Black Book Research flash poll of 112 hospital and health system finance leaders finds Medicare Advantage contract economics are moving onto the CFO agenda
CHICAGO, IL / ACCESS Newswire / August 14, 2026 / Three in four US hospital finance leaders with material Medicare Advantage exposure say their organizations have already reduced participation, expect to take action within the next 12 months or are actively reevaluating at least one Medicare Advantage payer relationship, according to a Q3 Black Book Research flash poll of 112 hospital and health system finance leaders.
Among 104 respondents with material Medicare Advantage exposure, 75.0% reported that their organizations have terminated, declined to renew or materially narrowed a Medicare Advantage contract, expect to take such action within 12 months, or are actively evaluating a pullback.
The stronger near-term indicator is that 41.3% have already acted or expect action within the next 12 months.
For hospitals, Medicare Advantage is increasingly becoming an economic issue rather than simply a payer-relations dispute. Prior authorization, claim denials, delayed reimbursement, underpayment disputes and the administrative labor required to document, appeal and collect payment can materially change the financial performance of an individual payer contract.
“Hospital dissatisfaction with Medicare Advantage is not new. What is changing is the willingness of finance leaders to translate that dissatisfaction into contracting decisions,” said Doug Brown, founder of Black Book Research. “For many health systems, Medicare Advantage performance has moved beyond revenue cycle and onto the CFO’s contracting, margin and network strategy agenda.”
Nearly One in Four Has Already Pulled Back
Black Book asked respondents which statement best described their organization’s current position because of Medicare Advantage contract economics, including denials, prior authorization, underpayments and administrative costs.
Among all 112 respondents:
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21.4%, or 24 executives, said their organization has terminated, declined to renew or materially narrowed at least one Medicare Advantage contract.
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17.0%, or 19 executives, said their organization has approved or expects such action within the next 12 months.
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31.3%, or 35 executives, said their organization is actively evaluating a pullback but has made no final decision.
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14.3%, or 16 executives, have formally escalated payer performance or contract terms but are not considering a pullback.
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8.9%, or 10 executives, are not formally reviewing or considering a pullback.
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7.1%, or eight executives, reported no material Medicare Advantage exposure.
After excluding respondents without material Medicare Advantage exposure, the substantive base was 104 executives. Within that group, 23.1% have already taken action, 18.3% expect action within 12 months and 33.7% are actively evaluating a pullback.
“The 75% finding demonstrates how broadly Medicare Advantage contracts are being reconsidered, but the 41% who have acted or expect action may be the more significant leading indicator,” Brown said. “Those organizations have moved beyond reviewing contract performance into an actual or anticipated contracting decision.”
Denials and Delayed Payments Add to Contract Pressure
The Black Book findings come amid broader provider scrutiny of Medicare Advantage administrative and payment practices.
The American Hospital Association reported in May 2026 that 50% of hospitals and health systems in an AHA survey had more than $100 million in unpaid claims older than six months. Across 772 hospitals surveyed, delayed or denied claims totaled more than $6.4 billion.
Prior authorization remains another pressure point. KFF reported in August 2026 that Medicare Advantage insurers denied 12% of standard prior-authorization requests in 2025, while 67% of MA denials that were appealed were overturned.
CMS has also imposed new prior-authorization requirements intended to improve transparency, timeliness and electronic exchange, with operational provisions beginning in 2026 and additional API requirements generally taking effect in 2027.
“Once authorization workload, disputed claims and delayed reimbursement begin affecting labor expense, working capital and cash flow, Medicare Advantage stops being solely a managed-care issue,” Brown said. “The CFO has to determine whether the reimbursement ultimately collected justifies the cost, complexity and delay required to collect it.”
Contract Reassessment Does Not Mean Wholesale Medicare Advantage Exit
Black Book cautions that reconsidering a Medicare Advantage contract should not be interpreted as abandoning the Medicare Advantage market.
Actions can include terminating one underperforming payer relationship, declining renewal with a specific plan, narrowing participation by product or geography, renegotiating reimbursement or authorization provisions, or maintaining some Medicare Advantage contracts while discontinuing others.
Organizations currently evaluating a pullback may also ultimately remain in-network after negotiating improved terms.
“The more probable scenario is not wholesale abandonment of Medicare Advantage,” Brown said. “It is greater payer selectivity as health systems determine contract by contract which relationships remain financially and operationally sustainable.”
Key Black Book Findings
75.0% of Medicare Advantage-exposed hospital finance leaders have already acted, expect action or are actively reevaluating at least one Medicare Advantage relationship.
41.3% have already reduced participation or expect action within the next 12 months.
23.1% have already terminated, declined to renew or materially narrowed at least one Medicare Advantage contract.
90.4% have either formally escalated payer performance concerns or progressed to reviewing, planning or executing contract action.
About the Flash Poll
Black Book Research conducted the flash poll among 112 US hospital and health system finance leaders, including chief financial officers, vice presidents of finance, corporate finance and accounting officers and other senior finance executives.
Eight respondents reported no material Medicare Advantage exposure. Those respondents were retained in the overall survey results but excluded from calculations specifically describing Medicare Advantage-exposed organizations, producing an adjusted base of 104 respondents.
Respondents selected the statement that best represented their organization’s current Medicare Advantage contracting position.
Results are reported as unweighted counts and percentages. The flash poll is not presented as a probability sample of all US hospitals, and findings should be attributed specifically to the executives surveyed.
About Black Book Research
Black Book Research provides global, independent, vendor-agnostic healthcare market intelligence, stakeholder research and performance benchmarking for healthcare organizations, technology companies, investors and industry decision-makers.
Media Contact:
research@blackbookmarketresearch.com
1.800.863.7590
SOURCE: Black Book Research
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