I want to thank Senators Vitale and Gill for raising the red flag on the Blue Cross Horizon Omnia Plan. Any time a private company wants to merge and become bigger, we run the risk of having a monopoly that ultimately has the power to charge whatever it wants. “Care-coordination” and “value based approach” are meaningless buzz words.
The sickest and most vulnerable patients are at risk, as these plans have no real way to “keep people well.” Hospitals must be places of mercy and not revenue centers. This should be about care– not big business and mergers. If a hospital is unprofitable, it may just be doing its job, caring for those who are in need. Arbitrary “measurements of quality and cost efficiency” are not what the people need when choosing a hospital.
There is no price transparency in medical care as demonstrated by the recent $42,678 hospital bill for a normal uncomplicated delivery. “Insurance payments and adjustments” were $42,624.60. What exactly did that insurance company pay? What were the real costs and how can such a bill be justified? All of these charges, adjustments and payments behind closed doors suggest skulduggery, plain and simple.
We need to remember what real insurance was meant to be– a buffer to protect one’s assets against the cost of major medical events. Insurance cannot keep people well. We must reduce the power of these plans and have them serve the people, competing with other plans on cost, service and ability to negotiate and pay for major medical expenses. All hospitals should be included.
Let’s work together. Let’s clear the way for direct primary care, where people pay directly or become members of a local physician office for as low as $50/month. Let’s reserve insurance for the catastrophic and reduce the power of these big conglomerates. And let’s figure out how to provide real charity care to the poor without erecting a huge bureaucracy that amounts to a barrier to care. Alieta Eck, MD For Real Health Care Reform
ANDREW KITCHENMAN | OCTOBER 6, 2015
State senators to call on attorney general to block controversial tiered insurance plan before planned November launch
The traditional role of New Jersey’s state government in regulating the hospital and insurance industries has been to balance the needs of residents against the realities of the market, to ensure, among other things, equitable access to healthcare.
Then why are two leading senators on insurance issues — Nia H. Gill (D-Essex and Passaic) and Joseph F. Vitale (D-Middlesex) — arguing that the state has abdicated its responsibility in the case of the new OMNIA Health Alliance from Horizon Blue Cross Blue Shield of New Jersey? And they’re not alone in claiming that Horizon’s secretive selection process has left hospitals that were shut out of the alliance facing a bleak future, one that could include going dark.
This situation helps explain why Gill and Vitale are calling for Acting Attorney General John J. Hoffman to step in and put a stop to the OMNIA rollout, at least until his office and legislators have more time to review the plans.
Both Horizon executives and critics of how OMNIA was put together attempted to build their cases during nearly eight hours of testimony before a joint meeting of Senate Commerce and Health, Human Services, and Senior Citizens Committee.
It’s a process that could play out again in legal proceedings, as those left out of the alliance are raising the possibility of going to court to block it.
That said, not everything about OMNIA is raising a red flag. Senators welcome the possibility of lower costs, as well as the improved care-coordination and value-based approach that the tiered insurance plan is supposed to deliver.
And OMNIA has its defenders. One of them, Dr. Jeffrey Le Benger, CEO of alliance member Summit Medical Group, said that Summit has already reduced the cost of providing care to Horizon members by 13 percent over a two-year period.
Ronald C. Rak, chief executive of New Brunswick-based St. Peter’s Healthcare System, is definitely not among OMNIA’s champions. He found a corollary to the actions of the state’s largest insurer in ancient Rome.
https://www.njspotlight.com/stories/15/10/06/critics-take-horizon-to-task-over-omnia-alliance-transparency/?utm_source=NJ+Spotlight++Master+List&utm_campaign=69e35f56a3-Daily_Digest2_5_2015&utm_medium=email&utm_term=0_1d26f473a7-69e35f56a3-398635969
