With nearly every Catholic hospital excluded from Horizon Blue Cross Blue Shield of New Jersey's new line of discounted health plans, the state's bishops have asked the insurance giant's CEO to expand the network to include "the vulnerable populations we serve."
TRENTON -- With nearly every Catholic hospital excluded from Horizon Blue Cross Blue Shield of New Jersey's new line of discounted health plans, the state's bishops have asked the insurance giant's CEO to expand the network to include "the vulnerable populations we serve."
In a letter sent to Horizon President and CEO Robert Marino Oct. 28 and obtained by NJ Advance Media, the 10 Catholic bishops said they had long considered the Newark-based company "a partner in delivering health services even to the vulnerable populations we serve."
"With the rollout of the Horizon Omnia Alliance that partnership seems to be a memory," the letter said.
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This is the second time a Catholic organization has criticized Horizon's OMNIA Alliance, a partnership with 22 hospitals that have agreed to accept smaller reimbursements but would be financially rewarded for quality and keeping people healthy. Another 14 hospitals Horizon designated as "Tier one" facilities also agreed to accept lower reimbursement in exchange for higher patient volume.
In September, Sister Patricia Codey, president of the Catholic HealthCare Partnership representing Catholic hospitals, accused Horizon of deliberately excluding Catholic hospitals from participating in a new plan that will discourage customers from using their facilities.
The eventual outcome will be cost-conscious people will avoid the 36 remaining "Tier 2" hospitals, which received a derogatory-sounding designation for reasons Horizon has refused to adequately explain, according to OMNIA's critics.
With 3.8 million customers, Horizon wields considerable buying power, and the excluded hospitals -- many of them Catholic, located in cities or serve a sizable number of uninsured and Medicaid clients -- say they fear they will lose a substantial amount of revenue.
"We are disappointed in the lack of transparency in the process Horizon utilized to exclude all Catholic hospitals except one (St. Joseph's Healthcare System) from Tier 1 designation," according to the bishops' letter.
"We are disappointed because the Horizon plan will 'steer' patients to preferred Tier 1 hospitals at the expense of Catholic and other hospitals. The end result of the Horizon decisions could be the closure of Catholic hospitals with disastrous impact on the people of our State, especially those who are most vulnerable," the letter said.
"Mr. Marino, we look forward to working with you personally to repair our broken partnership -- a partnership that for decades has been critically important for the people of New Jersey," the letter said.
Horizon's spokesman could not immediately be reached for comment.
But in previous interviews and public remarks, Horizon executives said they invited the 22 hospitals to join OMNIA because they had the lowest readmission rates and the best scores on patient safety and quality measures.
They offered a range of inpatient, outpatient and post-acute care services, and had already begun using a "value-based" payment model that rewards preventive care. They also had to score high on patient satisfaction surveys. Horizon also favored the largest hospitals and systems, including those that serve a sizable number of Horizon members.
Tier 1 hospitals were chosen to fill out the geographic needs of customers across the state, Horizon officials said.
Customers who buy an OMNIA coverage will pay about 15 percent less than they would using another Horizon plan, which take effective in January. But most other Horizon plans will remain, the company has said. Those plans include the same hospitals that are included in the network today.
The exclusion of most Catholic hospitals is a coincidence, Minal Patel, Horizon's senior vice president and chief strategy officer, said after Codey criticized the company two months ago.
"We did not take into account religious affiliation or tax status. . .We looked at who will be in the best position to avoid wasted medical spending, such as unnecessary tests," Patel said. The data used to evaluate the hospitals "is publicly available. The outcomes were the outcomes. There was no desire one way or another to include or exclude" Catholic hospitals, he said.
State lawmakers have also criticized Horizon for OMNIA's design and have asked the state Attorney General's Office and the Federal Trade Commission to investigate whether the plans violate any laws.
The letter from the Catholic Conference is signed by John J. Myers, Archbishop for the Archdiocese of Newark; Bernard A. Hebda Co-adjutor Archbishop for the Archdiocese of Newark; Bishop David M. O'Connell for the Trenton diocese; Bishop Dennis J. Sullivan for the Camden diocese; Bishop Paul G. Bootkoski for the Metuchen Diocese; Bishop Kurt Burnette of the Byzantine Catholic Eparchy of Passaic; Bishop Yousif B. Habash, Our Lady of Deliverance Syriac Catholic Diocese; Bishop John W. Flesey Auxiliary Bishop for the Newark Archdiocese; Auxiliary Bishop Manuel A. Cruz of Newark; and Bishop Arthur J. Serratelli, Diocese of Paterson.
Susan K. Livio may be reached at slivio@njadvancemedia.com. Follow her on Twitter @SusanKLivio. Find NJ.com Politics on Facebook.
