2024 End-of-Year Provider-Payer Dispute Data Update

In 2024, the healthcare sector was rocked by the violence against UnitedHealthcare CEO Brian Thompson.^[i] Throughout the year payers continued to navigate the ever-evolving payment reform landscape, while providers grappled with workforce shortages and financial challenges due to the inflationary pressures of the economy. At the same time, the industry is readying itself for a second Trump administration which promises to bring significant change to the sector. While ACA plan enrollment experienced record enrollment for the fourth consecutive year, with nearly 24 million individuals signing onto marketplace, Medicare and Medicaid plans,^[ii] the Trump administration has signaled intent to change the federally-funded health insurance system, potentially impacting coverage in the future.^[iii]

As organizations across the healthcare industry prepare for a public policy landscape that may shift dramatically, one trend that we expect to persist is the rising number of disputes between payers and providers regarding contract terms and reimbursement rates, especially for Medicare Advantage (MA) plans. While contract negotiations between payers and providers often take place over the course of several months and are largely conducted out of the view of the public, when negotiations break down and agreements cannot be reached, individuals and families, including seniors, who are increasingly electing to receive their coverage through Medicare Advantage (MA) plans, are left with uncertainty about their ability to continue accessing their preferred provider(s) through their health plan.

For nearly three years, FTI Consulting has been closely monitoring disputes between payers and providers through publicly reported news coverage and paid and earned media. Increasingly, both parties are facing greater challenges in reaching agreements related to important contract terms, including reimbursement rates, utilization management, care coordination and disease management, quality improvement and performance metrics and other contractual terms that impact coverage for tens of millions of individuals and families across the United States. These disputes have historically drawn attention from third-party players, including state and federal lawmakers, regulators, and local government officials, with an increasing level of attention from traditional and social media outlets and the public.

What we found: Q4 2024 saw the highest number of disputes covered by traditional media since we began collecting and reporting this data, with a total of 50 disputes.