almost 140 hospitals and more than 2,300 outpatient sites across 24 states.
Contract disputes between payers and providers are ramping up and increasingly being publicized by parties hoping the court of public opinion will sway negotiations in their favor.
MA contracts in particular are causing payers and providers to butt heads, as providers seek generous rate updates, citing inflation and higher costs of doing business, and insurers try to tamp down on skyrocketing costs. Providers are also upset about contractural provisions like prior authorization requirements that allow payers to delay care.
“CommonSpirit Health strongly believes that Medicare Advantage must work effectively and efficiently for patients and communities,” the system said Monday in its press release announcing the new contract. “As health systems and payers nationwide navigate the evolving dynamics of Medicare Advantage participation, CommonSpirit is actively leaning in to strengthen the program and ensure peace of mind for patients.”
CommonSpirit has been involved in a raft of contract disputes over the last few years, including a high-profile quarrel with Cigna in Tennessee that led CommonSpirit Memorial Hospital, a major provider in the Chattanooga area, to go out of network with Cigna’s employer plans on Feb. 1.
According to Cigna, CommonSpirit was asking for unacceptably high rate increases. Still, the two companies reached an agreement later that month, according to local reports.
