UnitedHealthcare’s commercial business is planning more prior authorization rollbacks and wants to be seen as a better partner to the health systems it negotiates with, the unit’s CEO and CFO said at Becker’s 16th Annual Meeting in Chicago.
Dan Kueter, CEO of UnitedHealthcare Employer & Individual, and CFO Joe Clark spoke before the audience of hospital and health system leaders on April 14, addressing payer-provider contract friction, prior authorization reform, self-funded employer trends, and the future of network design.
Payer-provider network tensions
Asked about publicly reported payer-provider contract disputes across the industry, which FTI Consulting data shows have risen from 51 in 2022 to more than 170 last year, Mr. Kueter acknowledged the trend while noting it represents a small share of the thousands of contracts the company executes each year.
“I agree with those facts. The trend is absolutely right, and there does seem to be more disputes in the industry,” he said.
In a recent notable example, contract negotiations between Johns Hopkins Medicine and UnitedHealthcare broke down without a new deal in September. The Baltimore-based health system said UnitedHealthcare was demanding overly burdensome prior authorization requirements, while the payer said the system wanted to be able to exclude certain employer-sponsored plans.
Mr. Kueter pointed to the growing complexity of hospital revenue streams as a key driver of the friction plaguing the industry, citing Medicare Advantage reimbursement shortfalls, 340B drug revenue, physician joint ventures, and the pressure of managing an evolving payer mix as compounding factors when health systems come to the negotiating table around commercial contracts.
“The reimbursement pressure from Medicare Advantage, despite the roughly 2.5% increase, that’s not keeping up with cost trend,” he said. “The urge and the requirement to continue to cost shift or revenue shift into the commercial side of the business, I think, has a lot to do with it.”
“We are each under pressure, under a change in environment and we also have constituencies with high expectations and alternative choices that we have to serve,” he added.
The fourth quarter of 2025 marked the highest number of disputes in any quarter since FTI began collecting contract negotiation data in 2022, with 76 total reported. Of those, 44 involved Medicare Advantage plans. The first quarter of 2026 saw 22 disputes, reflecting the typical seasonal dip at the start of plan years.
“I support full transparency at the negotiating table. Let’s share what we’re each looking at,” Mr. Kueter said. “Getting past any kind of parallax in looking at the data and getting to a common set of facts and then negotiating for value from there is much better than the closed hand of cards and lack of transparency that just increases the opportunity to talk past each other.”
Mr. Clark added that from the plan’s perspective, a provider going out of network is the outcome no one wants.
“That’s bad for everybody,” he said. “It’s bad for us, it’s especially bad for our employer customers and our members, and it’s bad for the providers. So that is the last resort in terms of what we want to happen.”
Prior authorization and gold carding
Mr. Kueter said the company has reduced prior authorization requirements in its commercial business by 20% and intends to go further, targeting roughly another 30% reduction tied to the commitments UnitedHealthcare made last summer alongside 50 other insurers with CMS. Since then, AHIP and BCBSA reported that health plans nationally have cut 11% of prior auth requirements.
“We’re continuing to work down this path and really limit it to where it’s most necessary, most beneficial, where care patterns are most aberrant, where care variation is most significant,” he said.
He added that prior auth applies to a narrow share of care to begin with, with 98% of covered services not requiring it. The remarks came one week before UnitedHealthcare announced its part in an expanded industrywide initiative to standardize electronic prior auth submission requirements. The company said that more than half of its prior auth volume is now part of the standardized process, with plans to reach more than 70% by year-end, applying across commercial, Medicare Advantage and Medicaid.
On gold carding, Mr. Clark said results have been strong since the program launched in October 2024, recording a more than 40% increase in the number of qualifying provider groups throughout last year. Providers qualify by maintaining an approval rate of 92% or higher over two consecutive years, after which they submit advance notifications in place of full prior auth requests.
“We’ve seen prior auths just plummet for those groups, and we haven’t seen any difference in care,” Mr. Clark said. “We run a lot of surveys for practices we move into gold carding, and those are resoundingly positive. When they’re not, we learn from it and we fix it. We are heavily tracking this. We’re very invested in it.”
Mr. Kueter framed the program as a competitive incentive for providers.
“We want the providers that are gold carded to be the winners in their community,” he said. “If we can give them an administrative leg up to match what looks like a clinical leg up, that’s going to spur competition and help those that are not gold carded, or perhaps have more variation in their care delivery practices, to increase their game as well.”
To close the session, Mr. Kueter told the room of hospital executives that the company’s commercial strategy in the coming years centers on becoming a more consistent partner, regardless of where the relationship might stand today.
“We want to be known as the innovation leader in our industry. We want to be known as your best partner,” he said. “I think we are in some places, and I know we’re not in others. We want to be known as that more pervasively.”
“Focus on value,” he added. “Transparency is among us, and transparency is only going to increase. The highly efficient, high quality provider of a service is going to win.”
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