2022 Horizon BCBSNJ HEDIS® results
| HEDIS Accreditation Measure for HMO/POS Combined | Description | Final HEDIS 2022 Performance Rate | Final HEDIS 2021 Performance Rate | HEDIS 2022 NJ State Average |
|---|---|---|---|---|
| Breast Cancer Screening | The percentage of women 50 to 74 years of age who had a mammogram to screen for breast cancer. | 70.85% | 71.91% | 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. | 81.31% | 76.8% | ND* |
| Childhood Immunization – Combination 10 | The percentage of children 2 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 three combination rates. | 57.04 | NA* | 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. | 60.69% | 58.82% | ND* |
| Colorectal Cancer Screening | The percentage of members 50 to 75 years of age who had appropriate screening for colorectal cancer. | 65.26% | 64.75% | 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. | 58.78% | 54.15% | 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. | 88.54% | 86.59% | 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. | 24.15% | 35.37% | 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. | 65.12% | 53.53% | 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 Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey was completed. | 49.20% | 54.29% | 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. | 58.92% | 59.75% | ND* |
*The Childhood Immunization Combo 10 measure previously reflected Childhood Immunization Combo 2 in HEDIS 2021.
*The 2022 NJ State average is not determined.
| HEDIS Accreditation Measure for PPO | Description | Final HEDIS 2022 Performance Rate | Final HEDIS 2021 Performance Rate | HEDIS 2022 NJ State Average Performance Rate |
|---|---|---|---|---|
| Breast Cancer Screening | The percentage of women 50 to 74 years of age who had a mammogram to screen for breast cancer. | 68.50% | 67.98% | 68.17% |
| 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. | 73.52% | 74.43% | 72.94% |
| Childhood Immunization - Combination 10 | The percentage of children 2 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 three combination rates. | 54.26% | NA* | 45.97% |
| 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. | 56.35% | 51.86% | 54.41% |
| Colorectal Cancer Screening | The percentage of members 50 to 75 years of age who had appropriate screening for colorectal cancer. | 60.44% | 55.33% | 63.07% |
| 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. | 46.96% | 40.63% | 43.71% |
| 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. | 90.27% | 86.37% | 89.86% |
| 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. | 30.90% | 53.53% | 31.79% |
| 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. | 54.74% | 46.72% | 56.73% |
| 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 Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey was completed. | 47.14% | 55.43% | 53.38% |
| 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. | 51.09% | 50.41% | 53.89% |
*The Childhood Immunization Combo 10 measure previously reflected Childhood Immunization Combo 2 in HEDIS 2021. Not applicable is reflected in HEDIS 2021.
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