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Results of the Adolescent Well-Care Focused Study
Tuesday, June 19, 200711:15 p.m. –12:00 p.m.
David Mabb, MS, CHCA
Sr. Director, Statistical Evaluation
Study Purpose
• To evaluate the provision of adolescent well-care services as outlined within the State’s Child Health Check-Up Coverage and Limitations Handbook.
• To provide the State with an evaluation of MCO-specific and overall performance on key quality indicators, allowing the State to identify areas for improvement and targeted interventions.
Study Population
• Medicaid eligible and enrolled in an MCO as of June 30, 2006
• Continuously enrolled in the same Florida Medicaid MCO between July 1, 2005, and June 30, 2006. Only a one-month gap in enrollment during the study period was allowed.
• Aged 11 to 20 years as of June 30, 2006
Study Population
• 11 Health Maintenance Organizations (HMOs)
• One provider service network (PSN)
• Medicaid Provider Access System (MediPass)
Sample Sizes
• A total of 5,343 members were selected
• 411 Members from each MCO stratified by age groups:
– 137 members 11–14 years of age – 137 members 15–18 years of age– 137 members 19–20 years of age
Hispanic21.9%
Other7.5%
White17.5%
Black53.1%
Study Sample - Demographics
Note: The Other category includes the following race groups: Oriental, American Indian, and Other.
Study Indicators
• Adolescent well-care visits
• Health history• Developmental
assessment• Comprehensive
physical examination• Health education
• Vision assessment and referral
• Hearing assessment and referral
• Nutritional assessment
• Dental assessment and referral
• Immunization assessment
Study Indicators
• Laboratory testing– Hemoglobin or
hematocrit– Urinalysis– Cholesterol
screening– Tuberculosis test– STD lab test– Pap test (females
only)
• Diagnosis and treatment
• Referrals• Care coordination
95.6%
44.9%
44.7%
43.0%
34.8%
29.8%
28.1%
25.4%
22.4%
19.6%
19.0%
14.1%
11.1%
9.0%
0% 20% 40% 60% 80% 100%
Unrelated Diag & Treat/Refer During Well-Care
Vision Assessment and/or Referral*
Hearing Assessment and/or Referral*
Comprehensive Physical Exam*
Developmental Assessment*
Nutritional Assessment*
Dental Assessment and/or Referral*
At Least One Laboratory Test
Immunization Assessment*
Adolescent Well-Care Visits (HEDIS 2006)
Health History*
Health Ed, Anticip Guid, and Ed/Smoking*
Communication Between Providers
Referral
Study Findings
* Indicates Child Health Check-Up services used to define composite adolescent well-care services measure.
Study Limitation
• Some of the Child Health Check-Up services were dependent upon age- and risk-based conditions.
• Not all members in the sample were in need of certain services (i.e. lab testing or referrals).
• The study was designed to show the frequency of these services rather than evaluate whether members who needed the service actually received the service.
Study FindingsAdolescent Well-Care Visits, by Age Group
19.6%
24.6%
15.2%
7.3%
0%
20%
40%
60%
80%
100%
O verall MCO Aggregate(n=5,343)
11-14 years (n=1,878)
15-18 years (n=1,875)
19-20 years (n=1,590)
Study FindingsAdolescent Well-Care Visits, by Race/Ethnicity
Race / Ethnicity Numerator Denominator RateAdjusted
Rate
White 154 935 16.5% 19.5%
Black 379 2,832 13.4% 17.1%
Hispanic 237 1,171 20.2% 22.6%
Other 70 405 17.3% 23.4%
Overall MCO Aggregate
840 5,343 15.7% 19.6%
Note: The Other category includes the following race groups: Oriental, American Indian, and Other.
Distribution of the Number of Child Health Check-Up Services Provided
Number of services N %
0 3,121 58.4%
1 136 2.5%
2 110 2.1%
3 199 3.7%
4 317 5.9%
5 246 4.6%
6 271 5.1%
7 330 6.2%
8 376 7.0%
9 237 4.4%
Percent Receiving Selected Child Health Check-Up Services, by Age Group
Note: This composite adolescent well-care measure identifies the percentage of members who received nine Child Health Check-Up services evaluated in the current study during the review period. Laboratory testing, diagnosis with treatment/referral, referrals, and care coordination were excluded from this measure since these services are provided to members on an as needed basis.
Age Group Numerator Denominator RateAdjusted
Rate
11-14 years 133 1,878 7.1% 6.5%
15-18 years 81 1,875 4.3% 4.8%
19-20 years 23 1,590 1.4% 1.2%
Overall MCO Aggregate
237 5,343 4.4% 5.5%
Percent Receiving Selected Child Health Check-Up Services, by Race/Ethnicity
Race Numerator Denominator RateAdjusted
Rate
White 36 935 3.9% 3.1%
Black 100 2,832 3.5% 5.5%
Hispanic 84 1,171 7.2% 8.2%
Other 17 405 4.2% 5.2%
Overall MCO Aggregate
237 5,343 4.4% 5.5%
Note: The Other category includes the following race groups: Oriental, American Indian, and Other.
Summary of Findings
• Among adolescents with a documented diagnosis other than a well-child diagnosis, 95.6 percent received the appropriate treatment and/or referral on the same date of service.
• The adolescent well-care visit rate was 19.6 percent, or well below the 2006 HEDIS National Medicaid 50th percentile of 39.4 percent.
Summary of Findings
• 19.0 percent had documentation of a health history.
• 43.0 percent had documentation of a comprehensive physical examination.
• 14.1 percent had documentation of health education, including anticipatory guidance and smoking education.
Summary of Findings
• Rates were generally higher for the youngest age groups.
• Blacks comprised 53.1 percent of the study sample, and the rates for Child Health Check-Up services provided to Blacks were consistently lower than rates for Whites, Hispanics, and Other.
Summary of Findings
• The least documented Child Health Check-Up services were for referrals (9.0 percent) and coordination of care (11.1 percent).
• More than half of the eligible adolescent population did not receive any Child Health Check-Up services during the time period under study.
• Approximately five percent received nine selected Child Health Check-Up services during the time period.
Recommendations
• The MCOs and AHCA should encourage the use of standardized forms, such as AHCA’s Child Health Check-Up form, to assist in determining and documenting the components of age-appropriate physician examinations and health education.
• The MCOs should continue reminding physicians of the essential components and documentation requirements of a Florida Medicaid Child Health Check-Up examination.
Recommendations
• The MCOs should consider evaluating the use of scheduling, patient reminders, and patient profiling systems to enhance the provision of Child Health Check-Up services.
• Providers should be encouraged to create standing orders for nursing personnel to perform the immunization, dental, nutritional, vision, and hearing assessments when a well-care examination has not been performed within the past year.
Questions and Answers