Great Plains Health
North Platte, Neb. – Effective January 1, 2025, the clinically-integrated Great Plains Health Innovation Network (GPHIN), including Great Plains Health clinics and many independent practices in the area, will no longer be in-network for any Medicare Advantage plan and will not be scheduling Medicare Advantage patients for visits, including patients that were previously seen as out-of-network.
To continue routine care with current providers, patients should opt into Traditional Medicare coverage during the open enrollment season, which happens yearly from October 15 to December 7. All patients, regardless of insurance or ability to pay, will continue to have access to emergency care through the emergency department.
The mission of Great Plains Health is to put the patient first – always – and Medicare Advantage does not align with that mission. Concerns relate to patient care, access and affordability.
“To put the patient first, we can no longer be under contract with a plan that causes significant delays in care, longer hospital stays and outright denials of care,” said Dr. Narayana M. Koduri, Great Plains Health Psychiatric Services, Great Plains Health Chief Medical Officer. “Medicare Advantage as it currently exists limits access to care in the region, as Medicare Advantage patients often have longer hospital stays as they await pre-authorization for post-acute services, which, in turn, limits bed availability for patients who truly need access to acute hospital care.”
Ultimately, outcomes and experiences for patients in Greater Nebraska lead us to believe that Medicare Advantage is:
• Bad for taxpayers
• Limits choices and delays care
• Bad for patients
Great Plains Health is not alone. Ninety percent of Nebraska hospitals report that Medicare Advantage plans negatively impact the care their hospital is able to provide to patients, according to a report by the Nebraska Hospital Association in October of 2023.
Traditional Medicare, which the GPHIN sees as a better option for patients, is funded and operated by the federal government. Medicare Advantage is funded by the government, but operated by private insurance companies.
Great Plains Health has served Greater Nebraska for nearly 50 years. Memorial Hospital and St. Mary's Hospital, from which Great Plains Health was formed, served patients for many years before that. To ensure the ability to continue providing quality care for the next 50 years and beyond, the GPHealth board of directors and physicians of the GPHIN stand united in this decision and their desire to see the longstanding health of our patients and viability of local healthcare.
“We are an independent, community-driven hospital lead by board members and physicians with local insight on this community,” said Dr. Benjamin F. Klug, North Platte Obstetrics and Gynecology, Great Plains Health Chief of Staff. “We want to see the long-term health of our patients, and the long-term viability of our hospital. My fellow physicians and I are confident that we are acting in the best interest of our friends, neighbors and broader community health when we vocalize our support of Traditional Medicare plans – not Medicare Advantage.”
Local physicians say the decision is sparked by the desire to provide patients with seamless care. It also follows a nationwide movement away from Medicare Advantage.
“I am pleased that our local physicians and their clinics are joining the dozens of healthcare systems across the country in not renewing Medicare Advantage contracts,” said Dr. David G. Lindley, Complete Family Medicine, Chair of the GPHIN. “Often, my patients do not truly understand the coverage that Medicare Advantage provides. I hope this transition starts conversations with families. Know what your coverage looks like, especially for unexpected health situations or serious illness. Medicare Advantage can look appealing, but it usually does not offer the best care for the types of health situations its insured population usually face.”
Medicare Advantage’s pre-authorization process can also be an unnecessary administrative burden for providers who want to spend their time treating patients.
“I know my patients on a personal level, and I have cared for some patients for decades, so when I order care that Medicare Advantage outright denies, it is frustrating,” said Dr. Todd E. Hlavaty, Great Plains Health Callahan Cancer Center, Chair, Finance and Payer Committee, Great Plains Health Innovation Network. “Medicare Advantage undermines my expertise as a physician and disregards my patients’ unique medical needs. I believe Traditional Medicare is the best option.”
Great Plains Health is communicating with patients to bring awareness to the upcoming change, giving patients time to research and discuss their Medicare options.
Local insurance agents are hosting educational sessions for the public over the coming days to connect patients with resources to understand their Medicare options and make informed decisions. Professional Financial Advisors, LLC is hosting sessions at Mid-Plains Community College, South Campus, 601 W. State Farm Rd., North Platte, Neb., on the following dates and times:
• May 28 – 1 p.m.
• June 3 – 10 a.m. and 3 p.m. (Both of these sessions are for Iron Road policy holders only)
• June 6 – 10 a.m. and 3 p.m.
Lane Hastings Insurance is hosting additional education sessions regarding Medicare options at the North Platte Senior Center, 901 E. 10th St., North Platte, Neb., at the following dates and times:
• August 8 - 10 a.m.
• October 7 - 10 a.m.
For information about your personalized needs and Medicare options, please contact your local insurance office, the State Health Insurance Program office ((1.877.839.2675) or 1.800.MEDICARE.
Visit gphealth.org/yourlocalcare for a complete list of FAQs and information on additional resources, including a list of local insurance brokers.