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This article series is a monthly tool to help physicians maximize patient
health outcomes in accordance with NCQA's* HEDIS®†
measurements for high quality care on important dimensions of services.
Go to our Highlighting HEDIS® page to view previously
published Highlighting HEDIS® topics. If you have feedback or
would like to request a topic, email us.
HEDIS® definition
Well-child visits in the third, fourth, fifth, and sixth years of
life: The percentage of members ages 3 – 6 who had one or more
well-child visits with a primary care physician (PCP) during the measurement
year.
Why this measure is important
This measure looks at the use of routine check-ups for preschool and early
school-age children. It assesses the percentage of children ages 3, 4, 5, and 6
who received at least one well-child visit with a PCP during the measurement
year. 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 recommends
annual well-child visits for children ages 2 – 6.
? NCQA, HEDIS 2015 V1
Plan performance
The chart below displays the rates for one or more well-child visits for
children ages 3 – 6 over a four-year period, comparing the national
average for commercial HMO/PPO plans vs. AmeriHealth HMO/PPO plans.
| Year |
Commerical |
| National | AmeriHealth |
| HMO |
PPO |
HMO |
PPO |
| 2013 | 74.3% | 70.3% |
82.1% | 83.0% |
| 2012 | 72.9% | 69.9% |
81.2% | N/A |
| 2011 | 72.5% | 69.8% |
82.7% | N/A |
| 2010 | 71.6% | 67.8% |
82.1% | N/A |
As this chart demonstrates, AmeriHealth performs above the national average
for both its HMO and PPO plans. The goal for AmeriHealth is to reach the
national 90th percentile benchmark, which is currently at 87.4 percent and 84.9
percent for HMO and PPO plans, respectively.
? Source: 2014 State of Health
Care Quality Report
Quick tips for improvement
- ✓Keep an active tracking system to monitor yearly visits for each
member.
- ✓Inform caregivers on the importance of well-visits.
- ✓Consider providing off-hours and weekend appointment times.
*The National Committee for Quality Assurance (NCQA) is
the most widely recognized accreditation program in the U.S.
†The Healthcare Effectiveness Data and Information Set (HEDIS) is an NCQA
tool used by more than 90 percent of U.S. health plans to measure performance
on important dimensions of care.
HEDIS is a registered trademark of the National Committee for Quality Assurance
(NCQA). Used with permission.
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