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 American Academy of Pediatrics 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. Independence's HMO/PPO plans.

As this chart demonstrates, Independence performs above the national average for both its HMO and PPO plans. The goal for Independence 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 (NCQA)

QIPS^‡ alert

Well-child visits in the third, fourth, fifth, and sixth years of life is included as a performance measure in the Quality Incentive Payment System (QIPS) program for measurement year 2015 for participating providers.

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.

^‡ 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.