Humana and Baptist Health reach contract agreement for in-network coverage

Kentucky-based Baptist Health Medical Group and Humana have reached a new contract agreement, restoring in-network coverage for Medicare Advantage and commercial patients.

The multi-year agreement comes after Baptist Health announced in September 2023 that Baptist Health Medical Group physicians and advanced practice clinicians would no longer qualify as in-network providers for Humana’s Medicare Advantage and commercial health plans.

The decision did not impact Baptist hospitals, which stayed in-network with Humana. However, non-emergency services provided at the hospitals by a clinician with the medical group would be considered out-of-network.

After several months of discussions and negotiations, the organizations have agreed to reinstate Baptist Health providers in Humana’s network starting April 1. The contract terms apply to both Medicare Advantage and employer-sponsored plans, although Humana announced in February 2023 that it would be exiting the commercial market over the next 18 to 24 months.

When the contract takes effect, all Baptist Health hospitals, physicians, clinics, and outpatient facilities will be in-network with Humana. Baptist Health said it will work to ensure Humana beneficiaries are reestablished with their providers.

Those who received care during the out-of-network period are responsible for what they were billed from their health plan, but they may contact Baptist Health for information on financial assistance programs.

Beneficiaries who switched from a Humana Medicare Advantage plan to another Medicare Advantage plan can make a one-time change back to Humana during the additional enrollment period through March 31.

Baptist Health’s initial decision to end negotiations with Humana was not an isolated occurrence in the industry. In 2023, several hospitals and health systems terminated their contracts with Medicare Advantage plans, including Cape Fear Valley Health with UnitedHealthcare and WakeMed with Humana.

Many health systems, including Baptist Health, cited frequent care denials as reasons behind the terminations. Low reimbursement from Medicare Advantage plans and health systems’ lack of infrastructure that supports the Medicare Advantage design have also contributed to contract terminations.

Medicare Advantage plans generally have narrower provider networks than traditional Medicare, meaning contract disputes can create additional barriers to affordable care for beneficiaries. Additionally, inaccurate provider directories can limit access to care for beneficiaries.

When it comes to choosing and maintaining high-quality provider networks, health plans must consider provider performance data, population health management strategies, and the level of communication between partners.

By solidifying contracts with various quality provider networks, plans can ensure their members have adequate access to affordable care across all specialties.