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Highlighting HEDIS®: Well-child visits in the first 15 months of life

April 1, 2015

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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 first 15 months of life: The percentage of members who turned 15 months old during the measurement year and who had the following number of well-child visits with a primary care physician during their first 15 months of life:

  • no well-child visits
  • one well-child visit
  • two well-child visits
  • three well-child visits
  • four well-child visits
  • five well-child visits
  • six or more well-child visits

QIPS alert

Well-child visits in the first 15 months of life is a performance measure in the Quality Incentive Payment System (QIPS) program for measurement year 2015 for participating providers.

Why this measure is important

The American Academy of Pediatrics recommends six well-child visits in the first year of life: the first within the first month of life, and then again at around two, four, six, nine, and twelve months of age. These visits are of particular importance during the first year of life, when an infant undergoes substantial changes in abilities, physical growth, motor skills, hand-eye coordination, and social and emotional growth. Regular check-ups are one of the best ways to detect physical, developmental, behavioral, and emotional health problems. – NCQA, HEDIS 2015 V1

Plan performance

The chart below compares the national average for six or more well-child visits in the first 15 months of life for commercial HMO/PPO plans vs. Independence's rates over a four-year period.

YearCommercial
NationalIndependence
HMOPPOHMOPPO
201379.0%76.9%78.2%83.6%
201278.2%76.4%76.2%83.0%
201178.0%76.1%70.5%61.2%
201076.3%72.8%76.1%75.2%

As the chart demonstrates, Independence performs below the national average for HMO and above the national average for PPO. The goal for Independence is to reach the national 90th percentile benchmark, which is currently at 89.8 percent and 86.9 percent for HMO and PPO plans, respectively. ? Source: 2014 State of Health Care (NCQA)

Quick tips for improvement

  • ✔Schedule the entire suite of visits with or at the conclusion of the first visit.
  • ✔Inform caregivers on the importance of well-child visits.
  • ✔Be proactive ? make outreach calls to members who are not on track to complete the recommended six visits.

*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.

‡ QIPS is a reimbursement system developed by Keystone Health Plan East for participating Pennsylvania primary care physicians that offers incentives for high-quality, accessible, and cost-effective care.

HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). Used with permission.

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This content was prepared for the Provider News Center and may not be reproduced in any way without the express written permission of Independence Blue Cross. Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.
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