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:
- Perform a comprehensive head-to-toe examination
- Collect complete history (birth history, prior screenings, diet, dental care, social histories, etc.)
- Administer immunizations or vaccinations
- Review, track, and discuss a child’s development and behavior
- Discuss illness prevention, nutrition and physical fitness, and health and safety issues
- Conduct screening tests
- Provide guidance on a variety of topics including sleep, safety, learning, and development
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:
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.
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