North Carolina workers using the State Health Plan will pay more for care at WakeMed starting next year.
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WakeMed is a “non-preferred” provider under the health plan’s new ranking system, meaning most members using the health plan will pay higher out-of-pocket costs if they seek treatment there.
Health plan administrators asked healthcare systems to compete for State Health Plan contracts. It’s part of their strategy to lower costs for the plan and for members.
About 750,000 teachers, state employees, dependents and retirees are enrolled in the State Health Plan. Many live in Wake County, where WakeMed is the largest hospital system.
Not all WakeMed services will become more expensive, the state treasurer’s office said. Individual primary care providers associated with WakeMed will remain in the “preferred” tier, and WakeMed emergency room charges will not increase.
The treasurer’s office also announced Wednesday that Duke Health will be an “access” provider next year, meaning state employees’ out-of-pocket costs will remain about the same this year if they use Duke hospitals.
Many Duke OB-GYNs also deliver at WakeMed. The State Health Plan will figure out a plan for a “seamless” experience, the treasurer’s office said.
Premiums rise, but overall costs could fall for NC State Health Plan members under a new system
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“Serving State Health Plan members is both a privilege and a responsibility for Duke Health,” said Dr. David Zaas, Duke Health CEO. “Our priority is making sure State Health Plan members and their families can continue turning to Duke Health. We’re grateful to Treasurer Brad Briner and his team for working with us to reach an agreement that preserves access to Duke Health for the people who serve our state every day,” Zaas said in a statement.
UNC Health will be one of the insurance plan’s “preferred” providers. Members seeking care at UNC hospitals, including UNC Rex, could see reduced out-of-pocket healthcare costs next year.
Atrium, which is seeking to merge with WakeMed, is also a “non-prefered” provider.
Duke Health and the State Health Plan waged a heated and public battle over a new contract last year. Aetna, the insurance plan’s third-party administrator, and Duke Health fought down to the wire over the new contract.
“Duke’s outreach and bold plan caught the Plan by surprise given the previous CEO’s very public push for rate increases for SHP members but we believe it is a clear demonstration that competition brings out the best of us and when we align our interests we get the best deal for all stakeholders,” Tom Friedman, State Health Plan executive administrator, said in a statement.
“WakeMed is an excellent facility and we continue to value their services such as their emergency department and their OB platform (which they currently partner with Duke Health on). But given the savings to the Plan and the human impact we believe Duke Health is the right access partner for the State Health Plan.”
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