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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.
| Year | Commercial |
| National | Independence |
| HMO | PPO | HMO | PPO |
| 2013 | 79.0% | 76.9% | 78.2% | 83.6% |
| 2012 | 78.2% | 76.4% | 76.2% | 83.0% |
| 2011 | 78.0% | 76.1% | 70.5% | 61.2% |
| 2010 | 76.3% | 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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