Vermont Medicaid (Global Commitment) (GC-21)

WCV: Child and Adolescent Well-Care Visits (GC-21)

54.7%2021

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Notes on Methodology

New measure, beginning with Report Year 2021.  The population sample for this measure consists of Medicaid-primary members, over 70% of whom are attributed to patient-centered medical homes. This is a claim-based HEDIS measure that calculates the proportion of children and adolescents 3-21 years of age who had at least one comprehensive well-care visit with a primary care practitioner or an OB/GYN practitioner during the measurement year.

  • The annual reported rate captures activity during the previous calendar year. 
  • This is a Healthcare Effectiveness & Data Information Set (HEDIS) administrative measure.
  • DVHA’s rates only include Medicaid Primary beneficiaries in HEDIS administrative measures.
  • This is a new performance measure in measurement year (MY) 2020.
  • Benchmarks will not be available for this measure until 2022.
  • Please note rates by age break out:
    • Ages 3-11 years:  62.6%
    • Ages 12-17 years:  54.6%
    • Ages 18-21 years:  28.6%
Partners
  1. Patient Centered Medical Homes
  2. Community Health Teams
  3. Vermont Child Health Improvement Program
  4. OneCare Vermont
  5. School nurses
Story Behind the Curve

Child and adolescent well-care visits provide an important opportunity to establish lifelong healthy behaviors, identify risk factors (e.g., sexual activity, substance use, depression, etc.), and intervene at an early stage if concerns are raised. However, the percent of adolescents who receive this care frequently drops off except for students participating in sports. While this payment model supports all patients in the medical home, regardless of payer, this measure show the statewide average for Medicaid-primary members, over 70% of whom are attributed to a patient-centered medical home.  Practices and communities continue their efforts to improve further upon this measure. Blueprint perfomance payments incentivize PCMHs in a region to perform the all-payer statewide average and to demonstrate improvement between measurement periods or have outcomes in the HEDIS 90th Percentile for adolescents 12-21.

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This measure assesses the percentage of members 3–21 years of age who had at least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement year.

This measure is based on the American Academy of Pediatrics Bright Futures guidelines for Health Supervision of Infants, Children and Adolescents.  In addition to the Bright Futures Guidelines, the AAP publishes a recommended schedule of screenings and assessments, known as the periodicity schedule, that outlines what to do at every visit, from infancy to adolescence.  Bright Futures recommends more frequent well-child visits in the first years of life and one or more well-child visits from age 3–21. They recommend that the well-child visits include, but are not limited to, an initial/interval medical history, physical exam, developmental assessment, immunization and anticipatory guidance.

The AAP/Bright Futures guidelines recommend annual well-child visits for children 3–11 years old. Well-child visits during the preschool and early school years are particularly important. A child can be helped through early detection of vision, speech and language problems. Intervention can improve communication skills and avoid or reduce language and learning problems.

The AAP/Bright Futures guidelines recommend annual visits for adolescents 12–21 years old. Given that the period of adolescence is marked by puberty and changes in physical appearance and psychological maturity, it is recommended that clinicians focus on concerns of the adolescent and the parent(s), and address social determinants of health, physical growth and development, emotional well-being, risk reduction (pregnancy and sexually transmitted infections, tobacco, e-cigarettes, alcohol) and safety (seat belt and helmet use, sun protection, substance use, firearm safety) over the course of multiple visits.

Last updated:  September 2021

Scorecard Result Container Indicator Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy