New Jerseyans Deserve Better from Horizon

When Horizon Blue Cross Blue Shield created its OMNIA plan a few years ago, the company said the intent was to provide patients with higher-quality care at a more affordable price. Fast forward to now and we know that's not the case.

Earlier this year, the court mandated that Horizon release details of how and why it created the OMNIA plan--details Horizon spent millions trying to keep from public view. Thankfully, the court ruled in favor of transparency and those details are now out (https://www.documentcloud.org/...)

No question, the information released on OMNIA is dense and hard to understand, but when broken down, it's clear that company misled the public about the purpose of the plan. Horizon executives said they categorized hospitals and providers into Tier 1 and Tier 2, primarily based on quality and affordability. The court-released documents, however, show that the OMNIA's tiers have little, if anything to do cost and quality, but rather everything to do with market share. In fact, hospital size was the driving factor.

Bigger was better every time for Horizon in choosing preferred partners for OMNIA. Tier 1 hospitals are mainly large, hospital systems. The documents show that many of the independent, community hospitals Horizon relegated to Tier 2 actually scored higher in quality and affordability than the bigger hospitals. Since when is hospital size the most important factor in patient care?

This is complex stuff that warrants a state investigation because put in simplest terms it's clear Horizon isn't being straight with consumers.