North Carolina officials are suing hospital giant Atrium Health over what government leaders claim is an illegal effort to meddle in the State Health Plan\u2019s new pricing program. As a result, plan officials are extending the upcoming deadline for state employees to choose their coverage options.<\/p>\n
Open enrollment for the State Health Plan begins Monday. It will now end Nov. 6, the state said Friday. Meanwhile, the state is also asking for a judge to shut down Atrium\u2019s new plan before then.<\/p>\n
State Treasurer Brad Briner oversees the health plan, which provides insurance to more than 750,000 state workers, retirees and family members.\u00a0<\/p>\n
The lawsuit stems from the health plan\u2019s efforts to move to a preferred-provider tier system<\/a> that is intended to help it become more financially viable. Atrium stands to lose patients to competitors under that system.<\/p>\n Briner\u2019s lawsuit <\/a>claims that a new effort by Atrium to incentivize state employees to stay with Atrium providers, when the new system goes into place next year, \u201csingle-handedly threatened the stability and long-term viability of the Plan.\u201d\u00a0<\/p>\n An Atrium spokesperson said Friday they’re still reviewing the lawsuit but that, in general, they stand by their efforts to sidestep the higher prices the state wants to charge teachers and other state workers for using Atrium providers.<\/p>\n “We strongly disagree with the characterization that this program was intended to harm the financial stability of the State Health Plan,” an Atrium spokesperson told WRAL in a written statement. “Our focus has always been, and remains, serving patients and making care more affordable for North Carolina’s public servants and their families.”<\/p>\n The outcome of the legal battle could also affect patients of Raleigh-based WakeMed \u2014 which has entered an agreement to merge with Atrium \u2014 if that merger goes through<\/a>. The deal is currently being reviewed by state and federal regulators.\u00a0<\/p>\n \u00a0 Briner has been an outspoken critic of Charlotte-based Atrium\u2019s effort to absorb WakeMed, which operates three hospitals and dozens more doctors\u2019 offices around Wake County, although the lawsuit doesn\u2019t address that merger. WakeMed and Atrium haven\u2019t officially merged yet, but the deal recently cleared a major hurdle when the Wake County Commissioners voted to back it<\/a>.\u00a0\u00a0<\/p>\n \t\t\t\t\t\t\t\t\t\t\u00a9 WRAL<\/p>\n Atrium is part of one of the biggest hospital chains in the nation. WakeMed is the smallest of three major Triangle-area providers and says it needs Atrium\u2019s financial backing to advance ambitious expansion plans.<\/p>\n \t\t\t\t\t\t\tWinners and losers in new tier system<\/p>\n The new health-pricing strategy, championed by Briner, seeks to drive State Health Plan members away from WakeMed and Atrium, by charging them higher prices to use those companies\u2019 doctors but offering discounts at competing providers, including state-backed UNC Health.<\/p>\n Earlier this year, the State Health Plan approved that new concept for pricing.\u00a0It divided healthcare providers including hospitals between new tiers called \u201cpreferred,\u201d \u201caccess\u201d and \u201cnon-preferred.\u201d Members of the health plan who go to doctors at \u201caccess\u201d providers will see their bills stay roughly the same as they have been. But going to \u201cpreferred\u201d providers will earn members a discount, while members who go to \u201cnon-preferred\u201d providers will be charged more.<\/p>\n Atrium and WakeMed were both put into the \u201cnon-preferred\u201d tier by the State Health Plan earlier this summer, after Briner and other plan leaders voted to approve the changes. UNC Health and Novant Health are the state\u2019s \u201cpreferred\u201d providers. Briner said at the time the decision had nothing to do with his personal criticism<\/a> of the proposed Atrium-WakeMed merger, and everything to do with other hospitals offering better rates<\/a> for the state.<\/p>\n The idea is to steer the health plan\u2019s hundreds of thousands of patients into healthcare chains that have agreed to charge the state lower rates, in part by using the threat of higher bills to convince people not to go to providers who didn\u2019t agree to lower their rates.<\/p>\n Cristy Page, CEO of UNC Health, said Friday that her hospitals and other doctors offices are preparing for an influx of new patients next year when the new tier system starts and names UNC as a preferred option. \u201cWe are working hard behind the scenes to ensure all patients receive the same excellent care at every UNC Health location and close to home,” she said in a news release.<\/p>\n Members of the health plan could save thousands of dollars a year, or pay thousands of dollars more, depending on which doctors they decide to use.<\/p>\n The changes go into effect next year, after the current open enrollment period ends. But Atrium has recently thrown a wrench into the State Health Plan\u2019s plans, rolling out a new strategy it calls its \u201cAffordability Protection Program.\u201d<\/p>\n