Statement of purpose

Horizon BCBSNJ leverages the R&R Program to improve clinical outcomes performance on HEDIS measures and promote the care received by our members. Horizon BCBSNJ has experienced improved HEDIS performance since the inception of the R&R Program in 2016.

Partnering to improve quality

The R&R program provides a variety of opportunities that lead to better care and improved health outcomes for members. It offers financial incentives to providers that are tied to improved performance for specific HEDIS measures through high-touch collaboration with Horizon BCBSNJ. Through this program, providers are educated on best practices for preventive screenings, immunizations and treatment of chronic conditions, as well as how to optimize the capture of data reflecting quality improvement outcomes. A designated Clinical Quality Improvement Liaison (CQIL) assists providers with clinical practice transformation, providing detailed reports that identify gaps in care and ensure compliance with HEDIS coding guidelines.

The primary goal of the R&R program is to maintain and improve the health and quality of care received by our members. Improvements in HEDIS performance reflect the value proposition of the R&R program and its ability to enhance the member experience and promote better care.

R&R Program structure

As part of the R&R Program, we offer providers:

• Incentive payments:
  • - Medicaid: Additional payments for every performance gap closed once you reach and surpass the NCQA’s prior year’s 50th percentile benchmark rating for selected HEDIS measures.
  • - Medicare: Once a practice reaches the 4-Star threshold on a measure, an incentive will be paid for each member who is eligible for that measure and has received the service, for selected HEDIS measures.
  • - FIDE-SNP: Once a practice reaches the 3-Star threshold on a measure, an incentive will be paid for each member who is eligible for that measure and has received the service, for selected HEDIS measures.
• Monthly quality report cards and patient level detail gap reports.
• Support and education for you and your staff on quality improvement and report analysis.
• Three payments a year and a detailed payment report.

For more information on the R&R Program, call 1-844-754-2451 or email Quality_R&R@HorizonBlue.com.