Atrium Health to Leave State Health Plan Network

North Carolina Treasurer Brad Briner announced on Thursday that most hospitals and doctors' offices under Atrium Health will be removed from the State Health Plan network beginning next year. This move intensifies an ongoing dispute related to healthcare pricing between Atrium Health and the State Health Plan.

Background: State Health Plan and Its Reach

The North Carolina State Health Plan serves over 750,000 individuals, including state employees, retirees, and their families. Atrium Health, as the state's largest healthcare system, operates hospitals and physician offices in cities like Charlotte and Winston-Salem, and is also aiming to expand into the Triangle region through a proposed merger with WakeMed, a Raleigh-based hospital system.

Conflict Over Healthcare Pricing and Network Providers

The dispute comes amid Treasurer Briner's efforts to address a large health plan deficit, reportedly in the hundreds of millions of dollars. Briner has responded by introducing a tiered provider system for the State Health Plan. Under this system, members get discounts when using providers who offer lower prices to the state, but pay more if they choose providers—like Atrium Health—with higher prices.

This change means that Atrium Health, as a higher-priced provider, would have patients facing increased out-of-pocket costs starting next year unless they switch providers.

Atrium Health's Response and Legal Action

In response to the tiered pricing system, Atrium Health announced a new program last week that would pay the cost difference itself for affected State Health Plan members. This was intended to prevent patients from leaving for competing providers.

Treasurer Briner opposed this strategy, filing a lawsuit on the grounds that it was illegal interference with the State Health Plan. The court, however, initially sided with Atrium Health, denying Briner's challenge. Following the court's decision, Briner announced on Wednesday that the health plan would proceed to take Atrium Health out of network entirely.

Impact on State Employees and Future Health Insurance Coverage

Briner emphasized that State Health Plan members should not experience direct disruptions to their health insurance coverage, contingent on Atrium Health's continued willingness to cover extra costs for patients.

“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,” Briner said in a written statement. “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.”

Ongoing Developments in the Atrium-WakeMed Merger

This decision comes as Atrium Health seeks to merge with WakeMed and expand further into the Triangle area, a development that has also prompted calls from state employees for public hearings. The story continues to develop as both parties navigate the evolving landscape of network providers and state health plan management.

This is a developing story. Check back for updates.

Source: wral.com.