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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