{"id":390130,"date":"2025-11-19T14:57:14","date_gmt":"2025-11-19T14:57:14","guid":{"rendered":"https:\/\/www.europesays.com\/us\/390130\/"},"modified":"2025-11-19T14:57:14","modified_gmt":"2025-11-19T14:57:14","slug":"oregon-flags-3-health-insurers-a-hospital-group-and-a-clinic-for-unexplained-surge-in-costs","status":"publish","type":"post","link":"https:\/\/www.europesays.com\/us\/390130\/","title":{"rendered":"Oregon flags 3 health insurers, a hospital group and a clinic for unexplained surge in costs"},"content":{"rendered":"

Oregon regulators are calling out five health care organizations for driving up medical costs<\/a> without offering a convincing explanation.<\/p>\n

The state in 2021 set a 3.4% limit<\/a> on how much organizations \u2013 hospitals, insurance companies and medical groups \u2013 can increase their per-person spending on patient care. The policy, first approved in 2019 and strengthened two years later, is part of a broader push to curb rising medical bills and keep care affordable. <\/p>\n

The companies must offer hard evidence or an acceptable explanation to back up anything above that percentage.<\/p>\n

The Oregon Health Authority said St. Charles Health System in Bend, The Corvallis Clinic and insurers PacificSource, UnitedHealthcare and Moda Health blew past that limit<\/a> in 2023 without making a convincing case for why.<\/p>\n

\u200b\u200bAnother 66 organizations also overshot the target, but state analysts found those increases reasonable \u2014 tied to factors such as rising prescription drug prices, higher spending on behavioral health services and caring for patients with exceptionally high medical bills.<\/p>\n

The state\u2019s latest report signals a turning point in Oregon\u2019s program aimed at bringing more transparency around where health care dollars go and how spending changes year to year. For the first time, state regulators are requiring organizations to answer for how much more they are spending each year.<\/p>\n

The scrutiny is necessary, state health officials said, at a time when health care costs continue to grow far faster than Oregonians\u2019 wages<\/a>. In 2023, per-person health spending in Oregon jumped 5%, well above inflation. That trend, they said, is pushing health care out of reach for many working families.<\/p>\n

\u201cMaking health care affordable benefits everyone,\u201d said Clare Pierce-Wrobel, who leads the health authority\u2019s Health Policy and Analytics Division. She said the cost growth program is designed to distinguish between cost increases that expand access to care from price hikes that offer little benefit to patients. <\/p>\n

\u201cNot all cost growth is bad,\u201d Pierce-Wrobel said. \u201cSome can address areas of historic underinvestment or ensure access to care.\u201d<\/p>\n

The biggest jump came at St. Charles Health System, where costs for commercially insured patients soared 26% in a single year, nearly eight times the state\u2019s cap. St. Charles operates hospitals in Bend, Redmond, Prineville and Madras, along with more than 30 clinics. <\/p>\n

Alandra Johnson, a spokesperson for St. Charles, argued that the state\u2019s finding overlooks real-world pressures facing central Oregon\u2019s only hospital system. She said many of the forces that pushed costs higher \u2014 post-pandemic recovery efforts, higher operating costs in rural areas and declining federal reimbursements \u2014 were beyond the organization\u2019s control and \u201ccannot fairly be attributed to St. Charles.\u201d<\/p>\n

Johnson said the health system \u201ccontinues to work hard on cost containment\u201d and plans to ask the state health authority to reconsider its determination. <\/p>\n

But Sarah Bartelmann, the state\u2019s cost-growth program manager, said St. Charles\u2019 dominance in the region plays a major role in driving up prices. <\/p>\n

\u201cThe payers in central Oregon have to contract with (St. Charles) if they want their members to have access to hospital care \u2026 because they\u2019re the only game in town,\u201d Bartelmann said. \u201cWe see that both health plans and the primary care patients who end up needing hospital services are paying more. It affects costs all the way through the system.\u201d<\/p>\n

At the Corvallis Clinic, costs for commercially insured patients rose nearly 9% \u2014 almost triple the state\u2019s cap. The medical group was purchased by Optum in early 2023<\/a> in an emergency deal that bypassed the state\u2019s regulatory review<\/a> intended to prevent corporate buyouts of physician practices from harming local access to health care.<\/p>\n

UnitedHealthcare, which shares a parent company with Optum<\/a>, reported a 6% increase in Medicare Advantage spending. The insurer attributed the rise to sicker patients, federal payment changes, post-pandemic care patterns and higher costs in provider contracts. But state analysts said the insurer did not provide enough evidence to support most of those claims. <\/p>\n

The company did not respond to an email seeking comment.<\/p>\n

Moda Health\u2019s Medicare Advantage line reported a 15% increase in spending. For insurers, analysts say rising prices and increasingly complex payment arrangements \u2014 especially in Medicare Advantage plans, where more payments now happen outside the traditional claims system \u2014 are playing a growing role. <\/p>\n

That complexity, the health authority\u2019s Pierce-Wrobel said, makes it harder to pinpoint exactly what is driving costs.<\/p>\n

Moda officials previously said the company\u2019s Medicare Advantage plans saw a surge in post-pandemic service use<\/a> that drove premiums to unsustainable levels. Because of that, the insurer left the Medicare Advantage market in 2025.<\/p>\n

The state found that PacificSource increased its commercial health care spending by 7% \u2014 more than twice the state\u2019s limit. Regulators accepted some of the insurer\u2019s explanations, such as higher pharmacy costs and required behavioral health investments, but rejected others, saying the insurer did not provide enough data to support claims that its members were sicker or that hospital price increases were unavoidable. <\/p>\n

Lauren Thompson, a spokesperson for PacificSource, said in an email that the insurer\u2019s commercial costs rose largely because of \u201cfactors outside any single organization\u2019s control, including steep specialty drug price inflation, higher utilization as members returned to deferred care, and broad inflation across the health sector.\u201d<\/p>\n

PacificSource, UnitedHealthcare and St. Charles will have to submit performance improvement plans by January, outlining what is driving their cost growth and how they will bring spending back in line with the state\u2019s target.<\/p>\n

State officials said they won\u2019t require Moda Health to file a plan because it has since ended its Medicare Advantage line. The state also temporarily excused Corvallis Clinic from filing a corrective plan so that regulators can instead evaluate its parent company in future review cycles, officials said.<\/p>\n

Financial penalties for exceeding the target are still years away and will apply only if an organization exceeds the target three out of five years without acceptable reason. That means the earliest any fines could come is 2028. <\/p>\n

Meanwhile, the state is reassessing whether its 3.4% spending cap should remain in place for the second half of the decade. A work group is expected to recommend changes later this month.<\/p>\n

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