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NC State Health Transition Advocate Service

A white-glove concierge service that proactively contacts NC state employees and retirees 90–120 days before network changes take effect, audits their current care patterns (primary care, specialists, hospitals), identifies which providers remain in-network, and delivers a personalized transition plan with specific alternative providers, cost comparisons, and enrollment steps. The service handles appeals and exceptions requests on behalf of clients.

SERVICE

4082 weeks • 70% confidence

Value Proposition

Eliminates surprise costs by catching beneficiaries *before* the change hits; removes the burden of decoding plan documents and calling providers; negotiates exceptions for high-risk transitions (e.g., mid-cancer treatment); reduces emergency room visits caused by access disruption.

Target Audience

NC state employees and retirees aged 45–75 with chronic conditions or established specialist relationships; initially target those with diabetes, cardiology, orthopedics care.

Key Features

Pre-transition outreach via phone/mail/email 4 months before effective date
Provider audit: cross-reference current claims data with new network to identify gaps
Personalized transition report showing out-of-pocket cost delta by scenario
And more, with full implementation detail...

Tech Stack

CRM (Salesforce or Pipedrive) for beneficiary tracking and outreach management Spreadsheet or Tableau for provider directory and cost-comparison modeling HIPAA-compliant phone system (e.g., Vonage, RingCentral) for outreach Mail merge and email platform (e.g., Constant Contact or in-house)

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Original Problem

State employees and retirees face unexpected out-of-pocket healthcare costs due to preferred provider network changes

North Carolina state employees and retirees are being hit with surprise surcharges when using WakeMed facilities starting July 2026, forcing them to either pay extra or switch to less convenient providers. Current health plan communications fail to adequately prepare beneficiaries for these sudden cost increases, leaving them scrambling to understand their options and find alternative care networks. This creates financial stress and healthcare access disruption for a population that believed their state health benefits were stable.

Score: 17.5%