When Big Health Systems and Big Payers Clash: Reflections on Johns Hopkins vs. UnitedHealthcare

As the Founder and Managing Partner of Steadwell Healthcare Consulting, I help providers, payers, and health systems navigate the complex world of contracts, reimbursement, and patient access. The recent breakdown between Johns Hopkins Medicine and UnitedHealthcare offers important lessons. At its core, this issue is not just about money. It is about patient access, trust, and the structural pressures within our healthcare system.

What Happened

As of August 25, 2025, all Johns Hopkins facilities, except Johns Hopkins All Children’s Hospital in Florida, are considered out of network by UnitedHealthcare.

Johns Hopkins stated that negotiations lasted more than eight months but ultimately stalled. The health system argued that UnitedHealthcare refused contract language that would reduce excessive prior authorization requirements and ease administrative burdens that often cause delays and denials.

UnitedHealthcare, on the other hand, said that some of Johns Hopkins’ requests were unreasonable, including provisions that would allow Hopkins to decline treating patients under certain employer sponsored plans.

The result is that tens of thousands of patients in Maryland, Virginia, and Washington D.C. now face higher costs, possible delays, and disruption in their care. Johns Hopkins has encouraged patients to review their coverage and consider alternate plans during open enrollment. Those with serious ongoing conditions may be eligible for limited continuity of care protections.

Why This Matters

Patient Access and Contract Leverage

Negotiations are necessary to protect standards of care, but when they fail, patients often feel the consequences first. Those with chronic illnesses or limited insurance options are most vulnerable.

Transparency and Timing

Johns Hopkins tried to notify patients and encourage early action. However, many patients may not have access to affordable alternatives that include Hopkins in network. While transparency is important, the timing still leaves many in a difficult position.

Power Imbalances

Large health systems and insurers each wield significant power. But for patients, employer based coverage and regional limitations often mean few choices. Hopkins took a strong stance by rejecting unfavorable terms, but that decision comes with risks, including lost revenue and potential harm to patient trust.

Administrative Burdens

One of Hopkins’ major concerns is the burden of prior authorizations and denials. These barriers not only create inefficiencies for providers but also delay necessary care for patients.

Continuity of Care and Trust

Patients in the middle of critical treatments such as cancer care or transplants face disruption that continuity provisions may only partially cover. Losing trusted providers in the middle of treatment can negatively affect health outcomes.

Costs and Behavior Shifts

When systems exit payer networks, the effects can ripple outward. Premiums may rise, referral patterns may change, and both insurers and health systems may alter their contracting strategies in response.

My Perspective from the Field

In my own work in practice operations, I see every day how these challenges play out on the ground. Prior authorizations, insurance denials, and complex payer rules do not just frustrate providers, they slow down care for patients who are often already anxious about their health. I have worked directly with staff who spend hours tracking down approvals or re-submitting claims, time that could have been spent on patient care.

When a health system and a payer cannot reach agreement, those day-to-day frustrations multiply. Front desk teams have to explain to patients why their long-standing providers are suddenly out of network. Clinical teams struggle to navigate new requirements or shift care plans. Leadership has to balance financial risk with patient loyalty. These are not abstract contract disputes, they are very real operational challenges that ripple through every corner of a clinic.

I know how important it is to anticipate payer dynamics, strengthen patient communication, and build workflows that can withstand disruption.

Lessons for Providers, Payers, and Health Systems

1. Negotiate with patient protections at the center.

2. Carefully assess the risks of leaving a payer’s network.

3. Strengthen continuity of care plans for patients in treatment.

4. Communicate clearly and support patients through the transition.

5. Advocate for policies that limit excessive denials and administrative barriers.

6. Track financial and clinical outcomes after changes take effect.

Final Thoughts

Healthcare decisions like this are never simple. Patients, providers, and payers all carry part of the burden when negotiations break down. The Johns Hopkins and UnitedHealthcare dispute highlights the need for contracts that balance financial sustainability with patient centered care.

From my own experience in practice operations, I know how deeply payer disputes affect not only financial outcomes but also the daily lives of patients and staff. At Steadwell Healthcare Consulting, we believe that alignment of incentives is critical. Reducing barriers, improving transparency, and protecting patient access must remain at the forefront if healthcare is to remain equitable, responsive, and sustainable.