Healthcare advocacy groups in North Carolina are expressing concern about a provider reimbursement strategy for the health plan for state workers.
The state will shift the North Carolina State Health Plan, administered by Blue Cross Blue Shield North Carolina, from a commercial-based payment model to a government pricing model based on a percentage of what Medicare pays, according to North Carolina Treasurer Dale Folwell.
The proposal, announced last month and slated to take effect Jan. 1, 2020, would apply to more than 727,000 teachers, current and former lawmakers, state and community college personnel and retirees and their dependents.
Mr. Folwell said the provider reimbursement initiative aims to lower healthcare costs by aligning the plan as a government payer.
"Medicare … provides a standard reimbursement measurement that is transparent and adjusts for provider differences. Reference-based pricing is intended to provide transparency in provider rates by indexing fees to a published schedule," he said.
While some medical providers will see their reimbursement cut under the initiative, he said many, including primary care physicians, critical access facilities and mental health practitioners, will see reimbursements increase.
Overall, the state expects the initiative will save the plan about $300 million and plan members more than $60 million.
But the North Carolina Healthcare Association and the North Carolina Medical Society have argued that the initiative will limit access to care for state employees and retirees.
North Carolina Healthcare Association President Steve Lawler also took issue with Mr. Folwell's assertion that providers would benefit financially from the initiative. He said that claim is not true "because government payers already reimburse well below the cost to provide care."
Robert Seligson, CEO of the North Carolina Medical Society, echoed Mr. Lawler.
"Over the past 40 years, unilateral rate cuts to physicians and health systems have not worked to achieve long-term savings," he told the Winston-Salem Journal. "Rather, rate cuts often result in reduced access to care for patients, particularly in rural areas, and jeopardize the financial stability of smaller physician practices and health systems."
Mr. Folwell has stood behind the initiative, and the state health plan board passed a resolution approving it Oct. 22.
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