Health systems buck at state health plan

July 22, 2026 - 03:58

Leaders from Atrium Health and WakeMed say they were blindsided by their exclusion from the top-tier status in the newly redesigned North Carolina State Health Plan. The plan, which covers more than 750,000 state employees, teachers, and retirees, restructured its network into multiple tiers with different out-of-pocket costs. Both hospital systems were placed in a lower tier, meaning their services will cost more for plan members.

Executives from the two major health networks expressed shock and frustration, arguing that the decision was made without clear communication or justification. They claim the move could steer patients away from their facilities, potentially disrupting longstanding care relationships and increasing costs for patients who want to stay with their current doctors.

The state plan's administrators have defended the tiering system as a way to encourage use of lower-cost, high-quality providers. They say the rankings are based on data around cost efficiency and quality outcomes. But Atrium and WakeMed argue that the metrics used were not transparent and that the process lacked input from the systems themselves.

The dispute highlights ongoing tensions between large hospital networks and public payers trying to control rising healthcare costs. With the plan set to take effect soon, both systems are now urging their patients to speak up and are exploring legal or administrative options to challenge their tier assignments.