Hundreds of thousands of North Carolina State Health Plan (NCSHP) members across the state will soon have access to no-cost, high-quality surgical care.
Through the SHP’s Lantern surgical benefit, members can receive surgical services at numerous Novant Health locations across the state.
This is the first major expansion to the healthcare benefit. The announcement was made during a Wednesday press conference at Novant Health Kernersville Medical Center.
State Treasurer Brad Briner, who oversees the NCSHP, said during the press conference that last year was one of the most challenging in the State Health Plan’s history, marked by rising medical costs, stagnant premiums, and increasing provider prices. They were staring at a projected shortfall of $507 million and scrutinized “every nook and cranny where they could find funding” and had one clear goal: make the State Health Plan sustainable.
“This year our focus is also straightforward: cut unnecessary costs from the system so we don’t have to raise the burden on our members,” he said. “That’s why we’re expanding our no-cost surgery options for members of the State Health Plan, especially in our suburban and rural communities. Here’s the reality: too often the price of the same surgery can vary dramatically depending on where it’s performed. One hospital may charge two or three times more than another for exactly the same procedure with no difference in quality and a high chance that our members won’t even be aware of the difference.”
Briner said those inflated costs don’t just hurt the plan. They eventually put pressure on premiums, deductibles, and the long-term sustainability of coverage for teachers, state employees, and their families.
With high-quality surgical providers who agreed to transparent, fair pricing, it will mean much less strain on the plan, while at the same time offering members access to certain procedures at no out-of-pocket cost, meaning no deductible, copay, or coinsurance for eligible surgeries when members choose participating providers.
The treasurer said it is especially important for those living in rural North Carolina where they have had limited provider options, longer travel distances, and, in some cases, much higher costs.
He said the agreement also sends a clear message to the healthcare market.
“If you want to serve State Health Plan members, you must offer value,” Briner said. “This is not about cutting corners. It’s about cutting waste. We’re demanding high-quality outcomes and accountability. We’re aligning incentives so that providers are rewarded for their results as well. While cutting unnecessary provider costs is essential, the key to long-term sustainability is even more important in keeping our members healthy.”
The Plan launched the Lantern surgical benefit last fall, which provides eligible members with no out-of-pocket costs for certain, non-emergent surgeries when performed by participating Lantern providers.
Tom Friedman, State Health Plan Executive Administrator said that the Plan has tens of thousands of people needing surgery every year and sometimes, when people need to make a choice without a lot of information, they make bad decisions that end up causing them to be readmitted or paying out of pocket up to $10,000, and if they are on the family plan, spending 20 to 40% of their salary.
“We need to make this very difficult time as simple as possible for members, not make it a financial burden or make it a challenge because it’s already scary and it’s already hard,” he said. “So, we are so grateful that Novant stepped up and really brought a statewide presence here because it’s doing healthcare differently.”
Lantern’s Lee Mendez said the company provides access to a high-quality network of curated surgeons and facilities at no cost to members by identifying high-performing surgeons and facilities, aligning pricing with quality standards, and simplifying the experience for members.
“When a member needs surgery, they are connected with a dedicated care advocate that guides them from the beginning all the way through to recovery,” she said during the press conference. “They help coordinate care, schedule appointments, and manage medical records on behalf of the member. Our commitment is to continue to expand the network across the state, increasing access while maintaining our rigorous quality standards. At the core, Lantern’s approach improves affordability and availability by aligning incentives around better outcomes because quality is the most substantial cost strategy in healthcare.”