Omina, the two-tiered hospital provider network recently launched by Horizon Blue Cross Blue Shield of New Jersey, is coming under increasing fire for creating a system that many perceive as shutting out some of the state's leading hospitals.
The Newark Star-Ledger, the Garden State's largest newspaper, criticized Omnia in an opinion piece over the weekend, calling it out for a lack of transparency in the tiering process. In particular, the Star-Ledger expressed concern that the grading of hospitals based on quality was occurring behind closed doors.
"You might think Horizon would pick the best hospitals for its Tier 1 network. But the opposite seems to be true. On average, Tier 2 hospitals are ranked higher than Tier 1 by the Leapfrog Group, which produces the most respected national rankings," the commentary observed. "It's not hard to see how this will play out: Patients will flock to Tier 1 hospitals, drain huge streams of revenue from Tier 2 hospitals. Some of them will likely close, and most will be forced to scale back on charitable services, according to several hospital executives and legislators."
Horizon CEO Bob Marino has said that creating a system such as Omnia would be a good way to cut down on healthcare costs. But the Omnia tiering issue has created animus between the insurer and hospitals, with Horizon suing some of the facilities, claiming their public criticism is libelous.
A group of hospitals have also filed suit against New Jersey regulators, claiming that the Omnia planned received a rushed approval.
The concerns that providers are being shut out by the insurer has also begun to lead to bipartisan support for more closely regulating such a process, the Asbury Park Press reported.
To learn more:
- read the Star-Ledger opinion piece
- check out the Asbury Park Press article