With a June 30 deadline looming to sign a controversial State Health Plan provider contract, Novant Health Inc. and Cone Health said Monday they are reviewing the requirements.
State Treasurer Dale Folwell is attempting to move the SHP to a government pricing model tied to Medicare rates. The program is similar to those used in Montana and Oregon.
It would move the SHP away from a commercial-based payment model.
The SHP is the largest buyer of medical and pharmaceutical services in North Carolina, spending $3.2 billion in 2017. It represents more than 720,000 state employees and their dependents and non-Medicare retirees and their dependents.
On May 13, the SHP posted the contract that providers must sign to stay in-network for patients. The contract is scheduled to begin Jan. 1.
“Novant Health has not signed, but is continuing to evaluate the proposed State Health Plan contract,” Novant said in a statement. “At this time, State Health Plan members’ network status remains unchanged.
“It is our understanding that State Health Plan members will have an opportunity to verify provider’s network status after July 1 and before their open enrollment begins on Sept. 29.”
Cone Health said in a statement that “it is evaluating its options and will inform the state at the appropriate time.”
Wake Forest Baptist Medical Center could not be reached for comment on its status with the contract.
Folwell, the SHP and the N.C. Healthcare Association have been butting heads since Folwell unveiled his initiative in October. Each claims the other side has not been willing to engage in earnest negotiations.
Folwell’s proposal would allow the SHP on Jan. 1 to begin paying about 61,000 providers based on a percentage above current Medicare rates, along with an additional and adjustable profit margin.
Folwell said the SHP will provide increased reimbursement payments to most independent primary care physicians, behavioral health specialists and many rural hospitals.
The NCHA said Friday it would make available contract rates between providers and insurance companies to the SHP and Folwell if it would help resolve the dispute.
However, Folwell said Saturday the offer made by NCHA president Steve Lawler rings hollow to him and is just public posturing.
Folwell has expressed his frustration repeatedly, including during legislative committee meetings, about his inability to gain access to those contract rates from providers and insurers.
Folwell said May 13 that “we’ve had hundreds of requests for information and a lot of buzz around the new network. We’re confident that the state’s medical community will work with us to create this new network.”
The largest independent medical practice in Charlotte, Tryon Medical Partners, signed the new reimbursement contract May 23.
Tryon has nearly 90 board-certified physicians specializing in internal medicine and cardiology, endocrinology, dermatology, gastroenterology, pulmonary sleep and internal medicine subspecialties.
The group separated from Atrium Health’s Mecklenburg Medical Group in September. It has eight clinics in Mecklenburg County and serves more than 100,000 patients.
The SHP has 38,850 members in Mecklenburg.
On May 15, Rehabilitation Associates Networks signed the contract. It has been the largest network of independently private practitioners of physical and occupational therapy operating in the Carolinas since 1997.
On June 11, Raleigh Orthopaedic Clinic, the oldest orthopaedic practice in Wake County, signed the contract. It has 20 board certified and fellowship trained orthopaedic surgeons with clinics in Raleigh, Cary, Garner, and Holly Springs.
The treasurer has the authority to decide on reimbursement cuts, but legislation could take that away from Folwell.
House Bill 184, which would halt Folwell’s initiative 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.
The SHP plans to phase the rate changes in over a two-year period. First-year rates are projected to produce $196 million in savings, and another $62 million in year two.