By Briana Vannozzi
Correspondent
By all accounts Horizon is moving full steam ahead with the roll out of the new Omnia Health Alliance.
However, there’s no shortage of lawmakers, health care providers and consumers who are calling on the state’s largest health insurer to put on the brakes.
“We’re asking the governor to step in and put a halt to this, at least temporarily, until we can get more answers,” said Assemblywoman Elizabeth Maher Muoio.
“The capital city, Trenton, is left with both its hospitals as tier two. It will cause real hardship for people especially with limited means,” said Assemblyman Reed Gusciora.
The Alliance creates new tiered health plans. It includes six major health systems, the state’s largest physicians group and 14 additional hospitals. Patients will get incentives for choosing the Omnia plan, like lower monthly premiums and less out-of-pocket costs. They’ll still have access to the tier 2 facilities, they just won’t get the discounts.
“We are asking for this roll out to be delayed by at least 90 days,” said Assemblywoman Valerie Vainieri Huttle.
Huttle is part of a bi-partisan contingent in Bergen County who say the plan has created a perception of winners and losers, and they want it reviewed.
“So we can find out how these hospitals were selected,” she said.
“Tiers are meant to be established for steerage. So there’s benefit to one or the other, or to have a differentiation between performance levels. Well those performance levels have never been established,” said Holy Name Medical Center President and CEO, Michael Maron.
The CEO of Holy Name Medical Center, also in Bergen County, believes this deal was more about market share. Horizon has said their criteria for the selection of hospitals was based upon, “a commitment to transformation and strong clinical quality…”
“How is an organization like Holy Name — who’s got a medicaid ACO, a Horizon ACO, participates in medicare bundle payments, has done all sorts of other value-based progressive, innovate delivery models here — how did they not make the cut?” said Maron.
Here’s an example of Horizon plans that were released to state employees under open enrollment today: a patient with an HMO will pay almost double in out-of-pocket costs, nearly $6,000 for an individual plan, compared to $2,500 for a consumer choosing a tier one facility under Omnia, or $4,500 for a tier two.
“In the end the consumer suffers when oligopolies are allowed to prevail, and that’s exactly what we’re creating,” Maron said.
Maron says standalone hospitals seem to be the common thread in those left out. 90 percent of catholic hospitals aren’t part of the alliance.
“This would have a devastating impact on catholic health care, our mission and our ability to serve the poor as well as the uninsured citizens,” said Sister Particia Codey, President of the Catholic Healthcare Partnership of New Jersey.
Horizon is remaining tight-lipped, saying only that they’re reviewing the letters and requests.
A hearing in the Senate Health Committee is planned for October 5. Horizon says several officials and dozens of others plan to testify. Lawmakers tell us you can expect to see legislation crafted to create more transparency and eliminate what they call a system of the haves and have nots.