Bergen County Superior Court Judge Robert Contillo has ordered Horizon Blue Cross Blue Shield to release details of how it chose the health care providers for the Tier 1 portion of its Omnia Health Plan.
Bergen County Superior Court Judge Robert Contillo has ordered Horizon Blue Cross Blue Shield to release details of how it chose the health care providers to be included in its Omnia Health Plan.
Contillo ordered Horizon to release a report produced by management consultant McKinsey & Co. that the insurer used to determine which providers could be in the Omnia Alliance. Tier 1 classification usually offers lower patient co-pays and deductibles. All of the providers in the Omnia plan are in Tier 1.
Horizon is being sued by CentraState Healthcare System, Holy Name Medical Center and Valley Health System, which allege they have been unfairly excluded from Tier 1 status. Saint Peter’s University Hospital is also suing Horizon on similar grounds.
The plaintiffs claim that they met certain value-based care criteria to be included in the Tier 1 portion. Horizon claimed the McKinsey report showed they didn’t but hasn’t made the report public.
“There is broad, legitimate, immediate public interest in how health care is delivered in this State, how patients are insured, and how they are incentivized to be evaluated, tested and treated by particular providers,” Contillo ruled.
“With Judge Contillo’s decision, the public should finally have an opportunity to learn the truth behind OMNIA,” said Michael Furey, an attorney with Day Pitney who represents the hospitals. “If Horizon truly believes that healthcare is an important issue to the public, then it should stop its efforts to hide the documents.”
Horizon, in a prepared statement, said it is “disappointed with the Court’s ruling as it permits public dissemination of information that the New Jersey Supreme Court has previously recognized as protected and that is critical to defending the interests of the policyholders we exist to serve. The company has always been clear and transparent about why it created OMNIA–to make high quality medical insurance more affordable to New Jersey families. Horizon respectfully disagrees with the Court’s ruling and plans to appeal this decision.”