Saint Peter’s, Horizon end litigation related to OMNIA health plans

New Brunswick facility will become Tier I hospital in agreement that ends more than five years of negotiations

When Horizon Blue Cross Blue Shield of New Jersey rolled out its OMNIA health plans in the fall of 2015, it was met with a handful of lawsuits from hospitals and health systems that felt they were wronged by the insurer’s Tier I and Tier II designations.

More than five years later, all of the suits have been settled.

On Wednesday, Horizon and Saint Peter’s Healthcare System announced they have agreed to end their dispute. Saint Peter’s will now be considered a Tier I hospital in the plan, effective May 1.

No other details of the agreement were released, but both parties expressed appreciation in a joint statement.

“We are pleased to have reached an agreement settling our legal dispute. Instead of continuing to focus on our differences, we look forward to working together to advance health care quality, affordability and the customer experience,” they said. “Saint Peter’s and Horizon BCBSNJ will continue our long history of collaboration to further enhance this partnership to improve the health and well-being of those we serve.”

The sides said the settlement builds on their shared history and accelerates the deployment of value-based care and reimbursement models that are an essential element of OMNIA health plans’ success.

“We are indeed very pleased that Saint Peter’s has reached a settlement with Horizon BCBSNJ to end the litigation and to put this issue behind us,” Saint Peter’s CEO Les Hirsch said. “We have always valued our longstanding relationship and look forward to working together to advance our collective missions to serve the health care needs of our patients and communities.”

Allen Karp, Horizon BCBSNJ’s executive vice president for health care management and transformation, agreed.

“We’re excited to work with Saint Peter’s to expand models of care and reimbursement that have proven effective at improving health care quality, affordability and convenience for our members,” he said. “OMNIA health plans empower our members to achieve their best health, give them more control of their out-of-pocket expenses, and include every doctor and hospital in Horizon’s managed care network.”