Use of Horizon Hospital Network Performance Data

Policy Name:
Use of Horizon Hospital Network Performance Data

Effective Date:
September 27, 2013

Last Revised Date:
September 25, 2015

Subject:
Use of Horizon Hospital Network Provider Performance Data

Scope:
This policy applies to the Acute Care Hospital Network of providers within the Horizon Healthcare of New Jersey, Inc. Managed Care Network, and the Horizon Healthcare Services, Inc. d/b/a Horizon Blue Cross Blue Shield of New Jersey PPO Network, who provide health care services to Horizon members/covered persons. For the purpose of this policy the above Horizon entities shall be collectively referred to as "Horizon".

Purpose:
The purpose of this policy is to outline when Horizon may use a hospital’s performance data.

Policy:
Hospitals shall allow Horizon to use performance data for various initiatives or programs including, but not limited to, voluntary participation in Horizon’s Hospital Recognition Program, partnerships in the New Jersey Infection Prevention Program, and participation in the Blue Distinction Centers for Specialty Care which is encouraged through the Blue Cross and Blue Shield Association.

Examples of performance data that may be utilized by Horizon include, but are not limited to patient safety, clinical outcomes, readmission rates, length of stay, adverse events and encounter data.

The Horizon Network Hospital Manual details Horizon BCBSNJ’s Quality Management Programs. All Quality Management Programs require the timely gathering and reporting of data for use in Hospital Performance and Quality measures.

References:

NCQA - Current Standards and Guidelines for the Accreditation of Health Plans

HCM-PP-HCS-021-0915