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Women’s Health Results and Recognition Program

Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) would like to collaborate with you to improve maternal and women's health in New Jersey. Our goal is to positively impact the health and wellness of women.

Horizon BCBSNJ launched the Women's Health Results and Recognition (R&R) Program to improve clinical outcomes, performance on HEDIS measures and promote the quality of care rendered to your patients, our members.

Early detection for any health issue has the best outcome. Prenatal care can help reduce the risk of pregnancy complications and fetal complications. We are focusing on early detection by encouraging and educating our members to have their prenatal and postpartum care visit, to be screened for breast cancer, cervical cancer, and chlamydia.

The Women's Health R&R program offers additional financial incentives to providers that are tied to improved performance for specific HEDIS measures through high-touch collaboration with Horizon BCBSNJ. Horizon Healthy Journey and Horizon Mommy's Health Choice programs offers incentives for women who have completed their mammograms and for women who have their prenatal visit, postpartum visit and were screened for postpartum depression.

Through this R&R program, your site will receive:

  • Clinical Quality Improvement Liaison - A dedicated single point of contact on quality for all lines of business with support through monthly touch-point meetings, report analysis, educational webinars and resources to promote best practices and suggested HEDIS billing codes to close gaps of care.
  • Additional Incentive Payments:
    • Medicaid - Additional payments for every quality performance gap closed over the percentile NCQA Benchmarks.
    • Medicaid Prenatal and Postpartum Visits - Additional payment for every quality performance gap closed once you reach the percentile NCQA Benchmarks.
    • Medicare Stars - Additional payments for every quality performance gap closed once you reach the identified Stars rating.
    • Fully Integrated Dual Eligible Special Needs Program (FIDE-SNP) - Additional payments for every quality performance gap closed once you reach the identified Stars rating.
  • Incentive payments - Payments are released through Electronic Fund Transfer (EFT) with detailed payment attribution reports.
  • Member Gap Reports - Practice-level monthly quality report cards and patient-level detail gap reports. Reports include detailed data, such as, open gaps of care, member specific information, Patient Risk Assessment (PRA) for expectant women who have completed the form, among other relevant information.
    • Included in the Women's Health member detail gap reports, are important HEDIS measures for women who fall into Prenatal and Postpartum Care measures.

Women's Health R&R HEDIS measures:

Incentivized HEDIS Measures:
Prenatal and Postpartum Care – Prenatal Visit
Prenatal and Postpartum Care – Postpartum Visit
Breast Cancer Screening
Cervical Cancer Screening
Chlamydia Screening in Women

Informational HEDIS Measures:
Prenatal Immunization Status – Influenza and TDap
Prenatal Depression Screening and Follow up
Postpartum Depression Screening and Follow up

Prenatal Care can help reduce complications and risks to both the mother and infant.

Incentivized HEDIS Measures Description Best Practices
Prenatal and Postpartum Care (PPC) - The percentage of deliveries of live births on or between October 8 of the year prior to the measurement year and October 7 of the measurement year.
Prenatal Care Visit Prenatal care visit in the first trimester, on or before the enrollment start date or within 42 days of enrollment in the organization
  • Stress the importance of the prenatal/initial visit
  • Review the visit schedule with the patient
  • Connect patients to resources for family assistance programs in New Jersey
  • Encourage patients to maintain the relationship with an OB/GYN to promote consistent and coordinated health care
  • Educate patients on the importance of keeping each prenatal and postpartum visit
  • Consider offering extended practice hours to increase care access
  • Remind patients of their appointment by making calls or sending texts
  • Make outreach calls and/or send letters to advise members of the need for a visit
  • Partner with Horizon Healthy Journey Program to assist with targeted outreach activities
Postpartum Care Visit Postpartum visit on or between 7 and 84 days after delivery.

Early detection is the key to better outcomes and offers care at the earliest possible stages of cancer.

