This was a new performance measure beginning with Measurement Year (MY) 2021.  The population sample for this measure consists of Medicaid-primary members, over 70% of whom are attributed to patient-centered medical homes. This is a claim-based HEDIS measure that calculates the proportion of children and adolescents 3-21 years of age who had at least one comprehensive well-care visit with a primary care practitioner or an OB/GYN practitioner during the measurement year.

• This is a Healthcare Effectiveness & Data Information Set (HEDIS®) administrative measure and only includes Medicaid Primary beneficiaries.
• The annual reported rate captures activity during the stated measurement year (MY).
• The target trendline in the graph above represents the 90th national benchmark percentile for Medicaid programs across the country. Benchmarks became available for this measure in 2022 for measurement year 2021. Please note rates by age break out:
  • Ages 3-11 years:  MY 2020 = 62.6%, MY 2021 = 65.3%, MY 2022 = 67.0%
  • Ages 12-17 years:  MY 2020 = 54.6%, MY 2021 = 58.6%, MY 2022 = 58.2%
  • Ages 18-21 years:  MY 2020 = 28.6%, MY 2021 = 29.9%, MY 2022 = 29.0%

The Healthcare Effectiveness Data and Information Set (HEDIS®) is a registered trademark of NCQA.

Child and adolescent well-care visits provide an important opportunity to establish lifelong healthy behaviors, identify risk factors (e.g., sexual activity, substance use, depression, etc.), and intervene at an early stage if concerns are raised. However, the percent of adolescents who receive this care frequently drops off except for students participating in sports. While this payment model supports all patients in the medical home, regardless of payer, this measure show the statewide average for Medicaid-primary members, over 70% of whom are attributed to a patient-centered medical home.  Practices and communities continue their efforts to improve further upon this measure. Blueprint perfomance payments incentivize PCMHs in a region to perform the all-payer statewide average and to demonstrate improvement between measurement periods or have outcomes in the Healthcare Effectiveness & Data Information Set (HEDIS) 90th Percentile for adolescents 12-21.

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This measure assesses the percentage of members 3–21 years of age who had at least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement year.

This measure is based on the American Academy of Pediatrics Bright Futures guidelines for Health Supervision of Infants, Children and Adolescents.  In addition to the Bright Futures Guidelines, the AAP publishes a recommended schedule of screenings and assessments, known as the periodicity schedule, that outlines what to do at every visit, from infancy to adolescence.  Bright Futures recommends more frequent well-child visits in the first years of life and one or more well-child visits from age 3–21. They recommend that the well-child visits include, but are not limited to, an initial/interval medical history, physical exam, developmental assessment, immunization and anticipatory guidance.

The AAP/Bright Futures guidelines recommend annual well-child visits for children 3–11 years old. 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 AAP/Bright Futures guidelines recommend annual visits for adolescents 12–21 years old. Given that the period of adolescence is marked by puberty and changes in physical appearance and psychological maturity, it is recommended that clinicians focus on concerns of the adolescent and the parent(s), and address social determinants of health, physical growth and development, emotional well-being, risk reduction (pregnancy and sexually transmitted infections, tobacco, e-cigarettes, alcohol) and safety (seat belt and helmet use, sun protection, substance use, firearm safety) over the course of multiple visits.

Last updated:  September 2021

1. Patient Centered Medical Homes
2. Community Health Teams
3. Vermont Child Health Improvement Program
4. OneCare Vermont
5. School nurses

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“The source for certain health plan measure rates and benchmark (averages and percentiles) data (“the Data”) is Quality Compass® 2022 and is used with the permission of the National Committee for Quality Assurance (“NCQA”). Any analysis, interpretation or conclusion based on the Data is solely that of the authors, and NCQA specifically disclaims responsibility for any such analysis, interpretation or conclusion. Quality Compass is a registered trademark of NCQA. 

The Data comprises audited performance rates and associated benchmarks for Healthcare Effectiveness Data and Information Set measures (“HEDIS® ”) and HEDIS CAHPS® survey measure results. HEDIS measures and specifications were developed by and are owned by NCQA. HEDIS measures and specifications are not clinical guidelines and do not establish standards of medical care. NCQA makes no representations, warranties or endorsement about the quality of any organization or clinician that uses or reports performance measures or any data or rates calculated using HEDIS measures and specifications, and NCQA has no liability to anyone who relies on such measures or specifications. 

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