On July 24, the New Jersey Supreme Court ruled that Horizon Blue
Cross Blue Shield of New Jersey must turn over the internal report
it used in determining the composition of its tiered
OMNIA health plan. Four hospitals, three of which are
represented by Day Pitney, continue to challenge their designation
as "Tier 2" in the plan, as
discussed frequently on this blog. The battle over disclosure
of the report dates back to
March 2016, when two lower courts ordered that the report be
released. An appellate court later reversed those decisions, but
its decision was in turn overruled by the Supreme Court.
In a statement, Day Pitney's Mike Furey said, "The
Supreme Court's decision today is an important step in
unraveling the secrecy surrounding the OMNIA plan by forcing
Horizon to disclose important information regarding its selection
process as detailed in the McKinsey report and the agreements
Horizon has reached with the large hospital systems. 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 Supreme Court's
ruling also recognizes the Appellate Division acted prematurely and
inappropriately in making certain findings on the merits of the
dispute before discovery was conducted."
Mike added, "The more we learn about the OMNIA plan through
this lawsuit, the more we know that — instead of relying upon
objective health care criteria — Horizon pre-selected the
state's largest and most expensive hospitals to be Tier 1
providers. We are also suspicious that OMNIA is not a value based
plan and OMNIA, in practice, is far different from how Horizon has
described it publicly. We are confident that, ultimately, our
lawsuit will prevail and the public will learn the truth about
Horizon's ill-conceived OMNIA plan."
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