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Executives from three nursing home operators said at Skilled Nursing News’ RETHINK conference that they have ended or challenged Medicare Advantage contracts over reimbursement, referrals and care pressures. They described using operating data, educating residents and advocating for policy changes, while details of specific contract terms and outcomes remain limited.
Executives from Saber Healthcare Group, Creative Solutions in Healthcare and Majestic Care said at a Skilled Nursing News conference in Philadelphia that low reimbursement and care pressures have led them to challenge or leave some Medicare Advantage contracts. Their accounts point to a practical risk for nursing home operators: they may lose plan-covered residents when they walk away, while anticipated referrals or higher payments may not make a contract worthwhile.
Saber president and founder Bill Weisberg said his company ended five to seven Medicare Advantage contracts over the previous 24 months, including one about two weeks before the conference. He said those plans did not cover the cost of care. Weisberg argued that accepting lower rates in return for more referrals can fail because plans do not control where hospital discharge planners, patients or families choose to send someone.
Weisberg said Saber evaluates cost of care, length of stay, readmissions and outcomes when negotiating. He said the company has used comparative data to seek increases of $25 to $35 per day in some cases, and that some plans returned to negotiations and agreed to higher rates. He described the exchange as a “game of chicken,” with the provider prepared to walk away if negotiations do not produce an adequate rate.
Creative Solutions CEO Gary Blake also said his organization is willing to end contracts. He said it educates residents and families about plan options, including traditional Medicare, when they believe a plan may not serve a beneficiary well. Majestic Care CEO Paul Pruitt said operators can be asked to meet quality and cost targets on the expectation that better performance will improve their economics, but he said that outcome often does not follow.
Contract Choices Affect Facility Finances
Medicare Advantage plans are a source of coverage for nursing home residents, while operators depend on reimbursement to pay for staff and care. The executives’ accounts describe a trade-off: keeping a contract with low payments may strain a facility’s finances, while leaving it can disrupt access for residents covered by that plan. The discussion does not quantify how many residents were affected by the contract decisions.
The referral question adds another uncertainty for operators weighing an exit. Weisberg said Saber does not accept the promise of additional referrals as a substitute for adequate payment, because plans cannot dictate where patients go after a hospital stay. Blake’s comments put the issue from the resident and family side: he said they need information about their coverage choices, including whether another plan or traditional Medicare may be a better fit.
The speakers also described pressures beyond payment rates. Pruitt and Blake said plan requirements can place financial targets alongside clinical decisions, including pressure around how long a resident remains in a facility. Their remarks raise questions about how operators can meet plan terms while maintaining care that clinicians consider appropriate. The conference discussion presented their views; it did not establish how widespread these experiences are across the nursing home sector.
How Operators Describe Negotiations
The comments came during the opening session of Skilled Nursing News’ RETHINK conference, held in Philadelphia in September 2026. The session focused on the financial and operational challenges Medicare Advantage plans can create for skilled nursing providers. The source report identifies the participants as executives from three large providers, but does not provide a complete transcript or detailed contract documents.
Weisberg described a two-part approach at Saber: use facility data to argue that higher reimbursement can support efficient care, and be willing to end contracts that do not cover costs. He said the company had secured some higher daily rates after presenting comparisons to plans. Those examples were his account; the report does not identify the plans, the specific comparisons used or the duration of the revised rates.
Blake described resident education as part of Creative Solutions’ response. He said supplemental benefits such as grocery cards can draw attention away from questions about care and coverage, and that families may need help comparing options. Pruitt, meanwhile, said the original aim of managed care was to control costs, but argued that providers do not necessarily gain referrals, patients or profit in return for meeting plan expectations.
““We will walk away from those contracts, but we also go into them when we negotiate.””
— Bill Weisberg, Saber Healthcare Group president and founder
Contract Outcomes Remain Unspecified
The conference remarks do not identify the Medicare Advantage plans Saber ended contracts with, the facilities or residents affected, or the financial effect of those exits. The source report also does not specify whether the contract Saber ended about two weeks earlier had been replaced, or whether the company’s reported higher daily rates applied to long-term agreements.
The executives described their own experiences and judgments. The report provides no plan responses, independent comparison of reimbursement rates, or sector-wide data showing how often operators leave contracts or face the pressures they described. It is also unclear how individual residents’ coverage changed after a provider exit, or what options were available to each family.
Blake and Pruitt raised concerns about care decisions, payment reductions and discharge pressure, but the report does not give specific cases, plan notices or clinical records. Their remarks do not establish how often such notices occur or whether a particular decision was inappropriate. The details needed to assess those claims were not included in the source material.
Advocacy and Contract Talks Continue
Blake said Creative Solutions is in ongoing discussions with lawmakers in Washington and argued that providers should keep pressing for policy changes. Pruitt said he has met with members of the House Ways and Means Committee to discuss challenges facing operators and seniors. The source report does not name a specific bill, policy proposal or next meeting date.
For Saber, Weisberg’s account suggests that negotiations can continue after a contract ends if a plan returns with improved terms. Whether that will happen for the recently ended contract is not stated. The executives’ next steps, as described at the conference, are to keep evaluating contract economics, explain coverage choices to residents and families, and raise their concerns with policymakers.
Key Questions
Which nursing home providers discussed Medicare Advantage contracts?
The conference speakers were Bill Weisberg of Saber Healthcare Group, Gary Blake of Creative Solutions in Healthcare and Paul Pruitt of Majestic Care.
How many contracts did Saber say it ended?
Weisberg said Saber ended five to seven contracts over the prior 24 months, including one about two weeks before the conference. The report does not name the plans.
Why did Saber say it left some contracts?
Weisberg said the contracts did not cover the cost of care. He also questioned whether lower payments would reliably lead to more referrals, saying plans cannot control where patients and families choose to go.
What did the executives say residents and families should know?
Blake said Creative Solutions educates residents and families about plan options, including traditional Medicare. The report does not describe the options available to any specific resident.
What policy action did the speakers describe?
Blake said his organization is in ongoing discussions with lawmakers, and Pruitt described meeting with members of the House Ways and Means Committee. No specific proposal or legislative timetable was reported.
Source: rss
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