August 2019

Well-Child HEDIS^® Update and Documentation Changes

Many health plans utilize the Healthcare Effectiveness Data and Information Set (HEDIS) to annually measure effectiveness of care. HEDIS audits are performed to assess clinical compliance and ensure that patients are receiving appropriate, preventative care from their primary care practitioner. Several measures assess well child visits, including:

• Well child visits within 15 months of life (W15)
• Well child visits from 3-6 years of age (W34)
• Adolescent well care (AWC)

The table below demonstrates Blue Cross and Blue Shield of Texas’ (BCBSTX) rates for each of these measurements by line of business – STAR, CHIP and STAR Kids – and demonstrates improvement year over year. But, there are still opportunities to improve well child visits for all members. Five components were assessed within the well-child measures:

1. Health history
2. Physical developmental history/surveillance
3. Mental developmental history/surveillance
4. Physical exam
5. Anticipatory guidance

*Pending NCQA 50th percentile

Helpful Hints for Well Child Visits:

• Ensure that identifiers are on each page of the visit notes, including assessments and handouts that include:
• Visit date
• Patient name
• Another identifier (i.e., date of birth or medical record number)
• The phrase “well developed” is no longer sufficient for the assessment of mental or physical development. Acceptable documentation includes: “all areas of development appropriate for age” or age appropriate developmental screening tools with documented results.
  
• Age-appropriate assessment tools include:
• ASQ (physical and mental)
• ASQ-SE or PEDS (mental) for children birth through 11
• For adolescents ages 12 through 20, one of the following may be used for mental development/surveillance:
• PSC-17
• PSC-35
• Y-PSC
• PHQ9
• CRAFFT
• PHQ-A (AAP’s anxiety, eating and mood problems screen).
• The Tanner Stage/Scale may be used for physical development in the adolescent.
• The Tanner Stages may only be used to document physical development in the adolescent patient.

Best Practice Summary

• Utilize Texas Health Steps to determine age-appropriate assessment(s) and anticipatory guidance/health education.
• Prepare for each visit by reviewing all necessary assessment paperwork before starting the exam.
• Include the patient’s name, date of service and date of birth on every page of the assessments and visit notes.

Resources
Reference and review BCBSTX’s Preventive Care Guidelines and Clinical Practice Guidelines, and the Texas Health Steps for Providers website for more information on this and other important topics for treating your patients.

HEDIS is an independent company that provides analytics to Blue Cross and Blue Shield of Texas. HEDIS is a registered trademark of NCQA.