Briner, 47, has 25 years of experience managing investments and recently retired as co-chief investment officer from Willett Advisors, the firm that manages assets for Michael Bloomberg. He studied economics at UNC Chapel Hill (Morehead Scholar) and has an MBA from Harvard. He lives in Chapel Hill with his wife and four children and serves on the UNC Board of Trustees.
The job
Our Q&A with Briner
With the State Health Plan projected to face a budget shortfall in coming years, what steps would you take to ensure the plan remains solvent?
In the short term, we need to re-negotiate the PBM contract to a cost-plus model, which should save millions annually. We also need to either complete or abandon the Clear Pricing Plan –a worthy initiative but without an ability to compel participation, it raises costs.
In the long term, the State Health Plan needs to move toward an accountable care model – empowering primary care doctors to help manage specialist care for their patients. With price and quality data now available, SHP members, working with their doctors, will be able to choose higher quality providers, at lower expense, going forward.
An increasing number of health plans are shifting to so-called ‘value-based care’ payment models, but the State Health Plan remains a fee-for-service model. What will be your philosophy about designing reimbursement for the State Health Plan?
As mentioned above, we must evolve toward using market forces to deliver higher quality outcomes for our state employees. Only by providing an informed choice – using transparent price and quality data to empower our employees and their doctors to make the best decision for them – will we be able to materially change the trajectory of the SHP over time.
The challenges to evolving from fee-for-service to a value-based-care paradigm are material – this cannot and will not happen quickly. The first step down this inevitable road is to run several trials starting as soon as possible once I am in office.
Do you favor the state health plan covering the new GLP-1 weight-loss medications? Why or why not?
The Plan should reinstate coverage of these drugs as they clearly provide material benefit. The way we will do that will be to negotiate with the providers of these drugs to both lower cost and to allow the State Health Plan to have discretion over access to them during this time of scarcity. I was encouraged to see Eli Lilly materially reduced the retail price for Zepbound in late August, which should portend well for the SHP’s negotiations, as should the development of many competing other weight loss drugs that should come to market in the coming year or two.
The third-party administrator for the State Health Plan will shift from BCBSNC to Aetna in 2025. What steps would you take as state treasurer to ensure that Aetna meets BCBSNC’s network adequacy levels, providing adequate health care access for state employees in rural areas with few hospitals and specialists?
I have met multiple times with both Blue Cross and Aetna to discuss this shift in the last several months and am deeply committed to insuring a successful transition on January 1st. Each of those meetings has focused on the progress toward onboarding providers, technology development, and staffing levels. As your next Treasurer, I will consistently monitor Aetna’s network development by county, and expect that they will exceed BCBSNC’s in-network options very early in the contract.
Treasurer Folwell has been outspoken in criticizing hospitals for inflating prices, not being transparent about costs and not providing enough charity care to poor patients. Do you believe his approach has been effective or not effective, and what would you do differently, if anything?
He is correct that cost transparency is an issue and is the only solution to rapidly escalating healthcare prices.
The data on charity care shows that hospitals are providing less charity care as a percentage over time. As Treasurer, I would take this issue up immediately.
That said, I think we need to take a more collaborative tone in our discussions with the hospitals and all the providers. While I think Treasurer Folwell has been effective, I will seek to build a better working relationship with the hospitals so that we can effect major change in their behaviors.
What other steps would you take as state treasurer specifically related to healthcare in North Carolina?
NC HealthConnex was launched in 2015 to address the common issue that electronic medical records are not well-shared across providers. This leads to duplication of testing, unnecessary procedures, and a lot of wasted effort. I will seek to re-invigorate this effort as a major area for efficiency.
An ounce of prevention is worth a pound of cure; for our State Employees it is critical that we enable them to have regular and inexpensive access to primary care providers. We will expand primary care access, at no cost, for our members.