In the midst of an ongoing dispute over healthcare pricing, North Carolina's State Health Plan has moved most Atrium Health facilities to its out-of-network tier of providers.
State Treasurer Brad Briner, who oversees the Health Plan, says the action is necessary to protect its solvency against a pricing structure that Atrium announced last week in response to the state plan's own decision to put Atrium in its non-preferred pricing tier.
"One of my duties is to keep the State Health Plan financially solvent so it can continue as an incentive for teachers and state employees. I will not let one hospital system destroy the Plan, raise premiums on every teacher and state employee and send us into overwhelming debt," Briner wrote in a press release.
Atrium is one of the largest healthcare providers in the state and operates in Charlotte and Winston-Salem, among other locations.
Under the plan Atrium announced last week, State Health Plan members seeking care at most of its facilities would pay co-pays lower even than they would at the Health Plan's preferred providers. Atrium would also waive coinsurance and deductible payments as part of what the non-profit healthcare system's executives call a commitment to affordability.
But Briner and other Health Plan officials said that commitment actually poses a problem for the health plan because Atrium is only generating savings for the customer, not for the plan. That could cost the Health Plan up to $250 million in 2027.
If Atrium keeps its commitment to state employees, Briner said, care at most of its facilities will remain affordable.
The NC Newsroom has reached out to Atrium for comment and will update this story when it hears back.
Atrium, Briner contends, is still charging the health plan high prices for its services, potentially imperiling its fiscal solvency and at minimum meaning that it needs to lean on taxpayers for additional funds.
Over the last two years, the General Assembly has appropriated about $4 billion to the State Health Plan.
The tiered pricing system introduced by Health Plan officials this summer was intended to present a solution to some of that spending, with preferred providers like Novant and UNC Health offering the health plan lower rates for services in return for the likelihood that members would choose them for care.
"This approach was solely to place the Plan on a better financial path and to avoid placing any additional burden on Plan members in the form of increased copays and premiums," Tom Friedman, the health plan's executive administrator, wrote in a press release.
Health Plan officials initially placed Atrium in their non-preferred provider tier, which would see members pay some of the highest copays and out-of-pocket maximums to seek care there. In response, Atrium offered to match the preferred provider rates, a step Briner previously said was a non-starter because it undercuts the agreements with Novant and UNC Health.
The State Health Plan and Atrium did reach a limited agreement on care at a dozen children's and rural hospitals, which would see care at those facilities placed into the plan's so-called Access Tier. At that level, rates for members are largely kept at 2026 levels.
Those facilities will remain in the access tier despite Wednesday's announcement.
Open enrollment for State Health Plan members is ongoing and will remain open until Nov. 6.
