Holy Name reaches agreement with Horizon, drops out of OMNIA lawsuit

By Anjalee Khemlani
Teaneck/Newark | Jun 26, 2018 at 6:02 pm

Holy Name Medical Center and Horizon Blue Cross Blue Shield of New Jersey announced Tuesday night that they have reached an agreement to work together and will no longer face off in litigation regarding the insurer’s tiered network health plan — ending a source of contention between the two that has lasted for more than two years.

“We are pleased with the outcome of our discussion with Horizon and looking forward to partnering with their health professionals to ensure the best outcomes for our patients,” Holy Name CEO Michael Maron said.

“Holy Name and Horizon will continue our long history of working together to transform the health care system to one that promotes health and wellness over sick care and shifts the focus from the volume of care delivered to the quality of outcomes and the value of care achieved.”

 Details of the agreement will be kept confidential, both companies said in a release.

The dispute between the two parties begin in 2015, when Horizon introduced its OMNIA plan.

The plan created significant controversy in the hospital community because it divided the state’s hospitals into two tiers — largely consisting of the bigger, suburban hospitals in the top tier, while mostly standalone and Catholic hospitals were relegated to Tier 2.

Holy Name was one of seven original plaintiffs in a lawsuit against Horizon, by far the state’s largest insurer.

The plaintiffs have slowly been dropping out. With Holy Name bowing out, only CentraState and Valley Health System remain.

This presents a significant win for the health insurer, which also received significant scrutiny from the Legislature when it first rolled out the tiered network plan — despite similar plans from AmeriHealth and Aetna also existing in the state.

Allen Karp, executive vice president for health care and transformation at Horizon, said OMNIA continues to be a way to lower the cost of health care.

“The OMNIA Health Alliance was born out of a desire to lower the overall cost of care while improving both outcomes and the patient experience,” he said.

“OMNIA health plans offer New Jerseyans a high-quality option that gives them broad access to providers, including Holy Name, and empowers them to take greater control of their health spending. These are goals that both organizations share and we are eager to continue working collaboratively to implement additional strategies that advance Holy Name’s efforts to lower the cost of care while improving outcomes and the patient experience.”

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Anjalee Khemlani | akhemlani@roi-nj.com | AnjKhem