Treasurer criticizes new Atrium affordability program ahead of State Health Plan open enrollment period
State Treasurer Brad Briner has publicly criticized a new Atrium Health program, which he called a “scheme,” saying it could cost taxpayers and State Health Plan (SHP) members hundreds of millions of dollars.
The program is “a new initiative designed to preserve access, patient choice and affordability for enrolled North Carolina State Health Plan members,” according to an Atrium Health press release. “Through the new program, enrolled members will have the lowest copays and lowest overall cost-share for care at any Atrium Health facility or provider — less than any other health system across North Carolina.”
Atrium Health’s Affordability Protection Program, announced Tuesday morning — less than a week before the SHP open enrollment period begins on Oct. 12 — would lower costs for SHP members receiving their healthcare from Atrium. Briner said that will come at the expense of taxpayers and SHP members at large.
Briner, the chair of the SHP board of trustees, told EdNC the program would make it “cheaper for you to show up at Atrium today, but much more expensive tomorrow in the form of premiums, cost-shares, and all the other things we’re going to have to do to keep the State Health Plan solid.” The SHP is a division of the Department of State Treasurer, and provides healthcare coverage to nearly 750,000 teachers, charter school employees, community college employees, other state employees, retirees, and their dependents.
“We are disappointed with the characterization that this program was designed to harm the financial stability of the Plan,” Atrium Health said in a statement emailed to EdNC. “The Atrium Health Affordability Protection Program’s sole purpose is to make healthcare more affordable for North Carolina’s dedicated public servants and their families.”
Atrium’s Tuesday announcement didn’t specify how the savings under the program will be facilitated, but Atrium’s emailed statement said, “In essence, Atrium Health is absorbing these additional costs so that NC State Health Plan members don’t have to.”
Briner is skeptical.
“What Atrium is proposing to do is design the State Health Plan to their own benefit,” he said. “Of course, we can’t let them or any provider do that.”
Briner and Thomas Friedman, executive administrator of the SHP, both said the Atrium program infringes on the SHP’s authority to set benefit rates, and that Atrium could face a legal challenge from the SHP.
Asked about a potential lawsuit, Atrium Health responded: “We also disagree with the assertion that offering discounts to NC State Health Plan members is somehow unlawful.”
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Tuesday’s announcement comes after a September agreement between the SHP and Atrium which added a dozen Atrium Health hospitals to the “access” tier of the SHP’s new tiered-provider structure — meaning prices at those hospitals would not increase. Atrium’s hospital network had previously been designated as “non-preferred,” meaning prices would have gone up.
Other health providers negotiated to be designated as “preferred” providers by offering lower prices to the SHP. Deductibles, out-of-pocket costs, and other expenses will decrease for members who choose to use providers in the preferred category starting in 2027. See a full explanation of the SHP’s new structure in the article below.
The announcement also follows the Wake County Board of Commissioners’ approval of a merger between the Raleigh-based WakeMed and Atrium, which Briner has said will lead to higher prices for SHP members.
“We would like to strike mutually beneficial agreements with our partners, and we’ve been very successful in doing that with (Novant Health) and (UNC Health) and others,” Briner said. “This is not a monolithic, all-hospitals-are-the-problem kind of thing. It’s one specific system.”
Details on Atrium’s new program
Atrium’s announcement says the program is a response to “the higher healthcare costs created for patients seeking care at Atrium Health by the NC State Health Plan’s new tiered provider structure.”
Those price increases are by design. The SHP’s tiered-provider structure incentivizes SHP members to shop for their care in an effort to lower overall plan costs.
UNC Health and Novant Health were among the providers designated as preferred at the July SHP meeting. At the time — before the September agreement added a dozen Atrium hospitals to the access tier — the SHP board also designated Atrium Health, Granville Health, and some Duke LifePoint Healthcare facilities as non-preferred providers.
Providers not in the preferred or non-preferred tiers (and that are not out-of-network) are designated as access providers. Members using access providers will pay roughly the same next year as they did this year for the same services.
Below, see a chart outlining the benefits for members receiving healthcare at preferred, access, and non-preferred providers starting in 2027.
