Deadline passed, but standoff continues between hospitals, State Health Plan
Just three hospitals in the state have signed on to a revamped State Health Plan to provide cheaper health care for hundreds of thousands of state employees, teachers and retirees.
Posted — UpdatedSo what now?
"Stay tuned," said State Treasurer Dale Folwell, who is pushing the change to save taxpayers and state employees hundreds of millions of dollars on health care.
“We’re still a long way off from a panic-button scenario," said Robert Broome, executive director of the State Employees Association of North Carolina, which backed Folwell's play and joined him in a standoff against hospitals across the state.
The State Health Plan is the largest purchaser of health services in North Carolina, covering more than 700,000 state employees, retirees, teachers and their dependents in a self-funded plan paid for, in part, by taxpayers. Folwell wants to cut costs by ending a long-standing practice of negotiating deals in secret with hospitals and instead paying for health care by setting standard rates for services.
He'd pin those rates to what Medicare pays, adding an average of 82 percent.
The deadline for hospitals and other providers to sign the new contract was supposed to be Monday. It's not unusual for hospitals and insurance providers to fight over contracts – or for those fights to bust through deadlines. The July 1 deadline was essentially an arbitrary one, but both sides are dug in.
Folwell referred to the state's hospitals this week as "a cartel." A spokeswoman for the North Carolina Healthcare Association, the hospitals' lobbying group, called Folwell's health plan a "pricing scheme."
The current State Health Plan has deals with some 65,000 providers. Folwell said this week that the new one got agreements from about 25,000 of them, including three hospitals.
"As Randolph Health continues work to secure a partner, we aren’t in a position to decline anything that is advantageous for the citizens of Randolph County and for Randolph Health," a hospital spokesperson said in a statement. "While participating in the State Health Plan has a positive impact on our organization, our focus continues to be on securing a partner to ensure this community has access to local, high-quality health care."
If nothing changes, hospitals and doctor groups that didn't sign on would be out-of-network for state employees and others on the State Health Plan come next year, either increasing out-of-pocket costs for plan members or reducing their access to care.
The money was refunded, and UNC Health called the payment an "administrative oversight" after the station asked questions. SEANC's Broome called the explanation ludicrous.
UNC Health that submitted a counter-proposal to Folwell's "Clear Pricing Project" late last week, sending the Treasurer's Office a five-page outline for its preferred plan and sharing it with Gov. Roy Cooper's office and legislative leaders as well. Cooper has been largely on the sidelines, at least publicly, in this fight, but his spokesman said this week that Folwell's "plan requires more study and negotiation, and more time is needed to do that," signaling hopes for a delay.
Folwell, in the Winston-Salem Journal, called UNC Health's counter-proposal “a silly back-to-the-future strategy that was presented to the previous treasurer and State Health Plan administration over three years ago and was rejected because of its lack of transparency and no concrete, measurable savings to the plan.”
A UNC Health spokesman said the plan "achieves many of the principles" Folwell has outlined and that it expected the ideas in it to be "broadly welcomed" by other hospitals. The spokesman said this week that, not only did the hospital system not sign Folwell's new contract, but that it would not.
• Credits
Copyright 2024 by Capitol Broadcasting Company. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.