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Fewer than half of the state's health care providers sign up as second deadline for State Health Plan contract passes

The second sign-up deadline for the controversial State Health Plan reimbursement contract came and went Monday with just one hospital agreeing to join during the 10-day period.

Only five out of 126 hospitals have signed the Clear Pricing Project contract backed by the SHP and state Treasurer Dale Folwell.

The initial sign-up period ended July 1. CaroMont Health of Gastonia signed July 22 and Catawba Valley Medical Center in Hickory during the second sign-up period.

Of 61,000 providers statewide, 27,000 have signed up.

Hospitals and medical providers that do not sign the contract could become out-of-network for more than 727,000 SHP participants starting Jan. 1. The plan is North Carolina’s largest purchaser of medical and pharmaceutical services at $3.2 billion in 2017.

Cone Health said July 1 it was rejecting the contract. Novant Health Inc. said it continues to review the contract. Wake Forest Baptist Medical Center said it will not discuss its plans.

Open enrollment for SHP participants begins Oct. 1. The SHP is expected to let participants know by open enrollment whether providers are in network or not.

Employers and health insurers negotiate rates that provide in-network discounts to individuals covered by an employer-based plan.

Without the negotiated discount, out-of-network costs can be significantly higher for most medical procedures. Some hospitals, including Cone, have encouraged SHP participants to consider signing up for their spouse’s or partner’s health insurance if it keeps them in-network.

"We would recommend, prior to open enrollment, that state employees consult with a licensed health insurance agent who is located in their county," said Hughes Waren, chairman of the N.C. Association of Health Underwriters' General Assembly action committee.

"This will help them understand the changes they may face with the State Health Plan and understand which individual insurance products are available in their area.

"Each region has individual plans with different in-network or preferred provider availability," Waren said.

As an enticement during the latest sign-up period, the SHP and Folwell raised reimbursement payments again.

UNC Health Care took a lead lobbying role with legislative leaders from both parties and Democratic Gov. Roy Cooper to get Folwell and the SHP to delay, if not halt, the contract roll out. Cooper’s office said it is reviewing the UNC Health Care proposal.

Folwell and UNC Health Care have held negotiations, including Monday.

UNC Health Care said Monday that while it has not agreed to sign the contract, “board members had a good discussion (with Folwell) and we expect to engage in additional discussions.”

“We have the same goal as Treasurer Folwell — improving the health of employees, and that is accomplished through the provision of a sustainable health plan, implemented in a transparent fashion.”

Charles Owen III, UNC Health Care's board chairman, said in a letter to Folwell that he suggests getting a mediator involved "as soon as possible."

Folwell took a less diplomatic stance on the current negotiations with UNC Health Care.

“Taxpayer-owned UNC Health Care has turned down a reasonable 100% profit and boycotts its own employees, and others, in favor of secret contracts and higher costs,” Folwell said.

“We can no longer be involved in activities that are designed to restrict competition and raise prices. We look forward to partnering with UNC Health Care when they are committed to the same.”

When asked about another deadline extension, Folwell said “deadline or no deadline, our responsibility is to figure out what we are spending $3 billion of taxpayer and employee money on.”

Cynthia Charles, communications director with N.C. Healthcare Association, said Monday that “we are not aware of any other hospitals having that level of discussions” as UNC Health Care.

“Decisions about whether or not to opt-in to the treasurer’s new offer remain up to individual hospitals and health systems.”

Folwell said he and the SHP have not received a firm counter-proposal from the NCHA.

Zagros Madjd-Sadjadi, an economics professor at Winston-Salem State University, said that “we are not going to see either side blink until much later in the year or perhaps even early next year.”

“This is a very high-stakes gamble by the treasurer and I predict that it will not end well if thousands of state employees find themselves out of network due to this.

“The hospital systems know this and are seeing how far they can push back,” Madjd-Sadjadi said. “Eventually, there will be a compromise, but the question is how bad the political damage will be.”

The Republican-controlled state legislature has given the treasurer the authority to decide on reimbursement cuts to hospitals and providers as part of a mandate to reduce overall SHP expenses.

