Oregon health system threatening Medicare Advantage split strikes deal with PacificSource

A health system that encouraged its patients to avoid Medicare Advantage plans has found common ground with at least one MA insurer. 

Bend, Ore.-based St. Charles Health System reached an agreement with PacificSource Health Plans to keep Medicare Advantage patients in-network with the system through 2024, according to a Sept. 29 news release. 

As part of the agreement, patients at the system's cancer center will not need prior authorization from PacificSource for any care prescribed by their physician. The health plan and St. Charles will also work together to ensure patients are discharged from the hospital when they no longer need hospital-level care. 

In August, St. Charles said it was reevaluating its participation in all Medicare Advantage plans. The system encouraged its patients to opt for traditional Medicare over Medicare Advantage during the open enrollment period. 

"The reality of Medicare Advantage in Central Oregon is that it just hasn't lived up to the promise. A program intended to promote seamless and higher quality care has instead become a fragmented patchwork of administrative delays, denials and frustrations," St. Charles CEO Steve Gordon, MD, said in August. 

In the news release, Mark Hallett, MD, chief clinical officer for St. Charles, said the agreement addresses many of the system's concerns about MA. 

"We are grateful to PacificSource for working with us to identify creative solutions that we believe will benefit patients and healthcare providers throughout the region," Dr. Hallett said. 

St. Charles Health System is yet to reach an agreement with Humana, HealthNet and WellCare (Centene) plans for 2024, according to the release. 

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