Earlier this month New Jersey’s largest health insurer, Horizon Blue Cross Blue Shield, announced the formation of its “OMNIA Health Alliance,” a partnership of hospitals and physician groups that Horizon believes will lead to lower premiums and out-of-pocket costs for its customers.
The chosen hospitals, including Hunterdon Healthcare and the Robert Wood Johnson Health System, plus several others, including the Princeton Healthcare System, have been designated by Horizon as Tier 1 hospitals and Horizon patients seeking treatment there are expected to benefit from lower premiums and out-of-pocket costs.
Other hospitals including St. Francis Medical Center in Trenton and Capital Health, have been categorized as Tier 2 under the plan and will not participate in the compensation structure planned for the Tier 1 hospitals.
Four elected officials representing central New Jersey and Trenton submitted a letter to the state Department of Banking and Insurance calling for a review of the proposed plan. Excerpts are below:
We have serious concerns regarding the process whereby this Alliance was created, the resulting lack of access to more affordable care for our constituents, and the long term potential repercussions that those gaps in affordable coverage will create. As such, and recognizing that in less than two weeks public employees will enter the open enrollment period for the State Health Benefits Plan, we write to request that you review and place on hold the implementation of the Horizon Blue Cross Blue Shield OMNIA Health Alliance Plan.
How these hospitals were chosen to receive Tier 1 status, while 34 other New Jersey hospitals were denied this status, is a mystery. Hospitals not chosen have been relegated to Tier 2 status, meaning that patients who utilize them will have higher co-pays and deductibles.
St. Francis Medical Center is one of two hospitals located in the capital city of Trenton, both of which have been excluded from the Alliance and Tier I status. The second hospital, Capital Health Regional Medical Center, a leader in population health management in Mercer County, was excluded without notification or explanation. This, as you may be aware, will have detrimental financial consequences for the two largest non-governmental employers in the Capital City.
These two hospitals are also the main providers of charity care in the region. Moreover, insured persons, who reside in Trenton, will not have easy access to providers included in Horizon BCBS’s most affordable plans.
Accordingly, we are respectfully requesting DOBI, under the Network Adequacy Rule and the Health Services Law, to intervene and seek a hold on this plan from taking effect until a more public airing of the benefits for this plan take place. Additionally, we request DOBI review the process under which Horizon met with certain hospitals and providers and excluded other hospitals such as Capital Health and St. Francis.
The letter was signed by Reed Gusciora and Elizabeth Muoio of the State Assembly, Trenton mayor Eric Jackson, and Mercer County executive Brian Hughes.