Healthcare pricing MRFs are the foundation of predictive intelligence
At a recent Crumdale Specialty seminar, Ria Shah showed the audience how to get better at predicting future healthcare needs. She explained this can be accomplished by enriching healthcare MRFs with other data. Read more.
DATA ANALYSIS
A mixed bag: BUCA negotiated rate changes
Carrier-negotiated rates are increasing across the board and have been for a while; that’s no secret. But at a handful of major hospitals around the country, average negotiated rates are actually falling.
Specialized treatment centers seem to be seeing the biggest rate decreases. At Memorial Hospital for Cancer and Allied Diseases in New York, Blue Cross Blue Shield negotiated rates dropped by 36.2% in the six months between October 2025 and March 2026.
The AdventHealth Lab system in Florida and the City of Hope Cancer Center in Atlanta saw BCBS negotiated rate decreases of 24.2% and 17.3%, respectively.
Blue Cross Blue Shield rates fell at 13 of the 62 major providers analyzed, and the carrier also returned the largest negotiated rate declines overall. However, UnitedHealthcare rates dropped at 18 hospitals, with the largest decrease reaching 7.2% over the same six-month period. We also found a large negotiated rate decrease from Aetna at 12.9%; Cigna’s biggest decrease came in at 6.2%.
Even with these declines, overall negotiated rates continue to rise. Aetna, Blue Cross Blue Shield, Cigna and UnitedHealthcare all returned increases at the vast majority of hospitals analyzed, with median increases ranging from 0.8% (UnitedHealthcare) to 7.4% (Aetna). UnitedHealthcare rates rose by an average of 1.8%, while BCBS rates increased by 2.9%.
For plan sponsors offering Aetna plans, those higher negotiated rates can create meaningful cost exposure, particularly for high-volume inpatient and outpatient procedures at the facilities their members use most. Aetna’s largest increase — nearly 79% — occurred at Cedars-Sinai Marina Spine Center, while the next largest increase of 44.6% occurred at Stanford Health Care in California.
What does all this mean? Network evaluation is more important than ever. In a world of rising hospital rates, employers need visibility into where negotiated prices are increasing — and where opportunities for savings still exist.
IN THE NEWS
4 Questions with…Sean Trainor
Domain knowledge is critical in healthcare data analysis
In healthcare, being technically sound isn't good enough: Domain knowledge is crucial. Read more about how Handl’s lead data analyst uses domain knowledge to decipher healthcare data. Read more.
TEAM NEWS
Meet Jasmina
Jasmina Cesko has joined Handl as an enterprise account executive. She joined the company because, in her words, Handl’s mission “aligns deeply with my purpose, passion and vision for impact. This mission is personal. It’s powerful. And it’s needed for our society.”
Jasmina also has a befuddling healthcare story, just like so many of the folks here at Handl. She recalled a time she paid a large out-of-pocket sum for healthcare. The fees started piling up for an in-network procedure after she already met her deductible. “No one could explain why,” she said. “That bill changed everything for me.”
She continued: “My journey here has been anything but ordinary. I’ve built my career through resilience, growth and a passion for making an impact and having a purpose. I am excited to bring that energy here and collaborate with such a talented group.”
FROM THE DESK OF AHMED
Employers are at an insurance crossroads
Wherever I go, everyone is talking about the fallout from runaway employer healthcare costs. The past few weeks have seen companies cutting headcount fueled, in part, by the massive cost of healthcare. Employers need a solution. And fast. They need an immersive strategy to bring high-value healthcare to their employees.
In this environment, you have to go deeper than surface-level pricing. You need to focus on specific episodes of care, everything that happens in a given care pathway bundled up into one, clear bill. One price, one bill for everything from having a baby to fighting cancer.
This might be a vision for the future, but it will be reality soon enough.
What can brokers do now? Get out of the once-a-year analysis mindset. Bring employers a solution that enables regular claims repricing, deep evaluation of utilization patterns are re-evaluated, and, most importantly, in-year plan adjustments.
I’m really talking about working with your employers on a healthcare strategy, a managed system that works for everyone involved. Not a static healthcare product that everyone kind of hates.
HANDL ON THE ROAD
Employee Benefits Leadership Forum
Join Ahmed, Shapari and Jasmina at the Employee Benefits Leadership Forum on May 26 in Colorado Springs, CO.