St. Charles reaches Medicare Advantage agreement with PacificSource; still in talks with three other providers

(Update: Adding video with more comments from Hallett, Swafford; KTVZ.COM Poll)

Health system says new contract 'reduces administrative burdens,' includes 'innovative ideas'

BEND, Ore. (KTVZ) -- St. Charles Health System said Friday it's reached an agreement with Medicare Advantage provider PacificSource that "promotes excellence in cancer care, reduces administrative burdens and keeps St. Charles hospitals and clinics in-network for PacificSource Medicare Advantage plans in Central Oregon through 2024."

The agreement, announced two weeks before Medicare open enrollment begins, includes PacificSource’s Oregon Health Plan and commercial insurance plans, according to the hospital system. PacificSource issued its own statement on the agreement, which we have included, in full, below the St. Charles announcement.

“We are excited to bring this agreement to our community and believe it addresses many of our concerns,” said Dr. Mark Hallett, chief clinical officer for St. Charles. “We are grateful to PacificSource for working with us to identify creative solutions that we believe will benefit patients and health care providers throughout the region.”

In particular, the teams agreed to focus on reducing administrative burdens for patients and health care workers, initially prioritizing the following innovative ideas:

• Beginning in 2024, St. Charles Cancer Center patients will be able to receive care prescribed by their physicians without prior authorization from PacificSource. This change recognizes St. Charles Cancer Center’s stellar record providing care within National Cancer Care Network guidelines.
• PacificSource and St. Charles will work together to ensure patients are able to be discharged from the hospital when they no longer need hospital-level care.

“We are all committed to ensuring Central Oregonians retain access to high quality health care, and this agreement is a step in the right direction,” said Matt Swafford, chief financial officer for St. Charles. “This is just the beginning of an ongoing conversation with all of our health insurance partners, and we hope the innovative solutions we are piloting with PacificSource will serve as a model for future discussions.”

Both organizations will monitor these new initiatives throughout the coming year to ensure they are achieving the desired outcomes of reducing stress on patients and families and increasing speed and access to appropriate levels of care, while also reducing the administrative burden on health care providers.

St. Charles will continue to evaluate participation in Medicare Advantage Plans going forward and has not yet reached an agreement with Humana, HealthNet and WellCare Medicare Advantage plans for 2024.

For more information on the traditional Medicare and Medicare Advantage options available in the Central Oregon region, seniors are encouraged to contact their health insurance provider, the Central Oregon Council on Aging at 541-678-5483 or the Oregon Senior Health Insurance Benefits Assistance (SHIBA) at 800-722-4134 option 2.

Open enrollment for Medicare begins Oct. 15.

About St. Charles Health System

St. Charles Health System, Inc., headquartered in Bend, Ore., owns and operates St. Charles Bend, Madras, Prineville and Redmond. It also owns family care clinics in Bend, La Pine, Madras, Prineville, Redmond and Sisters. St. Charles is a private, nonprofit Oregon corporation and is the largest employer in Central Oregon with more than 4,500 caregivers. In addition, there are more than 350 active medical staff members and nearly 200 visiting medical staff members who partner with the health system to provide a wide range of care and service to our communities.

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PacificSource announces it has reached an agreement with St. Charles to maintain its Medicare Advantage plans in Central Oregon
PacificSource Health Plans - 09/29/23 9:35 AM

Members will see no disruption to care or coverage—Medicare Advantage plans will automatically renew for 2024 with no action required 

(Bend, Ore.) Sept. 29, 2023—Today, PacificSource announced it has worked out an agreement with St. Charles Health System to ensure that its Medicare Advantage plans will continue in Central Oregon with no disruption in care or coverage to members. PacificSource Medicare Advantage members will automatically be reenrolled for 2024 plans with no action required. 

While St. Charles Health System had previously stated it was reevaluating its ongoing participation in Medicare Advantage contracts, PacificSource worked with St. Charles to ensure continuity of coverage and services for PacificSource Medicare Advantage members through the entirety of 2024.

“This agreement is a positive result for our region’s Medicare-eligible seniors, and also some of its most vulnerable community members,” said Dr. John “Espi” Espinola, PacificSource’s president and CEO. “PacificSource will continue to advocate for our members to make certain that they can continue to access affordable, high-quality healthcare in Central Oregon. We are pleased to have secured this successful outcome with St. Charles and will continue to work with them to improve the Medicare Advantage experience for their patients.”

Medicare Advantage is for seniors and people with disabilities under 65 and offers more benefits than Original Medicare. PacificSource has 15,500 Medicare Advantage members of which 2500 are dual-eligible seniors, who qualify for extra benefits due to health, income or disability needs. People choose Medicare Advantage because these plans offer more benefits with less cost. PacificSource Medicare Advantage plans offer vision, dental, hearing and gym membership benefits that would cost thousands more per year with Original Medicare. Dual-eligible members of PacificSource also qualify for essential benefits such as grocery stipends. 

“As a local nonprofit serving Central Oregon for more than 25 years, PacificSource is proud of our track record of creative problem-solving to improve the health systems in our community,” said Dr. Espinola. “We are always ready to work collaboratively with our partners and never lose sight of who is most important when we discuss care and coverage—our members and their families. Serving them will remain our priority.”

About PacificSource

PacificSource is an independent, not-for-profit community health plan serving the Northwest. Founded in 1933, PacificSource has local offices throughout Idaho, Oregon, Montana, and Washington. The PacificSource family of companies employs more than 1,800 people and serves over 600,000 individuals throughout the Greater Northwest. For more information, visit PacificSource.com.