Quality Improvement Program
The Quality Improvement (QI) Program is designed to:
- Expand access and enhance the quality of health care
- Enhance customer satisfaction
- Maximize the safety and quality of health care delivered to members
- Improve efficiency and effectiveness
- Fulfill quality-related reporting requirements of accrediting bodies and other local, state and federal regulatory and external review organizations
The annual QI Work Plan describes specific activities that Horizon NJ Health will perform to meet the established goals. The annual QI Program Evaluation monitors how well Horizon NJ Health has performed. Some of the activities include:
- Improve Healthcare Effectiveness Data & Information Set (HEDIS) scores
- Improve Member/Practitioner Satisfaction: Consumer Assessment of Healthcare Providers and Systems (CAHPS), is a standardized survey that allows members to evaluate their experiences with health care. Three populations were chosen for the survey: Adults, Children General Population and Children with Chronic Conditions. The Satisfaction Survey is a means of receiving feedback from practitioners and office staff regarding Horizon NJ Health operations and areas of improvement.
- Performance Improvement Projects (PIPs): These projects are initiatives that improve the safety of our members in all settings.
- Maintain National Committee for Quality Assurance (NCQA) accreditation.
For further information about Horizon NJ Health’s QI Program goals, processes and outcomes concerning care and service, and/or to obtain a copy of the QI Program information, please contact Practitioner Services at 1-800-682-9091. To access Horizon NJ Health’s current NCQA ranking, please visit NCQA Health Insurance Plan Ratings 2018-2019-Summary Report Medicaid or visit NCQA.org for more information and a summary of HEDIS results grouped by plan.