North Carolina State Treasurer Dale Folwell said Tuesday the decision to go with Aetna as the third-party administrator for the State Health Plan was in the best interest of plan members. During his monthly “Ask Me Anything” Q&A conference call with reporters, Folwell emphasized that neither North Carolina Blue Cross Blue Shield, nor incoming Aetna, have ever been the actual insurer for the SHP, but rather the administrator of it.
“I still read reports across the state where people are reporting that Blue Cross Blue Shield has been our insurer for 43 years,” Folwell stated. “That is inaccurate and false. They are our back-office operator.”
Folwell made the announcement last week and told Carolina Journal, “We have no choice but to drive transparency, higher quality, higher access, and lower cost into our state health plan,” he said.
“We continue to be a self-funded plan, and these benefits are benefits that are set by the board of trustees every year,” he said during the conference call. “Our expectation is that we continue to freeze family premiums for the next year or so and, hopefully, actually even reduce family premiums sometime during that period of time. As far as the deductibles and copays, we still have our Clear Pricing Project, which allows people who participate in that not to have to pay deductibles, which is very important.”
He said the Project has 27,000 healthcare providers across North Carolina representing thousands of patients and will continue to work on transparent pricing.
“Not only because it puts us on the right side of history, but it puts us on the right side of President Biden and President Trump’s executive order to get rid of secret contracts and healthcare,” he said.
Folwell said that during his tenure, the SHP has never adjusted deductibles or copays and are trying to take advantage of the program’s size as they have with their Medicare Advantage and pharmacy benefit management programs.
As for affecting retirees, Folwell said a small percentage of retirees are still on the Indemnity Plan, but 155,000 retirees are currently participating in the Humana Medicare Advantage program, which has a $0 premium to the member and $0 cost to the taxpayer.
Folwell could not specifically say why Aetna was chosen over NCBCBS, especially due to the fact that the latter company is appealing the decision. However, he would say that the process, which has been going on for a year, all came down to scoring based on a financial component, including how much charged per member per month to administer the plan, and technical requirements.
“We are optimistic that with Aetna that we are going to be partnering with somebody who has a more aligned interest with us regarding the transparency of healthcare,” Folwell said.
Folwell added that there shouldn’t be any changes to the formulary regarding prescription drugs as it is with the state’s pharmacy benefit manager. Still, they are anticipating further investigation into the 340 program to ensure that the SHP is receiving the proper contractual discounts regarding any drugs distributed out of hospitals. Additionally, he would also like to look into the pre-authorization process.
Questions, including whether an employee can keep their current doctor, will be answered after the SHP team sits down with Aetna’s senior management over the next couple of weeks to discuss timeframes and deliverables.
Folwell said trying to lower costs and having transparency is so crucial at a time when the state healthcare costs and prescription drug costs are going up by double digits, and the funding increase that they received from the General Assembly has increased at 4 to 6% a year.
“You can see by the combined ratio, by the participation rate, by just talking to the average state employee in this state if they’re having to make decisions between mortgage and healthcare premiums, energy and healthcare premiums, food and healthcare premiums, living their life and healthcare premiums not to mention what’s happened to the cost of all those other things, especially over the last two or three years,” he said.
“My point of saying that to you is that this is very, very important because we have to lower, not just freeze family premiums so that we can attract younger, healthier people to this plan to offset people like myself at my age.”