NJ’s Top Court Rules Horizon Must Divulge Details of ‘Secret’ OMNIA Plan

Source: NJ Spotlight.com
The New Jersey Supreme Court has granted four hospitals access to the McKinsey & Co. report, overturning an Appellate Court decision from June 2016 supporting Horizon’s claims that the materials were “irrelevant and confidential.” The top court noted that justice is better served when “all the available facts” are disclosed and suggested that trial judges had already outlined sufficient provisions to protect Horizon.
The plaintiff hospitals have insisted all along that the May 2014 consultant report was a critical tool in Horizon’s process to develop the OMNIA plan and assign providers to its two “tiers,” or networks, which offer discounts to patients who visit hospitals and providers in the Tier 1 category. Tiered plans have become a growing trend as insurance companies look for new ways to hold down the growing costs of healthcare; as of February, some 250,000 Garden State residents had enrolled in OMNIA.
Attorney Michael K. Furey, who represents three of the plaintiff hospitals — CentraState Medical Center in Freehold, Holy Name Medical Center in Teaneck, and Valley Hospital in Ridgewood — stated “This information will show that Horizon knew the harmful consequences of its tiered ranking system to Tier 2 hospitals before the selection process was completed and whether OMNIA is the value-based care program Horizon has trumpeted to the world.”
The decision was also welcomed by Saint Peter’s University Hospital, in New Brunswick, which filed a separate, but similar, lawsuit. “Saint Peter’s strongly believes it qualifies for the highest tier in any tiered network on the basis of cost and quality, and looks forward to proving that in court,” said interim CEO and president Leslie D. Hirsch.
Judge Clarkson Fisher, who has been temporarily assigned to the case, wrote that these hospitals should be able to review an unredacted version of the McKinsey report. In addition, Fisher said the confidentiality order and other restrictions — including limiting document review to attorneys and top company executives — put in place by the trial court would be sufficient to protect Horizon’s proprietary information.
Horizon maintains that tier status was determined through multiple criteria that reflect a hospital’s ability to work with them to provide more efficient, effective care — or “value-based” care — and is not simply a statement of quality. A spokesman suggested Monday that the long-awaited report won’t reveal many surprises either.
“The hospitals suing to block OMNIA might be disappointed to discover — after almost two years of litigation so far — that the company (has) simply developed a lower-cost, high-quality product that is fully consistent with the objectives of the Affordable Care Act,” said Horizon spokesman Kevin McArdle. OMNIA includes some 70,000 previously uninsured state residents, he said, and the focus should be on protecting their care — not dismantling a popular insurance product.

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