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2021 Horizon BCBSNJ HEDIS® results

2021 HEDIS® Results – HMO/POS Combined

HEDIS Accreditation Description Final HEDIS Final HEDIS HEDIS
Breast Cancer Screening The percentage of women 50 to 74 years of age who had a mammogram to screen for breast cancer. 71.91% 73.92% ND
Cervical Cancer Screening (Commercial) The percentage of women 21 to 64 years of age who were screened for cervical cancer using either of the following criteria: women 21 to 64 years of age who had cervical cytology performed every three years or women 30 to 64 years of age who had cervical cytology/human papillomavirus (HPV) co-testing performed every five years. 76.8% 82.43% ND
Childhood Immunization - Combination 2 The percentage of children two years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV); one measles, mumps and rubella (MMR); three haemophilus influenza type B (HiB); three hepatitis B (HepB), one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (HepA); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday. The measure calculates a rate for each vaccine and nine separate combination rates. 80.78% 75.43% ND
Chlamydia Screening for Women – Total Rate The percentage of women 16 to 24 years of age who were identified as sexually active and who had at least one test for chlamydia during the measurement year. 58.82% 63.93% ND
Colorectal Cancer Screening The percentage of members 50 to 75 years of age who had appropriate screening for colorectal cancer. 64.75% 67.01% ND
Comprehensive Diabetes Care Eye Exam The percentage of members 18 to 75 years of age who had an eye screening for diabetic retinal disease and included one of the following: a retinal or dilated eye exam by an eye care professional (optometrist or ophthalmologist) in the measurement year or a negative retinal or dilated eye exam (negative for retinopathy) by an eye care professional in the year prior to the measurement year. 54.15% 62.23% ND
Comprehensive Diabetes Care HbA1c Testing The percentage of members 18 to 75 years of age who had an HbA1c test performed during the measurement year. 86.59% 89.10% ND
Comprehensive Diabetes Care HbA1c Poor Control (>9.0 percent; Lower is Better) The percentage of members 18 to 75 years of age whose last HbA1c test had a result of >9.0 percent during the measurement year. 35.37% 31.91% ND
Controlling High Blood Pressure The percentage of members 18 to 85 years of age who had a diagnosis of hypertension (HTN) and whose BP was adequately controlled during the measurement year. 53.53% 57.66% ND
Flu Shots for Adults Ages 18 to 64 Years of Age (Survey measure) The percentage of members 50 to 64 years of age who received an influenza vaccination between July 1 of the measurement year and the date when the 54.29% 48.65% ND
Follow-Up After Hospitalization for Mental Illness (Seven-Day Rate) The percentage of discharges for members six years of age and older (hospitalized for specified mental illnesses) who had a follow-up visit with a mental health provider within seven days of discharge. 59.75% 56.39% ND

2021 HEDIS Results – PPO/EPO

HEDIS Accreditation Measure for PPO Description Final HEDIS Final HEDIS HEDIS
Breast Cancer Screening The percentage of women 50 to 74 years of age who had a mammogram to screen for breast cancer. 67.98% 69.34% 67.91%
Cervical Cancer Screening (Commercial) The percentage of women 21 to 64 years of age who were screened for cervical cancer using either of the following criteria: women 21 to 64 years of age who had cervical cytology performed every three years or women 30 to 64 years of age who had cervical cytology/human papillomavirus (HPV) co-testing performed every five years. 74.43% 76.74% 72.11%
Childhood Immunization - Combination 2 The percentage of children two years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV); one measles, mumps and rubella (MMR); three haemophilus influenza type B (HiB); three hepatitis B (HepB), one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (HepA); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday. The measure calculates a rate for each vaccine and nine separate combination rates. 64.48% 77.62% 61.16%
Chlamydia Screening for Women - Total Rate The percentage of women 16 to 24 years of age who were identified as sexually active and who had at least one test for chlamydia during the measurement year. 51.86% 58.56% 52.44%
Colorectal Cancer Screening The percentage of members 50 to 75 years of age who had appropriate screening for colorectal cancer. 55.33% 57.07% 59.61%
Comprehensive Diabetes Care Eye Exam The percentage of members 18 to 75 years age who had an eye screening for diabetic retinal disease and includes one of the following: a retinal or dilated eye exam by an eye care professional (optometrist or ophthalmologist) in the measurement year or a negative retinal or dilated eye exam (negative for retinopathy) by an eye care professional in the year prior to the measurement year. 40.63% 52.65% 42.78%
Comprehensive Diabetes Care HbA1c Testing The percentage of members 18 to 75 years of age who had an HbA1c test performed during the measurement year. 86.37% 87.28% 86.22%
Comprehensive Diabetes Care HbA1c Poor Control (>9.0 percent; Lower is Better) The percentage of members 18 to 75 years of age whose last HbA1c test had a result of >9.0 percent during the measurement year. 53.53% 36.66% 38.56%
Controlling High Blood Pressure The percentage of members 18 to 85 years of age who had a diagnosis of hypertension (HTN) and whose BP was adequately controlled during the measurement year. 46.72% 52.80% 51.45%
Flu Shots for Adults Ages 18 to 64 Years of Age (Survey measure) The percentage of members 50 to 64 years of age who received an influenza vaccination between July 1 of the measurement year and the date when the 55.43% 51.79% 59.17%
Follow-Up After Hospitalization for Mental Illness (Seven-Day Rate) The percentage of discharges for members six years of age and older (hospitalized for specified mental illnesses) who had a follow-up visit with a mental health provider within seven days of discharge. 50.41% 46.30% 54.79%

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