Duke Health and Aetna announced on Friday that they have reached a new multi-year agreement, avoiding the need for state employees on the State Health Plan and others to look for another in-network health care provider.
Duke Health originally stated that unless Aetna raised its reimbursement rates by an Oct. 20 deadline, many patients would lose in-network coverage for Duke’s doctors, hospitals, clinics, and services, including over 750,000 state employees covered under the State Health Plan, as well as others, with a total of 1.5 million North Carolinians.
Duke Health said in a recent emailed statement to Carolina Journal that they were asking for a modest increase below inflation.
“Despite escalating costs in pharmaceuticals, supplies, and labor, Duke Health has not received a rate adjustment from Aetna in four years, according to Aetna’s own data,” the email stated. “As a nonprofit academic health system, Duke Health is driven not by margin but by mission. Every decision we make is rooted in our commitment to hope, health, and healing for every patient we serve.”
The agreement includes all Duke Health locations and providers.
“Throughout this negotiation, we have remained committed to our nonprofit mission of serving the best interests of our patients and community,” said Thomas A. Owens, M.D., executive vice president and chief operating officer of Duke University Health System, in a press release. “We came to the table together to reach an agreement that covers the cost of care. Our agreement with Aetna prioritizes efficiency, promotes high quality care, and helps drive down health care costs.”
“Duke Health is a valued partner in delivering high-quality, convenient care to Aetna members in North Carolina,” said Amelia Lee, Aetna vice president of network, Southeast Region. “We look forward to continuing to work together to meet the needs of our shared members and patients.”
While it’s not clear from the press release what the new agreement entails, both organizations said they “look forward to continuing their partnership to provide high-quality health care while exploring new, innovative opportunities that focus on population health, value-based care, and other areas to benefit the health of members and patients in North Carolina.”
“We came together to do what is best for patients and worked together to make this positive outcome possible,” said Owens. “Patients and families will continue to have access to the Duke Health doctors and care teams they know and trust.”
Last Friday, the State Health Plan (SHP) Board of Trustees approved procuring a transition services vendor to help plan members find new health care providers if an agreement couldn’t be reached.
Aetna is the administrator of the SHP, which is the company’s largest customer in the state and is responsible for half of its member base in North Carolina.
About 22,000 members have Duke as their primary care provider, and approximately 40,000 members have filed a claim through Duke this year.
State Treasurer Brad Briner, whose office oversees the plan, had some harsh words for Duke Health during the SHP Board of Trustees meeting.
“If we end up out of network, Duke is the one who made that choice,” the treasurer said during the special session. “They will have made that choice that their financial goals are more important than their mission to serve. Not only did Duke initiate this negotiation, they also decided to adopt very aggressive tactics with the intent of scaring our members.”
Briner alluded to multiple letters sent to members and multiple radio ads that have been running as a “public pressure campaign.”
On Friday, he and Thomas Friedman, executive administrator of the State Health Plan, said they were pleased that a deal had been reached and thanked Dr. Owens “for his role in seeking an innovative solution to these negotiations, and our partners at Aetna for their steadfast commitment to affordability.”
“We appreciate the steps Duke has taken to keep costs down for the Plan,” said Briner in a press release. “We have worked hard to dig ourselves out of a massive deficit and needed the help from all providers in the state to get that done. This deal represents Duke’s commitment to serve North Carolina and our members.”
“Our priority has always been the health of our Plan members,” said Friedman. “This deal with Duke is a major step forward to keeping our costs under control while also allowing our members to keep the doctors they have chosen for care.”