Legislators Hold Hearing on Horizon Omnia Health Alliance

By Briana Vannozzi

The questioning went on for hours. The Senate Commerce and Health Committees dissected Horizon’s new tiered health insurance plan, called Omnia, during a joint hearing at the State House today.

“It was clear to me that the other hospitals that were not tier one were stigmatized by your announcement,” said Senator Richard Codey.

“It was not our intent to stigmatize, and in fact the selection criteria that we used were not intended to essentially comment on, or evaluate, their performance as a stand alone hospital,” said Executive Vice President for Horizon Blue Cross Blue Shield Kevin Conlin.

Lawmakers pressed Horizon’s CEO, Robert Marino, who also sits on NJTV’s board of trustees, about the selection criteria and why all hospitals weren’t given an opportunity to apply.

“Have you made those metrics or requirements public to anyone who may want to join that alliance?” asked Senator Nia Gill.

“Senator, we chose a deliberate process. It was an internal process. It was not a public process. It is a process that is widely used in the industry, by not only us, but all of our national competitors,” Marino said.

“But you did not give the metrics or the weighting,” Gill said.

The insurer used six broad categories to identify partners, but Marino said today all other criteria is considered proprietary.

“What we chose to do with the Omnia product is build a tiered network product as opposed to a narrow network product,” Marino said.

He went on to dispel concerns that consumers choosing tier two facilities will pay more. Adding that the same networks will be available at the same prices.

“Basically there are only incentives for a member to use a tier one provider. There are no penalties for a member that opts to use a tier two provider,” Marino said.

Horizon announced today that tier one obstetric services will be added in Burlington County, which currently lacks any tier one facilities. Lawmakers from that district grilled Horizon, who conceded hospitals have been added as issues arise.

“Virtua is the only provider of maternity services in Burlington County,” said Virtua Health System CEO Richard Miller. “I haven’t heard anything and I’m the CEO, so we would be interested in talking to Horizon about an overall tier one status.”

The heads of state worker unions added their support to Omnia. In a joint statement today they acknowledged the issues surrounding the designation of tier one hospitals, but said: “…we believe the program they’ve laid out will provide some of our members with the option we were looking for with a tiered network plan.”

A handful of hospital CEOs also gave testimony to the committee that went late into the afternoon. For now the Omnia Alliance will move forward as designed. The public and legislators will have to wait until the federal marketplace enrollment begins on November 1 to learn any more details about the exact pricing for the health plans.