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