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

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.

In the news