Incentivized HEDIS Measures Description Best Practices
Breast Cancer Screening Women 50–74 years of age who had a mammogram to screen for breast cancer
  • Educate members about the importance of early detection and encourage screening
  • Engage patients to discuss their fears
  • Advise women the test is less uncomfortable and uses less radiation then in the past
  • Establish a standing order to obtain annual mammogram for eligible population
  • Document the month and year of most recent mammogram and/or mastectomy status, in the medical record
Cervical Cancer Screening Women 21–64 years of age who were screened for cervical cancer using either of the following criteria:
  • Women 21–64 years of age who had cervical cytology performed within the last 3 years.
  • Women 30–64 years of age who had cervical high-risk human papillomavirus (hrHPV) testing performed within the last 5 years.
  • Women 30–64 years of age who had cervical cytology/high-risk human papillomavirus (hrHPV) co-testing within the last 5 years
  • Assess existing barriers to regular cervical cancer screening (i.e. access to care, cost)
  • Educate the members about the importance of early detection and encourage screening
  • Request to have cervical cytology results sent to you if done at an OB/GYN office
  • Engage patients to discuss their fears
  • Set care gap “alerts” in your electronic medical record
  • Document the month, year and results of most recent cervical cancer screening in the medical record
  • Reference The American Cancer Society Guidelines for the Prevention and Early Detection of Cervical Cancer: cancer.org/cancer/cervical- cancer/detection-diagnosis-staging/ cervical-cancer-screening- guidelines.html
Chlamydia Screening in Women Women 16-25 years of age who were identified as sexually active and who had at least one test for chlamydia during the measurement year
  • Incorporate universal screening of all women in this age range
  • Screening should occur with or without symptoms
  • Screenings should also occur at any visit where oral contraceptives, sexually transmitted diseases (STD) or urinary symptoms are discussed
  • Use phone, email or other means to have patients come in for their routine yearly visit
  • Reference the STD Screening Recommendations and Treatment Guidelines 2015: cdc.gov/std/tg2015/

According to The American College of Obstetricians and Gynecologists, depression is one of the most common complications of pregnancy, affecting one in seven women. It includes minor and major depressive episodes occurring during pregnancy or the first 12 months after delivery. (ACOG Releases Recommendations on Screening for Perinatal Depression - Practice Guidelines - American Family Physician)

Informational HEDIS Measures Description Best Practices
Prenatal Depression Screening and Follow up - The percentage of deliveries in which members were screened for clinical depression while pregnant and, if screened positive, received follow-up care.
Depression Screening Members screened for clinical depression during pregnancy using a standardized instrument.
  • Educate the members about the importance of early detection and encourage screening
  • Engage patients to discuss their fears
  • Set “alerts” in your electronic medical record
  • Screening should occur with or without symptoms
Follow Up Care Members received follow-up care within 30 days of a positive depression screen finding
  • Review the visit schedule with the patient
  • Connect patients to resources
  • Encourage patients to maintain the relationship with an OB/GYN to promote consistent and coordinated health care
  • Educate patients on the importance of keeping visit
  • Consider offering extended practice hours to increase care access
  • Remind patients of their appointment by making calls or sending texts
  • Make outreach calls and/or send letters to advise members of the need for a visit
  • Partner with Horizon Healthy Journey Program to assist with targeted outreach activities
Postpartum Depression Screening and Follow up - The percentage of deliveries in which members were screened for clinical depression during the postpartum period, and if screened positive, received follow-up care.
Depression Screening Members screened for clinical depression using a standardized instrument during the postpartum visit.
  • Educate the members about the importance of early detection and encourage screening
  • Engage patients to discuss their fears
  • Set “alerts” in your electronic medical record
  • Screening should occur with or without symptoms
Follow Up Care Members received follow-up care within 30 days of a positive depression screen finding.
  • Review the visit schedule with the patient
  • Connect patients to resources
  • Encourage patients to maintain the relationship with an OB/GYN to promote consistent and coordinated health care
  • Educate patients on the importance of keeping visit
  • Consider offering extended practice hours to increase care access
  • Remind patients of their appointment by making calls or sending texts
  • Make outreach calls and/or send letters to advise members of the need for a visit
  • Partner with Horizon Healthy Journey Program to assist with targeted outreach activities
Prenatal Immunization Status – Influenza and Tdap – Members who had received influenza and tetanus, diphtheria toxoids and acellular pertussis (Tdap) vaccinations for all women who are pregnant or may become pregnant.
Influenza Members received an adult influenza vaccine on or between July 1 of the year prior to the Measurement Period and the delivery date.
  • Schedule appointments to coincide with required time frames for immunization administration
  • Use your electronic medical record (EMR) system to set reminder flags
  • During visits, talk about the importance of having their immunizations
  • Ensure the member's medical record includes immunization history
Tdap Members received at least one Tdap vaccine during the pregnancy (including on the delivery date)

Additional resources are available to assist you in closing gaps of care through the Horizon BCBS Quality Resource Center.
https://www.horizonblue.com/providers/resources/quality-resource-center

The Resource Center offers such tools as educational webinars, provider guidelines and a provider tips booklet that provides suggested NCQA codes to close gap of care.

Products are provided by Horizon Insurance Company and/or Horizon NJ Health. Communications are issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations for all its companies. Both are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross® and Blue Shield® names and symbols are registered marks of the Blue Cross and Blue Shield Association. The Horizon® name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey. © 2022 Horizon Blue Cross Blue Shield of New Jersey, Three Penn Plaza East, Newark, New Jersey 07105. ECN002484 (0321)