BEND — After St. Charles Health System announced it would re-evaluate participation in PacificSource Medicare Advantage contracts, the two companies announced Friday, Sept. 29, that they had reached an agreement that would allow for no disruption of care or coverage to PacificSource members.

“We are very excited about this announcement and grateful to PacificSource for their partnership because this is going to make things better for patients; it’s going to support clinical quality in cancer care, and it’s going to be better for our staff and providers because it will reduce friction and speed up care, especially for cancer patients,” said Dr. Mark Hallett, chief clinical officer for St. Charles.

St. Charles Health System operates medical facilities and family care clinics in Bend, La Pine, Madras, Prineville, Redmond and Sisters. The group is a private nonprofit organization that employs over 4,500 caregivers in Central Oregon. PacificSource is one of the largest insurance providers in Central Oregon. This decision primarily impacts seniors and people with disabilities under 65, the demographic typically covered by Medicare Advantage plans, and includes PacificSource’s Oregon Health Plan and commercial insurance plans.

St. Charles decided to re-evaluate Medicare Advantage participation based on broader concerns that patients covered by Medicare Advantage plans were not receiving adequate or prompt access to care.

Hallett gave an example of how he feels Medicare Advantage plans are failing patients. Recently, St. Charles was treating a man with prostate cancer.

His doctor wanted to prescribe a PET scan, which Hallett said is a well-known standard of care. But before the patient could undergo the procedure, his clinicians were required to get authorization from his insurance provider. Hallett said three physicians were denied authorization before the final clinician asked to speak to a supervisor.

“If you have a diagnosis of cancer, every moment feels like a race against time,” said Hallett. “Time is invaluable, and this (agreement) will save time for patients. They will be able to get to diagnosis and treatment faster.”

Under the new agreement, physicians won’t have to wait for authorization to begin necessary procedures, such as a PET scan, leading to swifter care. An added benefit to this, said Matt Swafford, chief financial officer for St. Charles, is that it reduces administrative tasks for clinicians while also reducing the financial burden for patients who might otherwise have been denied coverage.

While this agreement is a windfall for those covered by PacificSource, Henrik Jahn, president and insurance adviser for Central Financial Service in Bend, has some concerns.

“We don’t want hurdles to cancer care, but I think it’s important some checks and balances on what is being done are in place,” he said. “My concern is going to be that if (other providers) find out how good a deal St. Charles got, they are going to want the same thing. And if everyone does that, it’s not sustainable. There is only so much money to go around.”

St. Charles has not yet reached agreements with Humana, HealthNet and Wellcare regarding their Medicare Advantage plans for 2024.

Nevertheless, Jahn said many of his clients insured by PacificSource are deeply relieved their coverage will continue through 2024. Almost everyone who had PacificSource was happy, he said, and the thought of losing coverage was “scary” for many people, especially seniors. Even in the short time since the new agreement was announced, Jahn said clients have been calling to express their satisfaction.

“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 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 health care 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.”