'Disappointed' bishops ask why Catholic hospitals excluded from new plan

Trenton, N.J.

New Jersey's Catholic bishops have weighed in on a growing concern over a new health insurance plan introduced by the state's largest insurer, saying they were "disappointed" all but one Catholic hospital was being excluded from preferred access.

"Over the years, we had considered Horizon to be a partner in delivering health services even to the vulnerable populations we serve," the bishops' letter said. "With the rollout of the Horizon OMNIA Alliance, that partnership seems to be a memory."

The letter -- sent to Robert Marino, CEO of Horizon Blue Cross Blue Shield of New Jersey -- reminds the corporation of the Catholic community's long history of providing health care in New Jersey. The bishops cited "the lack of transparency in the process" that kept all Catholic hospitals except one -- St. Joseph's Healthcare System in Paterson -- out of the Tier 1 designation, which is considered the "preferred group."

"To protect the financial stability of our health care systems and to ensure that no harm is done to the safety net for the poor, we, the Catholic bishops of New Jersey, request that you reopen the OMNIA Alliance process to allow hospitals designated as Tier 2 (considered a less-attractive grouping) to apply for designation as Tier 1 facilities," they wrote.

In September, Horizon Blue Cross Blue Shield of New Jersey, better known as Horizon BCBSNJ, unveiled the OMNIA health alliance, a collaboration with a number of large health systems to change how care is provided and reimbursed.

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Catholic hospitals fear that OMNIA's clients will be steered toward preferred-tier providers. They see a future in which their ability to provide services could be crippled and their reputation for high-quality care significantly damaged.

It's hard to overstate the "impact this would have on our mission, on our margin, and really the values we uphold," said Sr. Patricia Codey, a Sister of Charity, who is president of the Catholic HealthCare Partnership of New Jersey. "It's the Tier 1s and the Tier 2s, it's like the winners and the losers, or the 'haves' and the 'have-nots.' And that becomes important for the consumers, because the perception could be 'they don't have quality or low costs.'"

The Catholic HealthCare Partnership of New Jersey is a statewide coalition established by the leaders of Catholic health care to advance their ministry and mission. They are concerned, Codey said, about the impact OMNIA's tiers could have on their ability to provide services to at-risk populations.

"Most of (the hospitals) who were excluded were rural, urban and Catholic," she told The Monitor, newspaper of the Diocese of Trenton. "And those are the institutions that deliver health care to the poor, the vulnerable and the uninsured."

The letter to Horizon BCBSNJ was jointly signed by: Trenton Bishop David M. O'Connell; Archbishop John J. Myers and Coadjutor Archbishop Bernard A. Hebda of Newark; Bishop Dennis J. Sullivan of Camden; Bishop Arthur J. Serratelli of Paterson; Bishop Paul G. Bootkoski of Metuchen; Bishop Kurt Burnette of the Byzantine Catholic Eparchy of Passaic; and Auxiliary Bishops John W. Flesey and Manuel A. Cruz of Newark.

Another letter, sent by Sr. Sheila Lemieux, leader of the Congregation of the Sisters of St. Joseph of Peace, which sponsors Holy Name Medical Center in Teaneck, accused Horizon BCBSNJ of practicing "discrimination against Catholics." The letter, obtained by The [North Jersey] Record, sharply attacks the insurance company and says the sisters "find no justice. ... We find only the workings of those who would stifle our mission -- a mission of the church -- for the sake of profit."

In a separate action, St. Peter's University Hospital of New Brunswick, part of the Diocese of Metuchen, requested a Middlesex County Superior Court judge to issue a temporary restraining order to stop Horizon BCBSNJ from continuing to implement its plans.

Judge Frank Ciuffani called for an expedited hearing on the development and implementation of the tiered-network plan while denying their request for an immediate injunction.

In its filed complaint, St. Peter's claims Horizon BCBSNJ failed "to exercise its discretion in a fair and open manner that will rationally advance the public good." The hospital claims it could lose up to $36 million in reimbursements from Horizon because of the shift to the OMNIA alliance plan.

Horizon BCBSNJ did not open the door to re-examining the formation of the network, but stressed it was interested finding new health care strategies. "It is unfortunate that St. Peter's, one of our long-standing network hospitals, would choose litigation instead of conversation on how we can work together to provide those we both serve with access to lower cost health care," the insurance company said in a statement.

The chairs of the New Jersey state senate's commerce and health committees had requested the state's attorney general to investigate the formation and rollout of the new alliance. A spokesman for the office of the attorney general said that decision is still pending.

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