Standing up for healthier communities

Ensuring and protecting access to healthcare

The State Health Plan

Proposed changes to the State Health Plan will limit access to healthcare not just for state employees and teachers but for entire communities. There is a better way.

The background

State Health Plan
serves 720,000+

The State Health Plan (SHP) covers more than 720,000 members, including teachers, state government employees, retirees, current and former lawmakers, state university and community college personnel, and their dependents.

The plan spent $3.3 billion in each of the past two fiscal years (2016–17, 2017–18) on medical claims, pharmacy claims, Medicare Advantage premiums and administrative costs. Health Plan leaders say inflation, high-cost claimants and specialty drugs are the big cost drivers.

The challenge

New model puts
availability at risk

million

Estimated yearly cost to hospitals and providers if proposed changes are adopted

The State Treasurer, who oversees the State Health Plan, proposes cutting costs by tying healthcare provider rates to Medicare rates. This approach will jeopardize the availability of critical healthcare services and trusted providers for SHP member and millions more North Carolinians.

The better path

Value-based care
lowers costs

The recent shift toward paying healthcare providers based on patients’ health outcomes rather than the traditional fee-for-service structure is reaping dividends: improved health and lower costs.

Value-based care is consistent with best practices for most health plans, including those in North Carolina. The federal government, which uses this approach for Medicare, has realized significant savings and, more importantly, improved patient health.

Inside the issue

Even though his own staff recommended adopting value-based care for the State Health Plan, the Treasurer has refused to discuss this option. Across our state, value-based care programs are demonstrating that focusing on improving health outcomes is an effective way to control healthcare costs and improve population health. Check out the stories below and visit our YouTube channel to learn more about how hospitals and health systems are putting value-based care to work for North Carolina.

Chronic disease is the most common reason for preventable emergency departments visits and hospital readmissions. Through a partnership with local EMS, Johnston Health is helping patients with chronic obstructive pulmonary disease (COPD) stay healthy at home.

Value-based care models are designed with patients in mind – focusing on the end result, which is improved health. The Transition Care Clinic, operated by FirstHealth in Moore County, is helping patients like John avoid costly hospital readmissions by teaching him to take charge of his health.

In its first year of operation, an employee health clinic operated by Vidant Health helped the City of Greenville save more than $140,000 in healthcare costs. The value-based care offered through this partnership offers employees and families quality healthcare with no co-pays to incentivize care for minor illnesses and injuries before they become costly problems.

million saved

By Coastal Plains Network, LLC,
in 2017

million saved

By Triad HealthCare Network
in 2016

million saved

By Duke Health’s Accountable Care Organization in 2017

Voices for health

Why is the Treasurer proposing a model for the State Health Plan that doesn’t improve health and reduces access to healthcare services for plan members and others in their communities? Healthcare providers, community leaders and elected officials are asking that very question.

We cannot fix the problems with health care with a shock-and-awe model. We need to take baby steps and work collaboratively.

Rep. Donna White – NC House District 26 (Johnston County)

…like most employers, any decision the school system makes for our teachers and staff keeps these valued employees at the center. We carefully study and engage in conversations with experts before moving forward. I believe all state employees deserve this kind of consideration and urge North Carolina elected officials to take the time to thoughtfully consider and study any changes made to the State Health Plan.

Lynn Moody – Superintendent, Rowan-Salisbury Schools

It is poor governance to allow decisions of such magnitude to be made in a vacuum, and without consideration of the unintended, negative consequences.

Sen. Jim Perry – NC Senate District 7 (Lenoir and Wayne counties)

Rural hospitals are on the margins. There would be some that would stand to lose in this, and I’ve made no secret that part of my role down here that I see is to protect rural health care.

Rep. Josh Dobson – NC House District 85 (Avery, McDowell and Mitchell counties)

When I think of the impact this will have on our community and our (hospital) staff, I see community members threatened medically due to loss of services and see the livelihood of our staff threatened.

Judy Bruno – President, Vidant Roanoke-Chowan Hospital

I think it’s a myopic approach that has been taken. At the end of the day, I think it would be an enormous benefit if cooler minds ask to take a step back and look at it from a greater approach of how do we deliver health care and bring in stakeholders to this process so we can have a more comprehensive approach.

Sen. Don Davis – NC Senate District 5 (Pitt and Greene counties)

There will need to be some compromise and I am still gathering as much information as I can to be a better informed legislator. This will help me make the best decision possible for our region, the taxpayers and the businesses that have made a significant investment in our rural communities.

Rep. Chris Humphrey – NC House District 12 (Lenoir and Pitt counties)

We want a plan that we’re involved in creating — not a plan that is imposed upon us that we have to respond to. We want a collaborative resolution that supports our communities in a sustainable way.

Rev. Richard Joyner – Rocky Mount City Council member

…the approach that is being put forth by the state treasurer really seeks only to sort of change unit pricing. It has no long-term impact on the underlying driver of escalating costs, which is poor health status…
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Terry Akin – CEO, Cone Health

We have a large number of state employees in Burke County who rely on our services, and we’re concerned this plan will give them less options. In the everchanging healthcare landscape, sustaining the quality and availability of healthcare provided to this community is our number one goal.

Kathy Bailey – President and CEO, Carolinas HealthCare System Blue Ridge

The treasurer, he needs to take time to come to eastern North Carolina and spend time here and get to know the issue before he makes a decision. We need to recognize and no longer sit home and complain.

Rev. Roy Gray – Pastor at City Hill Missionary Baptist Church, Williamston, N.C.

Improving the health of the communities where we live and work is the collective mission of North Carolina’s hospitals and health systems. Creating a stronger, more sustainable state health plan is an important task that requires engagement from all parties involved.
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Steve Lawler – President, NCHA

Health systems have a duty to care for every patient. As an elected official, the treasurer has a duty to serve every citizen of North Carolina. If his proposal is enacted, it will compromise our ability to provide essential services — and people who live in rural markets will be impacted most.