Well-Child Visits: Closing the Quality Gap

Well-child visits

Well-child visits are an opportunity for providers to conduct a comprehensive assessment of a child. These checkups are a cornerstone of prevention and wellness. By examining for health issues and addressing future health problems early in a child’s development, providers can properly diagnose, treat, and even prevent certain conditions. As a result of its clinical importance, well-child visits are commonly included in Commercial and Medicaid quality programs.

During a well-child visit, a provider will:

When children receive the recommended number of high-quality visits, they are more likely to be up-to-date on immunizations, have developmental concerns recognized early, and are less likely to visit the emergency department. During these visits, providers should prioritize interventions with the strongest evidence for patient-oriented outcomes, including immunizations, vision screening, social determinants of health.

A quality measure that captures Well-Child Visits is the HEDIS® measure Child and Adolescent Well-Care Visits (WCV). This measure is based on the American Academy of Pediatrics Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, and is described as:

“The percentage of members ages 3–21 who had one or more well-child visits with a primary care provider or OB-GYN during the measurement year.”

This HEDIS® quality measure is submitted through administrative claims only. To be accepted, a claim for a member visit during the measurement year must be properly coded. For a complete list of codes that apply to this quality measure, refer to the NCQA website at NCQA.org. To ensure accurate and complete reporting, follow the below best practices:

  • Well-child visits must be completed by a primary care provider but does not have to be the member’s primary care provider
  • School-based health clinic visits count for this measure if the visit is for a well-care exam
  • Sports physicals meet the intent for quality purposes but are not the same as well-child exams. A sports physical form can be completed during a well-child exam to receive the proper documentation needed to participate in sports during this comprehensive exam.

About the Author

Tresa Shaw, MSN, RN

Tresa Shaw, MSN, RN

Director of Quality at CHESS