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. Lower-cost hospitals, if they were smaller, didn't get an invitation to the elite club - even if they were known to deliver high-quality care. The greatest weight was given to clinical quality and subjective judgments about the mindset of hospital CEOs. Horizon didn't consider prices in choosing its preferred hospitals.īut it gave weight to how big they were and how many services they offered, the document shows. Horizon gave some hospitals, like Hackensack University Medical Center, the sole preferred listing in their counties to entice them to the table. It was developed secretly to secure a competitive advantage against other insurers and lock in hospital partners before they did. Omnia, the name for the new Horizon health plan, was as much about protecting and expanding the market share of Horizon and its preferred hospital partners as it was about quality care, the document shows. The report shows how the company decided which hospitals to reward with preferred status, giving them more business by encouraging more Horizon members to use them.Īnd, by shedding light on the calculations of the state's most powerful insurance company, the once-secret document illustrates the forces shaping health care in the state. Now, the release of a confidential Horizon report - the result of a lawsuit brought by NJ Advance Media - has provided some answers. Those questions ignited a firestorm of lawsuits, legislative hearings and marketing campaigns. North Jersey institutions that didn't receive favored status, like Holy Name Medical Center in Teaneck and The Valley Hospital in Ridgewood, demanded an explanation - and inclusion. When the state's largest health insurer announced a new insurance offering in 2015 to answer consumers' demands for lower-cost health care, it said its new, transformative approach would lower costs by steering patients to doctors and hospitals that provided the best care.īut which hospitals and which doctors would Horizon Blue Cross Blue Shield of New Jersey select? And how?
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