"Covering a little more than 750,000 lives, the [North Carolina State Health Plan (SHP)] spends between plan costs and employee contributions nearly $4.5 billion annually ... [The SHP] faces an estimated deficit of greater than $500 million for Calendar Year (CY) 2026 and a total projected deficit of $949 million by the end of CY2027. In this article, [the authors] review the challenges that drove the fiscal instability of the North Carolina SHP.... [They] then describe the dynamic, market-driven tools that we are applying to efficiently and effectively control costs with sensitivity to the varied needs of more than 750,000 SHP members."  MORE >>