(The Center Square) – Atrium Health on Jan. 1 will be moved to out-of-network tier for the State Health Plan in North Carolina, first-term Republican state Treasurer Brad Briner said Wednesday.
One exception will be a previously agreed upon “access” level facilities pact. The open enrollment period that began Monday is already extended a week to Nov. 6.
The move on behalf of the nearly 750,000 teachers, state employees, retirees, lawmakers active and retired and members of higher education is expected to keep the plan solvent, whereas Briner says Atrium’s Affordability Protection Program introduced last week also brought potential for bankruptcy. Members choosing Atrium will be held harmless; the State Health Plan will have little to no financial responsibility to Atrium Health; and if the healthcare provider stays true to its promise, the Affordability Protection Program will stay in place and be an offering for members to get reduced costs of the program if choosing Atrium.
The Atrium promise, Briner said, was “regardless of how Atrium Health is categorized under the State Health Plan’s new structure, the new Atrium Health Affordability Protection Program is designed to ensure members can continue receiving care from Atrium Health at the lowest cost-sharing available under the State Health Plan.”
Briner is chairman of the trustees for the plan.
In a release, Briner said, “We understand that this back and forth is unsettling for our members, but this is all behind the scenes bookkeeping. Members should expect to have the same coverage as set by the plan over the summer. 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.”
Prior to publication, The Center Square was yet to hear from Atrium Health.
The State Health Plan was projected for a $500 million deficit this year, and $1 billion in 2027. Briner created a new tiered network structure called the Preferred Provider Program to combat the fiscal challenge.
State terms were agreed to by UNC Health, Duke Health and Novant Health. Briner says without moving Atrium Health out of network, the system would have charged the State Health Plan higher rates in 2027 – meaning, the 750,000 members would have paid less out of pocket on the front end, and the State Health Plan would have quickly acquired a quarter-billion dollars in costs.
In a release, Executive Administrator Tom Friedman said, “The plan’s new provider tier network created competition and resulted in providers like UNC Health, Novant Health and Duke stepping up and providing us with deeper discounts for high-quality 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.”
Atrium, less than a week before open enrollment was to begin on Monday, introduced the Affordability Protection Program. Atrium says it created the additional program to “preserve access, patient choice and affordability for enrolled North Carolina State Health Plan members.”
Briner’s office conceded it could lower out-of-pocket costs for some members at Atrium facilities, but it was not “affordable” for the State Health Plan as a whole.
Monthly premiums range from about $35 to $80 for the Standard PPO (70/30) and $66 to $160 for the Plus PPO (80/20) plan. He sought a temporary restraining order, which a judge on Tuesday denied, and then said monthly premiums might rise as much as $50 per month in 2028 regardless of the healthcare provider.
Briner says the state treasurer by law has the duty “to set the plan’s copays, deductibles and coinsurance amounts. Atrium has never been given this authority, yet it believes it can change these amounts simply by posting new ones on its website. That’s not how it works.”
Bankruptcy of the plan would threaten the state’s top-shelf credit rating. Additionally, recruiting and retaining state employees – with government and education at the forefront – would become more difficult.
The new healthcare access not impacted by moving Atrium out of network is the recent move for access in 12 Atrium Health hospitals. If plan members visit Atrium Health rural hospitals in Alleghany, Anson, Cleveland, Columbus, Lincoln, Scotland, Stanly or Wilkes counties, their benefit is nearly identical to the benefit they have this year for out of pocket and deductible costs. Levine Children’s Hospital in Charlotte, Jeff Gordon Children’s Hospital in Concord and Brenner Children’s Hospital in the Triad also move to the access-level for plan members on Jan. 1.