Dr. Eric Dickson, chief executive of UMass Memorial Health, said in a statement that as health systems face increasing challenges, those that serve underserved populations would need additional support.<\/p>\n
\u201cStakeholders across the health care ecosystem need to continue to collaborate differently to develop new solutions for reducing administrative burden for providers, creating new models for providing care in the home, and building more access to primary care,\u201d Dickson said.<\/p>\n
At a time when both UMass and Blue Cross are facing financial pressures, the sides had largely been at an impasse over the size of the reimbursement increase. Blue Cross had said it offered a bump in its payments to UMass that amounted to 3.58 percent annually over a three-year contract.<\/p>\n
UMass was close in its overall request \u2014 3.6 percent annually for its medical group and hospitals \u2014 however it was also seeking higher reimbursements for nurse practitioners and physician\u2019s assistants, as well as incentives for when providers hit certain quality measures. <\/p>\n
UMass had said without increased rates, it wouldn\u2019t be able to hire more nurse practitioners and physician\u2019s assistants to boost primary care access, and potentially would have had to cut primary care providers\u2019 compensation. Meanwhile, Blue Cross said it had to hold the line on rising health care spending, to protect employers and employees who can no longer bear the skyrocketing costs.<\/p>\n
It is unclear where the agreement ultimately ended up, with both sides declining to provide details.<\/p>\n
Though the contract wasn\u2019t set to expire until Dec. 31, Blue Cross had begun sending letters<\/a> to members in late October, warning about 185,000 patients that their primary care clinicians, specialists, or nearby hospitals could soon become out of network. Out-of-network medical providers can mean astronomically higher medical bills. <\/p>\n The announcement sent patients, employers, and politicians alike scrambling, worried over what might happen to health care access, or what higher health care costs would mean for employers\u2019 bottom lines. Some patients faced an hour\u2019s drive, or further, for care their insurer would cover. Those managing medical conditions feared additional complications<\/a> around switching doctors. <\/p>\n The dispute is a bellwether of what is likely to come with other providers and their insurance contracts, as both sides continue to face financial challenges, and particularly as Blue Cross has said it will stand firm to control ever-rising costs. <\/p>\n Health insurers in Massachusetts have reported record losses<\/a> amid rising costs for drugs and other parts of care. In the first nine months of 2025, Blue Cross alone reported its operating losses nearly doubled, to $213 million from $114 million during the same period a year earlier.<\/p>\n Meanwhile, hospitals expect the Trump administration\u2019s funding cuts to Medicaid, the government\u2019s insurer for poor or disabled people, to force them to have to foot the bill for care for a growing portion of uninsured and underinsured patients over the coming years. <\/p>\n \u201cThe federal government and the current administration has put providers in all health care in a very tough place,\u201d said Jim Roosevelt, counsel at Verrill-Dana Law and a former insurance executive. \u201cExpected revenue from Medicaid and other sources is all of a sudden going away. That will make the situation tougher.\u201d<\/p>\n Not only will the squeezing of all parties likely lead to more provider and insurer contracting disputes, but it has led to more aggressive tactics from different parts of the health care system. Insurers are imposing audits on providers<\/a> based on how they bill; others are penalizing hospitals for using out-of-network providers<\/a>.<\/p>\n At a Wednesday hearing on cost trends held by the state\u2019s Health Policy Commission, Blue Cross Blue Shield\u2019s Iselin referenced the troubling climate in which insurers and providers find themselves.<\/p>\n \u201cAs the federal government takes money away, we cannot expect employers and consumers to make up the difference,\u201d Iselin said. \u201cWe just can\u2019t. There\u2019s no more. And that is going to make for increasingly challenging negotiations and contracts between payers and providers.\u201d<\/p>\n Jessica Bartlett can be reached at jessica.bartlett@globe.com<\/a>. Follow her @ByJessBartlett<\/a>.<\/p>\n