St. Charles Medical System reached an agreement with PacificSource on Sept. 29 that will continue its Medicare Advantage plans with no disruption in care or coverage. The agreement will reduce administrative burdens and address previous problems with Medicare Advantage plans, prioritizing the ease of care.
Beginning in 2024, patients of St. Charles Cancer Center can receive care prescribed by their physicians without waiting for PacificSource authorization. Additionally, St. Charles will work with PacificSource in discharging patients from the hospital when hospital-level care is no longer needed.
PacificSource has over 15,000 Medicare Advantage members. Its members will be reenrolled for 2024 plans with no further action required.
“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 in a Sept. 29 press release.
St. Charles continues to evaluate Medicare Advantage participation and has not yet reached an agreement with Humana, HealthNet and WellCare for 2024, according to a St. Charles press release.
In August, St. Charles announced it may stop accepting Medicare Advantage plans, citing concerns such as delayed or restricted access to care and health care system costs and burdens. At the same time, St. Charles encouraged Central Oregonians to switch to traditional Medicare plans.
The decision to reevaluate Medicare Advantage participation was based on years of concerns at St. Charles and other health systems throughout the country.
“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,” Dr. Steve Gordon, president and CEO of St. Charles said in an August press release.
The organization’s plan to keep track of new initiatives to guarantee the agreement is reducing patient and family stress and improving speed and access to care while alleviating administrative burdens on health care providers.
Medicare Advantage plans cover seniors and individuals under 65 with disabilities, dsigned to offer more benefits with less cost than traditional Medicare. PacificSource Medical Advantage plans offer several benefits that would cost thousands more per year with Original Medicare, according to a PacificSource press release.
“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.”
This article appears in Source Weekly September 28, 2023.
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