New Jersey providers mystified over Blues selection for new network

A big New Jersey insurer has created a tiered network from scratch that has excluded many of the state's biggest hospitals, leading executives to engage in behavior ranging from head-scratching to claims of religious discrimination.

Consternation appears to be the primary reaction from the provider community to Horizon Blue Cross Blue Shield of New Jersey's decision to create what is known as the Omnia Health Alliance. It includes six of the state's 20 hospital systems statewide, according to the Philadelphia Inquirer, although some other providers may be included as well. The intent is to create a low-cost and tiered network product with significantly lower premiums and out-of-pocket costs compared to other insurance offerings.

"We still have no information at all about the criteria that Horizon used for this," Kimberly D. Barnes, vice president of planning and development for Lourdes Health System, told the Inquirer.

Other providers have gone farther. A high-ranking officials with the Catholic HealthCare Partnership (CHP) suggested to NJ.com that religious affiliation may have played a role in the selection process.

"Horizon was not transparent and schemed in secret with select hospital systems while refusing to detail the criteria they used," Sister Patricia Codey, the CHP's president, told NJ.com. "So in the end, not only did Horizon deliberately exclude Catholic hospitals, but they haveuse  chosen some of the most expensive hospitals in New Jersey which will cost their customers even more."

An Horizon spokesperson told NJ.com that it engaged in "a thoughtful and deliberate process in choosing the OMNIA Health Alliance based upon an understanding of the desire, ability, and demonstrated commitment by those health systems to move from fee-for-service to fee-for-value healthcare. We did not consider in our criteria, the health systems' tax status, religious affiliation, or governance structure." 

To learn more:
- read the Philadelphia Inquirer article 
- check out the NJ.com article

 

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