House Bill 184, which would halt Folwell’s initiative for at least a year in favor of a legislative study report, cleared the state House by a 75-36 vote April 3.

It has yet to be acted upon in the Senate since being sent to the Rules and Operations committee April 4. Senate leader Phil Berger, R-Rockingham, has signaled he has no desire to address HB184.


Columnists
Profiles in (non) courage so far from members of Congress following mass shootings

No doubt it was going to be an exercise in futility — a total waste of time — but it needed to be done.

Another weekend in America had dawned with two more random mass shootings this time in Texas and Ohio. At least 30 dead and a few dozen wounded.

Sorrow, outrage and frustration followed quickly by another outcry for those with a real ability to do something went up and went limp.

To start that conversation, you’d have to know what members of Congress were saying, thinking or doing. For our purposes, that would be U.S. Reps. Virginia Foxx, R-5th; Ted Budd, R-13th; and a couple U.S. Sens., Richard Burr of Winston-Salem and Thom Tillis of Cornelius.

The answer, judging by online presence — the

only metric these days, it would seem: Not the first darned thing.

You expected something different?

Standard stuff

A sampling of what the honorables had posted Monday morning on their website “Newsrooms” — we use the terms “honorable” and “newsrooms” loosely — reads this way:

“Local Educators Participate in Foxx’s Teacher in Congress Internship,” Aug. 1.

“Rep. Budd Urges Germany to Designate All of Hezbollah as a Terrorist Organization,” July 29

“Senate Intel Chairman Burr Statement on Departure of Director Coats,” July 29.

Perhaps it was random luck of a scrolling feed, but Burr’s website opened with … a peaceful, idyllic forest. Blanketed with snow. It’s August. Out of touch much?

Tillis’ site opened with a montage of the senator literally shaking hands, kissing babies and holding a dog. He is a man of action, no doubt about it.

At least Tillis — or more accurately, the people he pays to monitor such things — updated his social media accounts with … wait for it … thoughts, prayers and gratitude for police, firefighters and EMTs.

“Susan and I are heartbroken by the horrific tragedies in El Paso and Dayton, acts of hate and domestic terrorism targeting our fellow Americans. Grateful to the first responders who helped save innocent lives,” Tillis tweeted and posted to Facebook.

Burr got into the act. With a Tweet, naturally, that didn’t say much. “The shootings in El Paso and Dayton are acts of pure evil. We mourn the lives tragically lost, and my prayers are with the victims, their families, and the first responders who rushed to help.”

Budd crept a little closer to actually saying something in his tweet.

“We have to do more to end these mass shootings. We must look for realistic solutions based on the facts of each individual case that will actually prevent these terrible acts of violence in the future. I look forward to working with my colleagues to do just that,” tweeted the owner of a gun store and shooting range.

Thoughts and prayers with no specifics. The standard stuff.

Meanwhile, what did you talk about in your homes, churches and workplaces Sunday and Monday? Anyone engage in any robust dinner table talks about Hezbollah, teachers in Congress or the minimum wage?

I didn’t think so.

In 2013, post-Sandy Hook. and again in 2015, the very day after 14 people were shot to death in San Bernardino for who-can-even-remember what, the Senate declined action on a bill that would tighten background check requirements for prospective gun buyers.

Reliable, scientific polling conducted by the Pew Research Center indicates that 84 percent of Americans support expanded background checks to include private firearms sales and purchases at gun shows.

It’s not that hard. And that’s just one thing. There’s plenty more we can debate if only elected leaders had the will.

Empty suits, no comments

Most days, I could not care less about members of Congress or what they do. I doubt you do, either.

But the fact of the matter is, outside of tax matters that pumped an extra $12.32 into the take-home, the actions of Budd, Foxx, Tillis et. al. affect my daily life very little. I’m too old to get drafted and trade deals might cause the price of sneakers to increase.

Most days, I’m far more concerned about what’s happening in my neighborhood. Local people — and the stories they tell — are far more interesting. I bet you think so, too.

It only takes four members of the Winston-Salem City Council to cost the average homeowner a few hundred bucks in property tax or kick up a ruckus by voting to change the name of the Dixie Classic Fair.

If you want to buttonhole the mayor or a council member, they’re easy to find. And they return phone calls and texts.

