Adolescent well-care visits HEDIS measure

It is believed that behaviors established during childhood or adolescence, such as eating habits and physical activity, often extend into adulthood. Well‐care visits provide an opportunity for providers to influence health and development. For members enrolled in Anthem HealthKeepers Plus and Anthem HealthKeepers Plus, Commonwealth Coordinated Care Plus (Anthem CCC Plus), these visits are a critical opportunity for screening and counseling. The Adolescent Well-Care Visits (AWC) HEDIS^® measure looks for at least one comprehensive well‐care visit for members 12 to 21 years of age with a PCP or OB/GYN type provider.

An adolescent well-care visit should include the following:

 

• A health history – covers past illnesses (or lack of illness), hospitalizations, chronic health conditions, allergies, and the child’s emotional and social development. It also includes a family history of health problems. The health history highlights any special concerns about the adolescent.

 

• Physical developmental history – includes developmental milestones and an assessment of whether the adolescent is developing skills to become a healthy adult. Examples: Tanner score, onset of menstrual cycle, participation in a team sport.

 

• Mental developmental history – includes developmental milestones and assessment of whether the adolescent is developing skills to become a healthy adult. Examples: making good grades, good circle of friends, seems depressed or detached from family and/or friends, career development, smoking/ETOH/drug use.

 

• Physical exam – a comprehensive head to toe exam with vital signs; it must consist of more than one body system to meet criteria.

 

• Anticipatory guidance – given in anticipation of emerging issues that member may face; injury and illness prevention, nutrition, promotion of constructive family relationships and developing social skills. Preprinted forms or checklists may be used, but the check boxes must be checked off or initialed by the provider at the time of the visit.

Don’t miss an opportunity to perform a well‐child exam. Well-child preventive services count toward the measure, regardless of the primary intent of the visit (for example, GYN type visit or sick visit), but services that are specific to an acute or chronic condition do not count towards the measure.

 

If you have any questions about this communication, call Provider Services at 1‑800‑901‑0020 or Anthem CCC Plus Provider Services at 1‑855‑323‑4687.

Childhood Immunization Status HEDIS measure

Immunizations are essential for disease prevention and are a critical aspect of preventive care for children. Vaccination coverage must be maintained in order to prevent a resurgence of vaccine‐preventable diseases. Childhood immunizations are to be completed by a child’s second birthday for HEDIS® compliance. If the CDC immunization schedule is followed, immunizations can actually be completed by 18 months of age for Anthem HealthKeepers Plus and Anthem HealthKeepers Plus, Commonwealth Coordinated Care Plus (Anthem CCC Plus) members.

 

What is measured for Childhood Immunization Status (CIS)? The percentage of children 2 years of age in the measurement year who had the following:

4 – Dtap	3 – IPV (polio)
1 – MMR	3 – HiB (haemophilus influenza type B)
3 – Hep B	1 – VZV (chicken pox)
4 – PCV (pneumococcal)	1 – Hep A
2 or 3 – RV (rotavirus)	2 – influenza

 

Children also need a lead screen (by a capillary or venous blood test) on or before their second birthday.  Unfortunately, there has been an increase in the number of parents that are refusing to vaccinate their children. This is causing a growing concern for the recurrence of vaccine-preventable diseases. It is imperative to talk with the parents to allay their fears and dispel any misbeliefs they may have about vaccinations.

 

If you have any questions about this communication, call Provider Services at 1‑800‑901‑0020 or Anthem CCC Plus Provider Services at 1‑855‑323‑4687.

 

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

 

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