Action 9

Atrium, Novant will be in network for state health plan members next year

CHARLOTTE, N.C. — Blue Cross Blue Shield has been negotiating a new plan with hospital systems like Atrium Health and Novant Health because the state health plan could run out of money by 2023.

Atrium and Novant had until midnight Monday to settle the negotiations but missed the deadline after an agreement could not be reached.

On Thursday, Channel 9 learned that Atrium and Novant will be in network for state health plan members next year.

The state treasurer’s office said Blue Cross and Blue Shield and the two major health care systems agreed to extend their current relationship until the end of 2020.

Plus, 28,000 other providers signed on to the new state health plan -- the one Atrium and Novant didn’t agree to.

Action 9's Jason Stoogenke sat down with North Carolina Treasurer Dale Folwell last week to discuss a plan.

Folwell runs the state health plan and uses Blue Cross Blue Shield to administer it.

Because Atrium and Novant did not agree to the new plan, members could have had to pay out-of-network charges for any of those facilities or doctors come January.

"(Do) you think that one way or another, by Jan. 1, folks in our area will be able to go to Atrium or Novant and pay in-network prices?" Stoogenke asked Folwell.

"Absolutely," Folwell said.

Stoogenke asked, "How can you be so sure?"

"Well, because that’s my duty is to make sure that we have accessible, affordable health care for state employees and retirees," Folwell said.

Folwell told Stoogenke he was confident they would have a deal at some point before the plan goes into effect Jan 1.

Folwell's plan is based on how much Medicare would reimburse doctors for procedures.

He was offering for the state to reimburse Atrium and Novant more than the Medicare rate -- 182% of the Medicare rate.  Now, he's offering almost double the Medicare rate -- 196%.

Atrium has said it's hopeful it can find a "reasonable and cost-conscious solution."  Novant said it believes changes to the state health plan are necessary but doesn't think the current proposal is "the best solution."

When asked if the state will extend the deadline, Folwell said, "We're not extending the deadline at this time. We have a loyalty and duty of care to our participants, to our members."

Action 9 reached out to Atrium and Novant Tuesday morning after the missed deadline.

Novant said that it will continue to work with the treasurer to come up with a plan that "improves the health of state employees while addressing costs and increasing transparency."

Atrium sent the following statement: 

“Atrium Health remains committed to caring for our patients and the relationships they have established with their doctors, while also protecting their access to high quality care close to home. We hope the State Treasurer and the State Health Plan will be open to collaboration to find a reasonable and cost-conscious solution that benefits all residents of North Carolina.”

Deborah Johnson retired from teaching after 30 years and is still on the state health plan.

"We are all sitting on pins and needles thinking, 'Do we have health insurance?'" she told Action 9. "Who can handle that in a budget and handle it by January of 2020? That's the scary part."

Kathleen Zwally and her husband are teachers and are on the state health plan.

[Blue Cross insurers in N Carolina, Oregon to mix leadership]

"For us, basically, being out-of-network makes us feel that we're not insured," Zwally said.

Teacher Robb Neumann said: "What I understand is, they’re just waiting for hospitals to blink, but who are they playing with? They’re playing chicken with my pocketbook, my life and that’s just not right."

"(Hospitals) would stand to lose tens of millions of dollars for their operations," said Cynthia Charles, spokeswoman for the North Carolina Healthcare Association spokesperson. "So, they have concerns that this would cause a potential impact to their ability to offer comprehensive services to patients and communities."

N.C. Treasurer's Office emailed Action 9 Wednesday:

"Secret contracts and high medical costs are the problems we are trying to solve. We are very aware that our members need additional hospitals for the Plan to have coverage.

“That is why we increased reimbursement rates to double Medicare and have reopened the sign-up period until midnight Monday, August 5. We urge hospitals to sign up and not to boycott state employees and taxpayers like them who fund the Plan."

Novant Health statement on its website:

"At Novant Health, our top priority is our commitment to our patients. Every decision is made with the patient at the center. In 2018 alone, we cared for 60,000 valued teachers and other state employees, retirees and their dependents – they deserve better than the proposed changes to the state health plan.  We believe that changes to the state health plan are necessary, however, the current proposed plan is not the best solution. This plan demands rate reductions that cut from the wrong places and does nothing to improve the health of patients or lower the cost of care.

"Novant Health asked for an opportunity to collaborate with the treasurer’s office in order to thoughtfully design a solution that cuts costs while also improving health. Our requests were denied, and Novant Health did not sign the contract by July 1. We understand there is a new proposal, which we are independently evaluating.  Rate cuts alone do not equate to better health.

"The current proposed plan ignores proven models to improve health while lowering costs. While we did not sign the initial proposed plan, we remain open to having conversations with the state treasurer’s office to determine the best path forward for state employees.

"Novant Health is in favor of reducing costs and improving outcomes – which we’ve proven we can do as we move to value-based care – where the incentive is to get people well and keep them healthy. Last year, Novant Health saved over $26 million through one of its value-based employee health programs, improving the health of more than 80,000 lives.

"We are currently managing over 450,000 lives in various value-based arrangements – but not the state health plan. We stand ready to help any employer, including the state of North Carolina, achieve similar results."

Atrium Health statement to Action 9 Wednesday:

"We are reviewing the newly proposed rates for the state health plan. Atrium Health is committed to caring for our patients and the relationships they have established with their doctors, while also protecting their access to high-quality care close to home. We remain hopeful that we can collaborate with the N.C. state health plan to find a reasonable and cost-conscious solution that benefits all residents of North Carolina."

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