That’s just not true for our members of Congress.

Following President Trump’s comments suggesting that duly elected U.S. representatives should “go back to where they came from,” a colleague here tried to get a statement from Foxx, Budd and gang. After the weekend’s shooting, I reached out some, too.

Guess what came back?

Crickets, tumbleweeds, empty website searches and Tillis’ tweeted, regurgitated prayers. Those and a buck will get you a cold, soggy hamburger off the dollar menu.

You expected something different?


Crime
As death count rises in 2 shootings, a familiar aftermath

EL PASO, Texas Anguished families planned funerals in two U.S. cities, politicians pointed fingers and a nation numbed by gun violence wondered what might come next Monday as the death toll from two weekend mass shootings rose to 31.

The attacks 1,300 miles apart — at a packed shopping center in El Paso, Texas , and a popular nightlife stretch in Dayton, Ohio — also injured dozens more. They became the newest entries on an ever-growing list of mass shooting sites and spurred discussion

on where to lay the blame. President Donald Trump cited mental illness and video games but steered away from talk of curbing gun sales.

For all the back-to-back horror of innocent people slain amid everyday life, decades of an unmistakably American problem of gun violence ensured it wasn’t entirely shocking. Even as the familiar post-shooting rituals played out in both cities, others clung to life in hospitals, with two new fatalities recorded among those injured at the shooting at the Walmart in El Paso.

As in a litany of other shooting sites before, the public juggled stories of the goodness seen in lives cut short with inklings of the demented motives of the shooters, and on-scene heroics with troubling ideologies that may have sparked the bloodshed.

Equally familiar, Washington reacted along party lines, with Trump’s vague suggestion of openness to new gun laws met with skepticism by an opposition that has heard similar talk before.

“Hate has no place in America,” the president declared in a 10-minute speech from the White House Diplomatic Reception Room, condemning racism and rehashing national conversations on treatment for mental health, depiction of violence in the media, and discourse on the internet.

A racist screed authorities were working to confirm was left by the alleged perpetrator in the Texas shooting, 21-year-old Patrick Crusius, mirrored some of Trump’s anti-immigrant rhetoric. Some, like Ernesto Carrillo, whose brother-in-law Ivan Manzano was killed in the Walmart attack, said the president shares blame for inflammatory language Carrillo called a “campaign of terror.”

“His work as a generator of hate ended in this,” said Carrillo, who crossed the border from Ciudad Juárez on Monday for a meeting in El Paso with Mexico’s foreign minister. “Thanks to him, this is all happening.”

Trump, in turn, tweeted that the media “contributed greatly to the anger and rage that has built up.”

Trump suggested a bill to expand gun background checks could be combined with his long-sought effort to toughen the nation’s immigration system, but gave no rationale for the pairing. Studies have repeatedly shown immigrants have a lower level of criminality than those born in the U.S., both shooting suspects were citizens, and federal officials are investigating anti-immigrant bias as a potential motive in the Texas massacre.

Democratic Sen. Chris Murphy of Connecticut, a leading voice on gun reform since the 2012 shooting at Sandy Hook Elementary School in his state rattled the country with the slaughter of 20 children, immediately dismissed the president’s proposal as meaningless. “Tying background checks to immigration reform is a transparent play to do nothing,” he wrote on Twitter.

Whatever the political back-and-forth, or the re-energized presence of gun control talk on the presidential campaign trail, the very real consequences of gun violence were still being bared by victims badly injured in the two states.

In both incidents, a young white male was identified as the lone suspect. Though authorities were eyeing racism as a possible factor in Texas, where the alleged shooter has been booked on murder charges, in Ohio police said there was no indication of a similar motivation. Police in Dayton said they responded in about 30 seconds early Sunday and fatally shot 24-year-old Connor Betts. While the gunman was white and six of the nine killed were black, police said the quickness of the rampage made any discrimination in the shooting seem unlikely.

Betts’ sister was also among the dead.

“It seems to just defy believability he would shoot his own sister, but it’s also hard to believe that he didn’t recognize it was his sister, so we just don’t know,” said Dayton Police Chief Richard Biehl.

