Monday's legislative hearings in Trenton on tiered network health plans drew a variety of reactions from the health care and business communities.
Here are just some of the comments about tiered plans and Horizon Blue Cross Blue Shield of New Jersey’s OMNIA plan.
Larry Downs, CEO, Medical Society of New Jersey:
“The Medical Society of New Jersey has long advocated for true network adequacy — the requirement that insurers have enough physicians in network to provide patients the care they pay for through premiums, even in a tiered or narrow network. MSNJ urges carriers to increase patient literacy about their products. ‘Surprise billing’ happens largely because carriers have not adequately educated their members about their plans and the insurance payments only cover a fraction of the market value of the services in many cases.”
John Harmon, CEO and president, African American Chamber of Commerce of New Jersey:
“I implore the Legislature to refrain from implementing measures that would create setbacks in the evolution of how we deal with health care in New Jersey. Value-based care, the system on which Horizon’s OMNIA plans are based, is a way to reduce costs and allow for greater choice for our businesses and consumers. We should be doing everything we can to embrace this change, not putting up roadblocks to stop it.”
Matt Malat, government relations, New Jersey Chamber of Commerce:
“One of the main influencers on business decisions for our members has been the costs of health care. These businesses are hungry for diverse alternatives, including coverage tailored around patient-centered collaborations which pay for claims-based patient outcomes. Consumers have too often paid costly and redundant medical bills, which has a negative impact on a business’s fiscal plan. A diverse health marketplace is what employers need to help curb their health care costs.
“The state chamber is supportive of innovation and choice of products, which can help address the needs of the state’s employers. Tiered network plans have been an outgrowth of consumer demand for greater options, greater innovation and lower costs.”
Eric Boyce, business manager/financial secretary treasurer, Plumbers Local 24, and legislative chairman, New Jersey State Pipe Trades Association:
“We all must acknowledge the old way of doing things can no longer stand. Simply put, we need more options. Tiered network systems are one such important option. As someone charged with managing health benefit plans, I want and need every possible tool available to me in my toolbox. What I do not want or need are government regulations restricting or eliminating access to quality, affordable health care options.”
Mary Beaumont, health & legal affairs, New Jersey Business & Industry Association:
“In our 2014 Health Benefits Survey, the cost of health insurance was the top challenge facing the majority of our members, with 71 percent indicating it was one of their top concerns. NJBIA members want to provide health benefits as a way to attract and keep good employees, but have specific concerns about health care and rising health benefits costs. The survey found that 45 percent of our member companies lowered profits, 35 percent limited raises for employees and 22 percent delayed investments in order to afford to provide this benefit for employees. It is very important to find and develop ways to bring these costs under control.
“The association recognizes that the current health care system needs to be better coordinated, more consistent and less costly, and reward those who follow this approach. Innovative, successful, patient-centered, value-based collaborations between health insurers and doctors and hospitals have been established that tie payment to better patient outcomes. NJBIA believes that transparency, disclosure and consumer education are important aspects in the transformation of health care. Dissemination of information on how tiered networks are established, providers are included in tiers and the cost-sharing requirements, permit employers and employees to be more discerning in their health care decisions and choices.”
New Jersey Association of Health Plans:
“New Jersey is home to some of the highest health care costs in the nation. Hospital costs represent about half of medical spend, while pharmacy costs are growing at the highest rate. If your annual individual premium exceeds a set amount it will be subject to a 40 percent excise tax — the (Affordable Care Act)’s so-called ‘Cadillac Tax’ — beginning in 2020. The excise tax also applies to government health benefits, and the New Jersey Pension and Health Benefits Study Commission had projected that the tax will increase the State Health Programs’ costs by an additional $58 million in FY2018, rising to $284 million by 2020. Innovation is not optional, and health plans are responding with new products such as those that move from a fee-for-services model toward fee-for-value and consumer-directed services.”
State Sen. Loretta Weinberg (D-Teaneck):
“Our primary focus must be the ability of residents that are covered to get affordable coverage and, equally important, to adequately access health care. Horizon’s plans have the ability to limit access by harming health care institutions that are not included in particular tiers. I have strong concerns regarding the lack of transparency of the process thus far. Tiered network systems in New Jersey should be fair and equitable and they should be developed in a transparent manner.”
William Mullen, president, New Jersey State Building and Construction Trades Council:
“We applaud those insurers who are moving away from ‘fee for service’ care towards a value-based care system that allows for more options, better quality and lower costs. What is most important now is that the 150,000 members that I represent are allowed the option of more choice. More restrictions will only serve to hurt these hard-working people.”
Carlos Medina, chairman, Statewide Hispanic Chamber of Commerce:
“Business owners are looking for options for more affordable health insurance. Value-based care does just that. This is particularly true because value-based care is the result of cooperative relationships with hospitals and doctors to focus on higher quality care, a better patient experience and lower costs. Government should never get in the way of consumers being able to decide what health care options are best for themselves, their families, and their businesses.”
George Laufenberg, fund director, Northeast Carpenters Fund:
“Now is not the time to step in and try to eliminate choice. More options, lower costs and better care are all great things. Instead, we ask the Legislature to work with us, with health insurers and health care professionals and with those who know the industry best to ensure positive outcomes for the millions of New Jerseyans who need good, quality health care.”
State Senate President Steve Sweeney (D-West Deptford):
“Consumers benefit with more choice, better quality and lower cost. Value based care helps all consumers. Just this week, the Robert Wood Johnson Foundation released a study with Harvard University finding that 3 out of 5 New Jersey residents say that health care costs are a ‘major’ problem for their families. I want to thank the health care systems in New Jersey that also are moving away from ‘volume’-based care — to name just a few, Barnabas, Hackensack, Hunterdon and, in my backyard, Inspira health care systems.
“And this should serve as a wake-up call to those that are not: We can no longer afford a health care system that rewards the number of patients who enter a hospital or doctors’ office — almost like a sports team is rewarded for bringing fans into the stadium. The idea is to keep patients out of the hospital, not to bring them in.
“Consumers expect no less. So I applaud giving consumers the choice of products aimed at improving care and reducing costs. So I stand with the trade unions, public employee unions and business groups that have told me — both publicly and privately — that tiered products, whether they are offered by Horizon, Aetna or others, are good alternatives to high-deductible plans for consumers.
“At the same time, we need to make sure New Jersey law has protections in place for all consumers that are focused on transparency. “
Gene Mulroy, founding principal, Capital Impact Group:
"There is wide agreement between the Senate president's stated goals and those of the coalition hospitals. We have no fundamental issue with tiered health plans. We believe they can be effective when designed and implemented properly. They must be transparent in their metrics and the application of their metrics so that consumers can make informed health care choices.”