Atrium Health Reaches Deal With North Carolina State Health Plan
Atrium Health and North Carolina's public health insurance plan have reached a deal, ending a dispute over inclusion in a tiered network. The agreement improves access and reduces costs for members.
Original reporting · fiercehealthcare.com
Original: “Atrium Health, NC State Health Plan reach deal in preferred provider network dispute”
Read “Atrium Health, NC State Health Plan reach deal in preferred provider network dispute” at Fierce Healthcare →
How this was written. Diagnosis Forward wrote this article with a language model from Fierce Healthcare’s reporting (model: @cf/meta/llama-3.3-70b-instruct-fp8-fast); it describes that reporting rather than adding to it. The original, linked above, is the full story.
Key points from Fierce Healthcare’s report
- Atrium Health and the North Carolina State Health Plan have reached a deal, ending a dispute over inclusion in a tiered network.
- The agreement adds Atrium's hospitals to the Preferred Provider Program's in-network Access tier, improving access and reducing costs for members.
- The state health plan had implemented a Preferred Provider Program to reduce costs, but Atrium's facilities and providers were not included in the preferred tier.
- Atrium will sunset its Affordability Protection Program, and the state will withdraw its outstanding legal complaint.
- The agreement provides clarity for members during the open enrollment period and reduces the plan's overall spending.
Atrium Health and the North Carolina State Health Plan have come to terms on a dispute over inclusion in a tiered network, according to Fierce Healthcare. The pair announced a new multi-year contract, which followed months of negotiation and a trip to the courtroom. The deal was reached just a week before the close of open enrollment for the North Carolina State Health Plan.
The dispute began when the state health plan implemented a Preferred Provider Program, which reduced members' copays if they received care from lower-cost providers. Most of Atrium's facilities and providers did not receive a preferred tier, leading the health system to unveil an Affordability Protection Program. The program would have charged plan members smaller copays, but the state tried to block it, citing concerns that it would shift costs back to the plan.
The state health plan has 750,000 members and had recently implemented the Preferred Provider Program to reduce costs. Atrium's facilities and providers were not included in the preferred tier, which led to the dispute. The health system's Affordability Protection Program was seen as a response to the state's program, but the state alleged that it was unlawful and would bankrupt the plan.
A judge had previously rejected the state's request to block Atrium's Affordability Protection Program, allowing it to go into effect during the open enrollment period. The state had argued that the program would cause irreparable harm to the plan, but the judge denied the request. The state is still exploring other legal pathways and weighing how to maintain solvency through 2027 and beyond.
The new agreement adds Atrium's hospitals to the Preferred Provider Program's in-network Access tier, improving access and reducing costs for members. The parties said the decision will reduce the plan's overall spending while still providing high-quality care. Atrium will sunset its Affordability Protection Program, and the state will withdraw its outstanding legal complaint.
The agreement provides clarity for members during the open enrollment period, which is currently underway. The state health plan's treasurer, Brad Briner, said that the agreement provides members with more clarity about provider tiers and puts concerns to rest. Atrium's president, Steve Smoot, said that the agreement is about providing peace of mind for members who trust Atrium with their care.
The dispute had been simmering for months, with both sides exchanging barbs and allegations. The state had alleged that Atrium's program was unlawful and would bankrupt the plan, while Atrium had argued that it was necessary to address affordability concerns. The agreement brings an end to the dispute and provides a new framework for the relationship between Atrium and the state health plan.
Questions and answers
What was the dispute between Atrium Health and the North Carolina State Health Plan about?
The dispute was over inclusion in a tiered network and an alternative pricing program that Atrium had planned to implement in response to the state's Preferred Provider Program.
What is the outcome of the dispute?
Atrium Health and the North Carolina State Health Plan have reached a deal, which adds Atrium's hospitals to the Preferred Provider Program's in-network Access tier and improves access and reduces costs for members.
What happens to Atrium's Affordability Protection Program?
Atrium will sunset its Affordability Protection Program as part of the agreement, and the state will withdraw its outstanding legal complaint.
