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NC revises new health care plan for state workers after pressure from hospitals

The State Treasurer announced a new move Thursday to ensure that the health insurance plan covering more than 720,000 teachers and other state employees will include major N.C. hospital systems as in-network facilities.

Two big providers for the Charlotte area, Atrium Health and Novant Health, said the new deal means they will remain in-network for state employees next year. Duke Health also said it will be in-network.

The new plan will let those health care systems and other providers that didn’t sign on to State Treasurer Dale Folwell’s proposal of state-set prices for medical service to keep their existing agreements with Blue Cross Blue Shield of North Carolina. Blue Cross Blue Shield administers the state insurance plan.

Numerous N.C. hospitals systems, including Atrium, Novant and UNC Health, had refused to sign on to Folwell’s initial proposal. That would have left many workers across the state facing the potential of paying much bigger out-of-network costs if they wanted to keep using their local doctors and hospitals.

Folwell, whose office administers the employees’ health insurance plan, said the new deal includes the agreement with some providers for state-set prices for medical services as well as the existing network plan the state had tried to leave behind.

“UNC Health Care is pleased to learn that North Carolina’s State Employees and Teachers will be guaranteed the access to primary, specialty and hospital care they’ve become accustomed to through the State Health Plan,” The company said in a statement. “That includes thousands of our own colleagues at UNC Health Care.”

The new state plan will use a hybrid network of the new State Health Plan network and the Blue Options Network.

“We look forward to continue caring for State Health Plan members in 2020,” Novant said.

The new hybrid network will include more than 68,000 providers, according to the treasurer’s office. The proposed State Health Plan network only included 28,000 providers.

The fight

Folwell had set two deadlines for hospital systems to sign on to the state-set rates that would start next year.

The latest deadline had passed earlier in the week, with only five hospitals systems having signed on: CaroMont Health in Gastonia, Randolph Health in Asheboro, North Carolina Specialty Hospital in Durham, Martin General Hospital in Williamston and Catawba Valley Medical Center in Hickory.

The State Health Plan serves about 39,000 people in Mecklenburg County and more than 93,000 in Wake County.

Folwell said his initial proposal uses Medicare prices as a reference to set rates. Medical providers and hospitals joining the plan had to agree to accept the state-set prices, which would be set at almost double Medicare prices on average.

“I appreciate that 28,000 providers – independent primary care providers, behavioral health providers, independent provider networks and the five courageous hospitals – have chosen to provide care to those who serve in state government,” said Folwell.

The State Employees Association of North Carolina backed Folwell’s “Clear Pricing Plan.” Executive Director Robert Broome said he was glad 28,000 North Carolina medical providers signed on to the state-set prices, but was disappointed major hospital systems refused the plan.

“It’s a mixed bag” Broome said. “... For us the fight continues, and we will not rest until we make health care affordable for the members of our plan.”

Some state employees like Cabarrus County teacher Michael Landers felt caught in the middle of the fight.

He told the Observer Monday that all of his doctors are affiliated with Atrium, and when he was nearly unconscious from extreme hypoglycemia due to Type I diabetes last year, he was taken to an Atrium hospital.

Having to pay out-of-network prices at Atrium would have been financially devastating for his family, he said.

Landers said the Thursday announcement relieved his immediate anxiety. But he wants to see long- term changes to how the state handles health care for its employees. “This is a long-term issue and a Band-aid has been put on it,” he said.

News & Observer reporter Elizabeth Thompson contributed to this report.

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Hannah Smoot covers business in Charlotte, focusing on aviation and health care. She previously covered money and power at The Rock Hill Herald in South Carolina. She is a lifelong North Carolinian and graduate of the University of North Carolina at Chapel Hill.
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