Horizon said its consultant prepared those figures to help pitch the agreement to potential partners they do not reflect actual performance. Holy Name's Maron says that as far as his institution is concerned, that prediction has not come to pass. In Bergen County, that would mean additional profits for Hackensack of $25 million, and lost profits for Holy Name and Valley, as patients migrated from them to Hackensack, according to the report's projections. Under one scenario, 40 percent of emergency patients and 60 percent of patients admitted for elective procedures would shift their business from Tier 2 hospitals to Tier 1 hospitals because of the lower out-of-pocket costs. The report projected how patients' decisions would change after Omnia was introduced. How different institutions would be affected Community hospitals Horizon 'invested considerable time and resources and engaged outside experts to create an objective model that considered multiple and complex factors,' the company said after the report was released. The hospitals that filed suit argued that the last three categories show Horizon's bias in favor of larger health care systems. Financial resources, the scope of services and size each contributed 10 percent. Clinical quality and 'leadership mindset' together accounted for half of the evaluation. The report shows the criteria that Horizon used to decide which hospitals to include in Tier 1 and the weight it gave each. The confidential report, prepared in 2014 by the consulting giant McKinsey & Co., provided guidance to Horizon as it designed its Omnia health plans. It was made public last week after a lawsuit by NJ Advance Media publications. Horizon fought its release all the way to the state Supreme Court. The company's Medicare Advantage plan uses a subset of its hospital network to provide care, but it is not the same as an Omnia plan. Omnia plans are not sold to Medicare beneficiaries. Omnia premiums are about 10 percent lower than other Horizon insurance plans. They increased by 9.4 percent in 2017 and 23.6 percent in 2018 for people who bought their coverage individually, according to the federal website .Īll insurance premiums have been climbing, and New Jersey's insurance premiums overall have increased at a slower rate than the national average. Horizon attributed most of its price hikes to uncertainty in the health insurance market brought about by Congress's efforts to dismantle the Affordable Care Act. They can still go to a Tier 2 provider, but their out-of-pocket costs will be higher. Omnia-insured customers save two ways: They pay lower premiums to purchase insurance, and then - with Omnia - they pay less for care if they go to a hospital or doctor in Tier 1. Horizon divided the state's hospitals and doctors into two categories: Tier 1 and Tier 2, preferred and non-preferred. About 71,000 previously uninsured people have done so, the company said. An additional large group of public employees choose it through the State Health Benefits Plan. How Omnia worksĮnrollment in Horizon's Omnia plans - now in their third year - stands at about 450,000 people, the company says. Omnia plans are available through employers and to people who buy their own insurance, including those who get subsidies through the Affordable Care Act. The independent hospitals fought Horizon's implementation of the Omnia plan. Encouraging price inflation would be bad for them and their customers. Its Omnia partnerships were created 'with a focus on transforming the health care system to provide consumers with high-quality care and affordable coverage with a better health care experience,' the company said. Fewer than 10 hospitals, including Holy Name and Valley, remain unattached to larger systems.Ĭritics of Horizon say that by reducing competition and weakening independent institutions, the company ultimately will cause health care costs to rise and consumer choice to shrink. Smaller hospitals, faced with the loss of patients, will have to join with larger systems or operate with reduced revenue - a consequence the company did not address in the internal documents. Today, the landscape is dominated by three big players: Horizon itself, with 3.8 million people, or nearly half the state's insured population under coverage, and the two biggest hospital systems, led by Hackensack University Medical Center and Saint Barnabas Medical Center. An evolved landscapeĪ decade ago, a half-dozen insurers and more than 70 hospitals, most of the latter independent, jostled and competed in New Jersey's health care marketplace. Horizon accelerated a consolidation in New Jersey health care similar to those in banking, airlines and the pharmaceutical industry.

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