Update on State Employee Health Plan Changes

With the General Assembly temporarily in session to take up issues like voter ID and hurricane relief, there has also been a rich discussion behind the scenes about changes to the State Employee Health Plan (SHP).

State Treasurer Dale Folwell has said the plan will reimburse providers through reference-based pricing beginning in 2020. Based on feedback from our North Carolina Medical Society (NCMS) members, the move will have different impacts depending on your specialty. Some primary care practitioners will see a significant increase in reimbursement, while surgical specialties likely will see a decrease. The North Carolina Healthcare Association (NCHA), formerly the NC Hospital Association, has vehemently and vocally opposed the Treasurer’s method to get the State Health Plan out of the red since the NCHA maintains that such a change would be uniformly detrimental to hospitals, especially those in rural areas.

Legislators seem squeamish about getting involved in the debate, having given authority over the SHP to the Treasurer eight years ago, but several have some hesitation about the Treasurer’s plan. Reps. Josh Dobson (R-McDowell), Donny Lambeth (R-Forsyth) and Greg Murphy, MD (R-Pitt) have expressed concerns about a move to reference-based pricing and have suggested studying the impact of such a change before implementing it.

NCMS government affairs staff urge you to contact your legislator and explain how such a move will affect your practice – for better or worse.

The NCMS’ position has long been focused on a many faceted approach to transforming our health care system centered on improving health for a community or a defined population like those in the SHP. Rather than simply shifting reimbursement strategy, placing the emphasis on health outcomes will have a long term, lasting effect on health costs.

Watch our legislative update from Dec. 7 to learn more about these discussions at the General Assembly. Watch now.

Thank you to those NCMS members who participated in our recent Snapshot Survey on the topic of reference-based pricing and the SHP. Results show the majority of respondents feel that reference pricing is not a valid strategy to contain health care costs. A majority also agreed, however, that reference pricing brings transparency to what is currently an opaque process of reimbursement.

Watch your Bulletin for future updates on this developing issue.

 
 

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