Two Triangle hospital systems considered for key State Health Plan status. Who got it?

State employees in Wake County and surrounding areas now know which hospitals they can use to save money.

Meanwhile, a major healthcare provider in the Triangle area — previously said to likely end up in the State Health Plan’s access tier, which would have kept costs largely at their current levels — has been designated by the plan as a non-preferred provider.

In 2027, the State Health Plan will move to a four-tier provider network: preferred, access, non-preferred and out-of-network. Members who receive care from preferred providers will pay the lowest premiums, copays, deductibles and out-of-pocket costs. Meanwhile, the State Health Plan also saves money through more favorable contracts negotiated with those providers. Costs for members using access providers will remain largely unchanged from today, while those who choose non-preferred providers will face significantly higher out-of-pocket costs.

The State Health Plan Board of Trustees voted Friday on which hospital systems would be considered preferred providers under its new network structure.

Those designated as preferred providers were UNC Health and Novant Health.

State Health Plan spokesperson Loretta Boniti told The News & Observer that UNC Health has a 10-year contract while Novant Health’s contract runs through 2028 but can be renewed through 2030.

Atrium Health, Granville Health, and some Duke LifePoint facilities were designated as non-preferred providers.

Tom Friedman, the executive administrator of the State Health Plan, said Friday that the access tier in the Triangle was still being negotiated and that it would be either WakeMed or Duke.

Previously, the State Health Plan had said that WakeMed — Wake County’s largest healthcare provider — would likely be in the access tier.

Now the decision has been made. Duke Health has been designated as the access provider.

And with “Duke Health at Access tier, a majority of WakeMed services are now non-preferred,” Boniti said via email.

She said current individual primary care providers associated with WakeMed will remain preferred and WakeMed’s emergency room will remain as an access provider. She added that because many Duke OBGYNs also deliver at WakeMed, “we will figure out a path to ensure those members have a seamless experience.”

The N&O has reached out to WakeMed for comment.

This comes at a time when WakeMed is also in the midst of seeking to merge with Atrium. That’s brought concerns from State Treasurer Brad Briner, who has said it’ll lead to increased costs for the State Health Plan and its members.

The North Carolina Justice Center, an advocacy group, said in a news release that the decision to declare Atrium as non-preferred provider “due to its high costs raises further doubt about the value of this deal to Wake County residents.”

The group wrote that last month Friedman said that Atrium charges between 15 and 40% more than WakeMed for the exact same services and warned that the WakeMed-Atrium deal could raise state employee health care premiums by $7 to $11 per month.

The agreement means members will avoid higher costs when receiving care at Duke Health facilities.

“Every day, teachers, law enforcement officers, firefighters and so many other public servants dedicate their careers to serving North Carolina,” Duke Health CEO David Zaas said in a news release. “They deserve a health system that is equally committed to serving them.”

Zaas said the agreement preserves access to Duke Health for State Health Plan members and their families.

Briner, who chairs the State Health Plan Board of Trustees, praised Duke Health’s agreement to become an access provider.

“The extensive network of doctors, facilities and expertise they bring to our members is just the type of partnership we have been looking for,” Briner said. “We know we are pushing the boundaries in healthcare by asking organizations to reduce costs, but by working together we are strengthening the Plan, and giving our members best in class options for care.”

Friedman said in a statement shared by Boniti that following the June board of trustees meeting where Briner said the plan was still open for negotiations, Duke Health reached out.

“Given the substantial number of patients who utilize Duke Health, their excellent quality and many complex services they offer for our sickest members and a significant discount off current rates we felt this partnership aligned perfectly with our commitment to quality, access, and affordability while minimizing patient disruption.”

“It is rare a partnership can ... address so many member concerns,” he said. “Duke’s outreach and bold plan caught the Plan by surprise given the previous CEO’s very public push for rate increases for SHP members but we believe it is a clear demonstration that competition brings out the best of us and when we align our interests we get the best deal for all stakeholders.”

“WakeMed is an excellent facility and we continue to value their services such as their emergency department and their OB platform (which they currently partner with Duke Health on). But given the saving to the Plan and the human impact we believe Duke Health is the right access partner for the State Health Plan.”

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