Gill and Vitale Call on AG to Intervene in Horizon OMNIA Case

Senate Commerce Chair Nia H. Gill and Senate Health Chair Joseph F. Vitale today called on the state’s acting attorney general to investigate Horizon’s new OMNIA Alliance and tiered benefits system and to establish a permanent oversight mechanism for the program.

Following an all-day hearing, the senators issued a joint statement in response to testimony delivered by Horizon, experts and various stakeholders at today’s hearing of the Senate Commerce and Health, Human Services and Senior Citizens committees.

“Our hearing revealed that Horizon misrepresented to the public and legislators the makeup of the widely-publicized OMNIA Alliance and failed to disclose all participating providers within the tiered system,” said Gill and Vitale. “In addition, the Department of Banking and Insurance may have violated state law and its own regulations by approving the tiered plans even though they did not meet the established requirements.

“The attorney general must immediately intervene and establish a permanent oversight mechanism for the process to ensure fairness, transparency and consistency in the hospital and physician ratings and a focus on quality of care. Precedent for this was established in New York under then-Attorney General Cuomo in response to a tiered system in that state.

“With the introduction of this plan in New Jersey under an extremely flawed process, it is critical that we act. Failure to do so could compromise the quality of care patients receive and the health of hospitals throughout the state. Strong oversight and accountability of this program is vital to ensuring our residents are protected.”

For more details on today’s hearing, go here.

In a statement, Thomas Vincz of Horizon said, “Today, Horizon provided more transparency than any other insurer in the state about how it developed its tiered network plans. Horizon will be offering new lower cost health plan options for consumers who are paying some of the highest health care costs in the nation. We are projecting that approximately 250,000 consumers will choose these new plans, including 40,000 who are currently uninsured. The remaining will largely be individuals and small employers, who are most impacted by high costs.”

That was a matter of opinion, at least by the reckoning of Gill, Vitale and their colleagues.

During the hearing, senators probed Horizon representatives for answers to how and why certain hospitals received their designations as tier one and tier two hospitals, senators Gill, Diane Allen and Ronald L. Rice in particular curious about why poor areas in the state appear under-served by tier 1 facilities.

They were not alone in their worry.

Michael Maron, chairman of the Catholic HealthCare Partnership and CEO of Holy Name Medical Center issued a statement of his own following the hearing.

“New Jersey’s healthcare marketplace lacks the transparency, maturity and competitiveness to support a tiered insurance product of this scale,” Maron said. “The OMNIA Alliance features some of the most expensive hospitals in the state while ignoring some of the most effective and innovative healthcare organizations, such as Holy Name Medical Center.  Catholic hospitals and others have been designated  Tier 2 without any transparent criteria, or an opportunity to perform to meet clear and equitable criteria.”

Gill and Vitale Call on AG to Intervene in Horizon OMNIA Case