Bend, OR, – August 18, 2023 – Summit Health’s leadership team has been closely following the announcement by St. Charles Health System that it may end its participation in all Medicare Advantage contracts in the next four months. This unilateral decision by hospital leadership would significantly impact well over 25,000 Central Oregon seniors, creating significant, unintended consequences for our community.
As the premier Primary and Specialty Care provider in Central Oregon, Summit Health provides medical services to nearly 50,000 Medicare and Medicare Advantage patients annually. We want to take a few moments and share our perspective on this unprecedented development in our community, with our patients.
For over a decade, our medical group’s providers have worked closely with nearly all Medicare Advantage providers in Central Oregon. Many Advantage plans, including Regence Providence, Moda Health, Humana and PacificSource, work with Summit’s providers and staff routinely to focus on improving the delivery of care and enhancing the quality of life for all of the patients we serve. These unique partnerships with certain local health plan payers like PacificSource and Humana have transformed Summit Health’s entire care delivery model – producing some of the best healthcare outcomes in America.
In 2022-2023, Summit Health in Oregon produced a perfect 100% Medicare quality score (MIPS) and averaged a 4.8-star rating on most Medicare Advantage plans while maintaining our 95% customer satisfaction rating for over three years. Our on-going partnership with these local health plans has been vital in creating extraordinary outcomes for patients.
Here are a few examples of collaboration between the health plans and Summit Health:
During the pandemic, when Central Oregon faced unprecedented inpatient bed capacity challenges, PacificSource partnered with Summit Health to launch a first-of-its kind skilled nursing facility program. This new service helped patients transition from hospitals to transitional care facilities, and back to their homes, in a coordinated system of care. This collaboration significantly reduced the length of stay and unneeded readmissions.
To reduce the impact of expensive lifesaving oncology and rheumatology medications, Summit Health, Humana, and PacificSource came together to launch a new drug waste reduction and biosimilar utilization initiative in 2021. This new initiative utilized best practice treatments and data sets and enhanced the collaboration between pharmacists and physicians. Thanks to this partnership, Summit Health has one of the highest Bio-Similar utilization rates in the Pacific Northwest and has saved patients well over $500,000 annually in drug waste reduction.
In 2022 during the peak of the national staffing crisis, Summit Health met monthly with PacificSource and Humana to highlight the administrative burden of the authorizations process. Through our collaborative partnership with local health plan leaders, along with multiple innovative workflow changes, Summit Health was able to streamline our processes and dramatically reduce the authorization burden with these plans. Patients get in to see their healthcare provider faster because of this valuable process improvement.
Over the past decade, Summit Health and the Medicare Advantage Plans have worked together on dozens of projects and collaborations just like the ones discussed above. The Medicare Advantage plans in the market have worked extremely hard with us to expand benefits and services including offering meal support, transportation, and expanded preventative care within their plans. Summit Health believes Medicare Advantage plans can, and do, offer tremendous benefits for many patients based on their needs and lifestyle.
If the leadership at St. Charles Health System unilaterally ends its Medicare Advantage contracts in the coming weeks, that will have serious consequences for tens of thousands of seniors in Central Oregon. This action may include increased out-of-pocket costs, diminished access to vital medical services, limited primary care availability, disruptions in care, challenges finding supplemental plans, and unnecessary emotional stress.
We’re eager for an explanation of the reasoning behind this decision, which could place thousands of Oregon seniors at greater risk. We’re encouraging St. Charles Health System to put the health of seniors in our community first when they are making the decision whether to drop their relationship with many patients’ chosen insurance plans. We hope St. Charles’ leaders will recognize that when health plans, provider groups, and hospitals come together to cooperate, the patients are the ones who really win.
Irrespective of St Charles decision, Summit Health remains dedicated to you, our patients, and the community. We will navigate the outcome of the hospital’s decision together and appreciate the opportunity to share our thoughts on this issue with all of you.
