The State Health Plan (Plan) and Atrium Health are announcing a new partnership to provide affordable healthcare access for North Carolinians to important services, including rural care, children's hospitals, primary care, emergency care, behavioral health services and specialty care for patients with complex medical needs. Twelve Atrium Health hospitals and associated clinics will be added to the Access-level for Plan members starting Jan. 1, 2027. This will help provide greater certainty for members and preserve access to key medical services — while supporting efforts to keep coverage affordable for teachers, state employees and their families.
All members using a primary care provider with Atrium Health will be able to continue that care at no change in cost or benefit. The same applies for behavioral health office visits, and most importantly, for emergencies. If a member has an emergency, members should always go to the nearest emergency department, and the entire care event will be covered at the same benefit members currently have today.
This agreement means when Plan members visit Atrium Health rural hospitals in Alleghany, Anson, Cleveland (Shelby and Kings Mountain), Columbus, Lincoln, Scotland, Stanly or Wilkes Counties (including Hugh Chatham Health), their benefit will be almost identical to the benefit they have this year for out of pocket and deductible costs. The agreement also moves Levine Children’s Hospital in Charlotte, Jeff Gordon Children’s Hospital in Concord and Brenner Children’s Hospital in the Triad area into the Access-level for Plan members.
See which tier hospitals are assigned at this link.
“Our objective has always been clear and consistent — we must offer our members high-quality care for affordable prices,” said Treasurer Brad Briner. “For the Plan, that must include reduced prices from providers as compared to what they are charging today. This agreement includes meaningful affordability commitments from Atrium Health that help us improve access for members while supporting the long-term sustainability of the Plan. This new provider tier system, which has now forged partnerships with all of the state’s leading hospital systems, is putting us on the right path.”
Briner continued, “Atrium Health is nationally recognized for its patient-centric care leveraging clinical research and education which gives North Carolinians access to cutting-edge expertise and care, and I am grateful for to their leadership for presenting multiple proposals for consideration to the Plan. The addition of a dozen of their hospitals will give our members an affordable choice to take advantage of this expertise.”
The new agreement addresses the fact that in many cases, highly complex care can only be provided locally and patients needing treatment for cancer, cystic fibrosis, unique heart and transplant care will still have access to the advanced clinical care available at Atrium Health. Similarly, pregnant members will not be asked to change their obstetrics or delivery plans for 2027. Members who qualify for these situations will receive notification from the Plan. With this new partnership, both entities will continue to work together on refining this list and granting benefit exceptions to members, which will be posted prior to open enrollment.
"We recognize many State Health Plan members have been concerned about what these changes could mean for them and their families,” said Michael Parkerson, EVP and chief managed health officer for Advocate Health, which Atrium Health is a part. “This agreement provides greater clarity and preserves access to important services, including primary care, emergency care, behavioral health services, rural care, children's hospitals and continuity of care for patients with complex medical needs. We appreciate the collaborative work that made this agreement possible and look forward to continuing discussions about how we can continue to improve access, quality and affordability for North Carolinians in the future."
Atrium Health and the Plan have been engaged in constructive discussions since mid-July, with both organizations focused on preserving access to care for members while addressing affordability concerns. This agreement reflects the commitment of both parties to find common ground and provide clarity for members ahead of open enrollment. During this negotiation, the Plan also clarified any confusion that prior to the launch of the Preferred Provider tiering, Atrium Health was no more expensive than other leading health systems in North Carolina.
With this new agreement, there is now participation from all of the state's major healthcare systems in the Plan's tiered network strategy, helping provide members with clear coverage options while supporting the Plan's long-term sustainability.
The Plan expresses its appreciation to state leaders at the legislative level that have remained involved throughout this process. Many elected officials have been highly involved in direct conversations with the SHP to both communicate the changes and help focus efforts for rural communities. The Plan is thankful to lawmakers who have hosted meetings in their districts with the State Health Plan team and gave us room to negotiate. The Plan looks forward to future visits to directly answer questions from members.
The current goal for the Plan and Atrium Health is to continue conversations for future opportunities to work together to provide the best care for its members.
About the State Health Plan:
The State Health Plan, a division of the Department of State Treasurer, provides healthcare coverage to nearly 750,000 teachers, state employees, retirees, current and former lawmakers, state university and community college personnel, and their dependents.
About Atrium Health:
Atrium Health is advancing clinical care and research across the communities it serves by redefining care for all. The care network is anchored by Atrium Health Carolinas Medical Center, an academic medical center ranked No. 1 in Charlotte by U.S. News and World Report, that includes Levine Children’s Hospital, Levine Cancer Institute and Sanger Heart & Vascular Institute, along with 11 hospitals, more than 900 care locations and over 1,400 physicians serving communities across the greater Charlotte region. With 10 “A” ratings by Leapfrog, Atrium Health earned the most top patient safety grades of any health system in North Carolina. It is part of Charlotte, North Carolina-based Advocate Health, the third-largest nonprofit, integrated health system in the United States. Advocate Health is a preeminent academic health system at the forefront of clinical excellence, innovation and research, with Wake Forest University School of Medicine serving as its academic core. Nationally recognized for expertise in heart and vascular, neurosciences, oncology, pediatrics and rehabilitation, Advocate Health is also a pioneer in the delivery of virtual healthcare. It’s accelerating discovery by making research participation part of the standard-of-care through its one-of-a-kind National Center for Clinical Trials. Advocate Health has one of the nation’s largest graduate medical education programs, with an experiential learning focus and specialized residencies to help protect the long-term sustainability of rural health care in America. Each campus of the school of medicine has an affiliated life-sciences focused innovation district: The Pearl, in Charlotte, and Innovation Quarter, in Winston-Salem, North Carolina. With more than 165,000 teammates serving patients at 69 hospitals and over 1,000 care locations across eight states, Advocate Health reinvests over $6 billion each year to improve community health, making it one of the nation’s largest providers of community benefit.