Religious leader claims Horizon BCBS "schemed" to exclude most Catholic hospitals from new plan

New Jersey's dominant insurance company "schemed in secret" to intentionally exclude Catholic hospitals from a new plan, Sister Patricia Codey, president of the state's Catholic HealthCare Partnership said Monday, according to an NJ.com report.

Sister Codey heads the statewide coalition representing Catholic hospitals that are part of the Catholic Healthcare Ministry of New Jersey. She pointed to religious discrimination to explain why seven out of eight Catholic hospital systems were shut out of Horizon Blue Cross Blue Shield of New Jersey's new line of health plans.

For the new plans, Horizon penned an agreement with 34 of the state's largest hospitals to accept lower reimbursement rates for higher patient volumes. The centerpiece of Horizon's new plan is the launch of the OMNIA Alliance, which allows 22 of its deemed 34 "tier-one" hospitals to earn more if they show they are providing high-quality care at a lower cost.

Some of New Jersey's biggest hospital players have been included in the alliance, such as Morristown-based Atlantic Health, New Brunswick-based Robert Wood Johnson University Health, Livingston-based Barnabas Health and Hackensack (N.J.) University Medical Center.

Sister Codey said most Catholic hospitals achieved high scores on the Leapfrog Group's national safety report card, and they are used to operating leaner systems while treating high volumes of poor people compared to many of the large hospital systems Horizon invited to join its OMNIA Alliance and first tier network.

"Horizon was not transparent and schemed in secret with select hospital systems while refusing to detail the criteria they used," Sister Codey said, according to the report. "So in the end, not only did Horizon deliberately exclude Catholic hospitals, but they have chosen some of the most expensive hospitals in New Jersey which will cost their customers even more. Insurance companies should not be able to dictate which of our state's hospitals succeed and which ones fail. However, that is exactly what Horizon — the state's largest insurer — is doing with its plan to designate Catholic hospitals as second-tier facilities. The implication of Horizon's decision is clear to Catholic patients."

Horizon denied religious affiliation had any influence on its selection of hospital participants.

"Horizon BCBSNJ engaged in a thoughtful and deliberate process in choosing the OMNIA Health Alliance 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. We did not consider in our criteria the health systems' tax status, religious affiliation or governance structure," said Horizon spokesman Tom Vincz, according to the report.

Horizon officials estimate 250,000 people will join the health plan in 2016.

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