The North Carolina State Health Plan and Duke Health announced a new agreement Wednesday that keeps Duke Health as an access provider under the plan’s recently established tiered network system, preserving current levels of service and member costs statewide with a focus on the Triangle region.
What the agreement means for members
Under the terms released by the plan and Duke Health, State Health Plan beneficiaries will continue to be able to use Duke’s network of hospitals, physician practices and outpatient locations without facing changes to the member cost structure next year. The State Health Plan serves nearly 750,000 members.
"Serving State Health Plan members is both a privilege and a responsibility for Duke Health," said David Zaas, MD, chief executive officer of Duke Health. "Our priority is making sure State Health Plan members and their families can continue turning to Duke Health."
The announcement emphasized continuity: patients will retain access to primary care, specialty services and highly specialized treatment available through Duke Health systems across the state.
Context and numbers
State Health Plan officials highlighted the extent of use of Duke services by plan members; in 2025, members received care through Duke Health more than 253,000 times. State Treasurer Brad Briner, who chairs the plan’s trustees board, said the pact reflects the type of partnership the plan sought.
"To see this kind of dedication from a world class organization like Duke Health shows just how important our members, and their families, are," Briner said in a press release.
The plan had been negotiating with both Duke and WakeMed to define which systems would be designated as access providers under the new tiering approach. As part of the outcome, a majority of WakeMed’s services will be designated as non-preferred for most services, according to a statement from the plan’s communications director. However, individual primary care providers affiliated with WakeMed will remain preferred in many cases.
- Plan membership: nearly 750,000 people
- Duke visits in 2025: more than 253,000 encounters
- Network impact: Duke designated an access provider; many WakeMed services non-preferred
| Metric | Value |
|---|---|
| State Health Plan membership | ~750,000 |
| State Health Plan encounters with Duke (2025) | >253,000 |
Implications and next steps
The agreement is designed to preserve member access to Duke Health facilities and clinicians at current costs as the State Health Plan implements its tiered provider framework. Members who receive care through Duke should see continuity of services; those who typically use WakeMed facilities may experience changes in benefit status for many services, though primary care relationships with WakeMed-affiliated physicians are largely maintained as preferred options.
Plan officials did not provide additional details about which specific WakeMed services will be non-preferred or how patient referrals between systems will be managed going forward. Members with questions were directed to plan communications for further guidance.
This arrangement between a large public plan and a major health system reflects ongoing negotiations nationwide as payers and providers seek to balance network access, costs and the concentration of specialty services.
