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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
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 on the right compares the national average for six or more
well-child visits in the first 15 months of life for commercial HMO/PPO plans
vs. AmeriHealth rates over a four-year period.
As the chart demonstrates, AmeriHealth performs above the national average
for both HMO and PPO plans. The goal for AmeriHealth is to reach the national
90th percentile benchmarks, at 89.8 percent and 86.9 percent for HMO and PPO
plans, respectively. –
Source: 2014 State of Health Care (NCQA)
| Commercial |
| Year |
National |
AmeriHealth |
| HMO | PPO | HMO | PPO |
| 2013 | 79.00% | 76.90% | 83.30% |
80.70% |
| 2012 | 78.20% | 76.40% | 76.20% |
N/A |
| 2011 | 78.00% | 76.10% | 70.50% |
N/A |
| 2010 | 76.30% | 72.80% | 76.10% |
N/A |
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.
HEDIS is a registered trademark of the
National Committee for Quality Assurance (NCQA). Used with permission.
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