Ohio Gov. Mike DeWine visited the scene Sunday and said policymakers must consider: “Is there anything we can do in the future to make sure something like this does not happen?”

Hours later, hundreds of people stood at a vigil and vented their frustration at the Republican governor, interrupting him with chants of “Make a change!” and “Do something!” as he talked about the victims.

“People are angry, and they’re upset. They should be,” said Jennifer Alfrey, 24, of Middletown, who added that she didn’t agree with interrupting the vigil but understood why so many did.


Crime
A registered sex offender performed magic tricks at a Family Fun Night in Winston-Salem. That’s against state law.

A registered Rockingham County sex offender repeatedly violated state law by performing magic tricks for children and adults at a Winston-Salem restaurant, a Forsyth County prosecutor said in court Monday.

Kevin Daniel Pegram, 35, of Kimrake Lane in Madison, pleaded guilty in Forsyth Superior Court to 10 counts of being unlawfully on premises. At the time of the offenses, he was on post-supervised release and wearing an ankle bracelet, which authorities used to track his whereabouts, according to prosecutors.

Judge David Hall of Forsyth Superior Court consolidated the charges into four separate judgments as part of a plea arrangement. He ordered Pegram to serve a minimum of two years and eight months with a maximum of six years and four months in prison.

Pegram had previously been convicted on several charges of sexual exploitation of minors, indecent liberties and second-degree rape and was released from prison in 2015.

As a registered sex offender, Pegram is prohibited from going to places or living near places frequented by children, including schools and playgrounds.

Assistant District Attorney Lizmar Bosques said Pegram repeatedly violated that prohibition when he was performing as a magician under an alias during Family Fun Night at the Mario’s Pizza restaurant on Cloverdale Avenue.

He was doing the same thing in Greensboro, Bosques said. On Feb. 9, 2018, a Guilford County Sheriff’s detective contacted the Forsyth County Sheriff’s Office about Pegram. Det. Paulo Gargiulo of the Forsyth County Sheriff’s Office started investigating.

Gargiulo found that the Mario Pizza’s restaurant on Cloverdale held a Family Fun night every week and saw an advertisement for it that included information about a magician who went by the name of “Angelo Colletie.”

Gargiulo went to Family Fun night at the restaurant on Feb. 15, 2018, posing as a patron. He approached Pegram, who was using another alias, Kris Hoffman. Pegram told Gargiulo about his availability as a magician.

Bosques said that, eventually, Pegram was taken into custody by the Guilford County Sheriff’s Office, and Gargiulo interviewed Pegram about the allegations against him in Winston-Salem.

Pegram was on post-release supervision from the earlier charges and was required to wear an ankle bracelet. Gargiulo obtained GPS data from the ankle bracelet to determine the days when Pegram performed at Mario’s.

Chris Clifton, Pegram’s attorney, said Pegram was never alone with children and that there are no allegations that he abused any of the children at Mario’s. He asked Hall to accept the plea.

Indictments allege that Pegram performed at the restaurant from December 2017 through February 2018. He was not an employee at the restaurant, and a manager told investigators that the restaurant officials did not know anything about Pegram’s sex offender status.

Pegram pleaded guilty last year to one count of being a sex offender at or near child premises, Maury Hubbard III, a Guilford County prosecutor, has previously said. Other charges were dismissed because video showed that he performed s in the main dining room that was not exclusive to children.

The charge he pleaded guilty to involved allegations that he performed as a magician at a children’s tent for an event thrown by a law firm, Hubbard said.

In 2005, a Guilford County couple sued Ham’s restaurant, alleging that managers at the restaurant failed to screen Pegram. The couple said Pegram sexually assaulted their 12-year-old daughter repeatedly in a vehicle.

The lawsuit said Pegram performed as a magician at the restaurant. Pegram was accused of manipulating the girl into a relationship that included rape, abuse and assault. Pegram was criminally charged and later convicted.

Hall told Pegram that the crimes he pleaded guilty to are “abhorrent to the people of North Carolina.”

“Should you engage in this kind of conduct again, it is in the realm of possibility that you will spend the rest of your life in prison,” he said.


GCSO 

Pegram