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."

The Supreme Court decision was covered in articles in the New Jersey Law Journal, NJBIZ and NorthJersey.com.