Horizon handles criticism of OMNIA
A major health care announcement last week has already produced a healthy gathering of critics.
When Horizon Blue Cross Blue Shield of
CEO and President
The alliance is a partnership between Horizon, six health care systems and the state's largest physicians group, all of which will have three representatives each on the alliance's governing committee. Twelve other hospitals in the state will also benefit from the partnership by being part of a so-called Tier 1 plan.
Those in favor said it was a bold step - and that it could change the landscape of health care in the state.
Those against it or not a part of it are concerned about how this affects health service to some parts of the state.
"We're extremely disappointed and shocked that we were not selected as a Tier 1 hospital, given our status as the sole provider for
"Surprisingly, Horizon is withdrawing the Exchange Product from the market effective
Horizon has said it will continue to offer all broad network products, which it expects will remain the most popular among consumers in 2016.
"No consumer in
Similar to Trinitas,
"As
Horizon said that health systems chosen to be a part of the alliance weren't just top quality providers, but those who had already invested in making a change to a value-based health care system.
"(The alliance was created) based upon an understanding of the desire, ability and demonstrated commitment by those health systems to move from fee-for-service to fee-for-value health care," Rubino said. "We did not consider in our selection criteria the health systems' tax status, religious affiliation or governance structure."
Horizon already has a tiered plan, and those currently in Tier 1 will not be moved, he said. And Horizon is not the only one offering tiered plans in the state.
Aetna, which currently has 1.1 million insured lives in
"Approximately 20 percent of our
Marino said the difference with
The alliance has the power to set budgets, create quality metrics and determine technology investments in order to ensure the best quality for population health management.
It is a new definition of how an insurer is working with a provider, Marino said.
Rather than seeking bids and signing contracts every few years, this new partnership is like a multiyear contract.
"I think it's going to be interesting to see whether the product sells in the marketplace," said
Manigan noted politicians already are concerned about the new plan, but wonders if they will be able to act.
"If there is a thirst for this product, what are they going to do?" he said.
Some already fear there could be a rush to the product that will hamper others ability to do business. Marino isn't so sure that's a legitimate concern.
"Is that a theoretical possibility? Sure it's a possibility, but for that to happen all 3.9 million Horizon members would have to sign up for the
Actions taken by employers to contain cost
53% Increased deductibles
29% Increased employee contributions
25% Introduced high deductible health plan
26% Changed carriers
21% Reported no actions taken
19% Reduced benefits
8% Increased wellness programs
8% Switched to a narrow network
8% Discontinued plan options
8% Spousal surcharge
SOURCE: NJBIA 2014
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