“While we can’t control the tier designation assigned by the State Health Plan, we can take action to ensure our dedicated public servants across the state are not left to face the consequences of these decisions,” said Steve Smoot, president of Advocate Health’s North Carolina and Georgia Division, in the press release. Atrium Health is a part of Advocate Health.
Atrium’s website has a page devoted to educating SHP members on the new program.
The website gives examples of the kind of savings Atrium patients could receive:
Through the program, deductibles and coinsurance are waived and replaced by a copay commitment.
An enrolled member in the Standard Plan under the NC State Health Plan’s tiered structure receiving outpatient surgical care at a non-preferred facility would face a $1,000 copay, a deductible up to $5,000 for an individual and then 30% coinsurance. Under the new Atrium Health Affordability Protection Program, that cost would be reduced to a $400 copay — thousands of dollars less.
Another example is an enrolled NC State Health Plan member on the Standard Plan receiving inpatient care at one of Atrium Health’s urban hospitals under the non-preferred benefit would be responsible for a $1,500 copay, up to a $5,000 deductible and 30% coinsurance under the State Health Plan’s tiered provider structure. Under the new Atrium Health Affordability Protection Program, that cost would be reduced to a $500 copay.
— The Atrium Health website
SHP open enrollment period begins on Monday, Oct. 12
The Atrium announcement comes just ahead of the SHP’s open enrollment period, a fact stressed on Atrium’s website. During the open enrollment period, which lasts from Oct. 12 to Oct. 30, SHP members can choose a primary care provider.
“Members should review all open enrollment materials provided by the NC State Health Plan and carefully consider the coverage options that best meet their healthcare needs,” Atrium’s website says. “As you do, it is important to keep in mind that State Health Plan materials do not reflect Atrium Health’s new Affordability Protection Program or the impact it could have on their costs.”
Briner said Atrium announced the program with “no notice” and that the announcement is an attempt to “muddy the waters for open enrollment.”
In a conversation with EdNC, Briner addressed SHP members directly: “We’re sorry for the distraction. Please ignore what Atrium has said this morning. It will never come to pass.”
Read more of EdNC’s State Health Plan coverage
Education leaders quoted in Atrium announcement
Nearly a dozen leaders of school districts, community colleges, and other state organizations whose employees are served by the SHP were quoted in support of Atrium’s program in Tuesday’s announcement. Those quotes came before Briner’s public response.
“Atrium Health’s new Affordability Protection Program will allow our State Health Plan members to maintain provider patient relationships that are well established. This adjustment in response to the Plan’s tiered structure reflects an intentional focus on patient well-being and peace of mind. As an employer of thousands of state employees in a rural county, this move provides relief from a big unknown that has loomed over our community for months. Thank you, Atrium Health,” said Aaron Allen, superintendent of Lincoln County Schools.
“Access to quality healthcare is important for our employees and the families they serve. We appreciate efforts that help State Health Plan members maintain relationships with trusted healthcare providers while providing clarity as they make important enrollment decisions,” said John Kopicki, superintendent of Cabarrus County Schools.
“Teachers and school employees play a vital role in our community, and access to trusted healthcare providers helps them continue that important work. We appreciate efforts that help preserve continuity of care for State Health Plan members and their families,” said Heath Belcher, superintendent of Davie County Schools.
Spokespeople for Allen, Kopicki, and Belcher all told EdNC that they had no further comment following Briner’s public criticism on Tuesday.
Below is the full list of leaders quoted in support of Atrium’s program:
- Spencer B. Merriweather III, district attorney, NC Prosecutorial District 26
- Melissa Balknight, acting superintendent of Charlotte-Mecklenburg Schools
- Carol Spalding, president of Rowan-Cabarrus Community College
- John Kopicki, superintendent of Cabarrus County Schools
- Crystal Smith, human resources director for the town of Mount Pleasant
- Andrew Houlihan, superintendent of Union County Public Schools
- Aaron Allen, superintendent of Lincoln County Schools
- David Shockley, president of Surry Community College
- Jenny Varner, president of Davidson-Davie Community College
- Heath Belcher, superintendent of Davie County Schools
- Mike Rodgers, president of Wilkes Community College