Horizon BCBS NJ CEO Explains OMNIA and Its Tiered System

Bob Marino, Chairman, CEO and President Horizon Blue Cross Blue Shield of NJ, talks about OMNIA, the benefits it offers consumers and addresses the controversy and lawsuits that rolled out as a result of the service’s tiered system.

10/1/16 #628






"We are pleased to be joined by Mr. Bob Marino, chairman, C.E.O., president of Horizon Blue Cross/Blue Shield New Jersey. Good to see you, Bob. Good to see you, Steve. Rafael, good to see you. Not that there's anything happening in the health-care landscape in New Jersey and the nation... [ Laughter ] Bob, let's do this. First of all, you are a board member of Public Broadcasting in the state of New Jersey, a supporter of public broadcasting in the state, full disclosure, and I've done some leadership development at the company. We'll not hold that against you. [ Laughter ] Um... And he won't hold it against you. Raf, we didn't need that. [ Laughs ] Um, can we do this, Bob? Talk to us about the OMNIA initiative. Last time we talked about it with those who had questions about it, it was a very different situation. Some of the quote/unquote "tier 2" hospitals -- tier 1, tier 2 -- There have been some court decisions. There have been some changes. Where are we today? Well, where we are with today is OMNIA has been fully rolled out for 2016. We've got approximately 270,000 members that signed up for OMNIA, and we're really pleased with the initial results with OMNIA. What is it? Well, when you take a step back and you look at why did Horizon roll out the OMNIA product, we really did it in response to what our customers are telling us very loudly and very clearly over the last several years, which is health-care costs are unsustainable and the current system that we use to finance and deliver health care, which we call a fee-for-service system, is basically unsustainable. And when you look at health-care spending nationally in the United States, this country spends $3 trillion a year on health care -- basically 18% of the gross domestic product. And if you talk to the experts, they're telling us that that's gonna grow to 20% of the gross domestic product by 2025. So, if you really want to get our arms around health-care cost and we really want to change the paradigm of, year over year, increasing in health-care costs, we've got to change the system. And that's what OMNIA is attempting to do. It's attempting to change how we pay for and deliver health care in New Jersey. How is it doing that? Well, Rafael, the way we're doing it is, today, as I said earlier, we operate in this world called fee-for-service. As the name implies, the more services you do, the more fees you collect. What we need to do in health care and what we're trying to do with OMNIA and the OMNIA partners is change that to what we're calling fee-for-value, meaning that we want to pay for value..."