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Horizon NJ Health Tops All Medicaid Managed Care Plans in New Jersey with Highest Overall Compliance Scores

Posted By Horizon NJ Health on March 20, 2013
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Horizon NJ Health, a subsidiary of Horizon Blue Cross Blue Shield of New Jersey, has achieved a 96% overall compliance performance score, the highest of all New Jersey’s Medicaid Managed Care plans, according to the recently released 2011 NJ FamilyCare/Medicaid HMO Performance Report.

The NJ FamilyCare/Medicaid HMO Performance Report is prepared by the New Jersey Department of Human Services, Division of Medical Assistance and Health Services. The report provides information on the quality of each health plan’s performance, including the quality of care provided to clients, client satisfaction levels in their health plans and the performance of internal operations.

“The performance report validates our commitment to our members and providers,” said Karen L. Clark, Vice President, Medicaid, Horizon Blue Cross Blue Shield of New Jersey / President, Horizon NJ Health. “To have the highest compliance score among all of the plans serving New Jersey confirms our efforts and the trust our members place in us to dependably deliver quality, accessible care.”

The NJ FamilyCare/Medicaid HMO Performance Report uses several quality measures to track member utilization of provider services, health service delivery and client satisfaction with their health plan. The measures used are HEDIS (Healthcare Effectiveness Data and Information Set), which is a set of detailed measures that health plans use to report their overall performance results, CAHPS (Consumer Assessment of Healthcare Providers and Systems), a member satisfaction survey conducted annually by all plans, and IPRO (Island Peer Review Organization), an independent, external quality review organization that conducts reviews of each of the state’s Medicaid health plans to assess quality and compliance standards.

Horizon NJ Health received the highest HEDIS rating in the following areas:

  • Well-Child Visits (First 15 months of life)
  • Adolescent Well-Care Visits (adolescents 12-21 years of age)
  • Lead Screening in Children
  • Comprehensive Diabetes Care (three separate categories)
      • Eye Exams (19% higher than national average)
      • HbA1c Testing
      • Medical Attention for Diabetic Nephropathy
  • Use of Appropriate Medications for People with Asthma

The HMO Performance Report highlights Horizon NJ Health’s 2012 Best Practice – Pharmacy Case Management Program. This initiative uses clinical pharmacists to monitor prescribing among a member’s care providers to identify duplicate medications, or dosages higher than recommended. The program delivers more accurate pharmaceutical administration and cost savings by eliminating duplicative or inappropriate dosing.

The State of New Jersey’s HMO Performance Report can be found at

About Horizon Blue Cross Blue Shield of New Jersey
Horizon Blue Cross Blue Shield of New Jersey, the state’s oldest and largest health insurer, is a tax-paying, not-for-profit health services corporation, providing a wide array of medical, dental, and prescription insurance products and services. Horizon BCBSNJ is an independent licensee of the Blue Cross Blue Shield Association, serving 3.6 million members with headquarters in Newark and offices in Wall, Mt. Laurel, and West Trenton. Learn more at

About Horizon NJ Health
Horizon NJ Health is New Jersey’s largest managed health care organization serving the publicly insured, providing health services for more than 560,000 people in all 21 New Jersey counties. Headquartered in West Trenton, NJ, Horizon NJ Health, a partnership, is part of the Horizon Blue Cross Blue Shield of New Jersey enterprise, an independent licensee of the Blue Cross Blue Shield Association. Learn more at