1. Results of the Adolescent Well-Care Focused Study Tuesday, June 19, 2007 11:15 p.m. –12:00 p.m. David Mabb, MS, CHCA Sr. Director, Statistical Evaluation

2. 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.

3. 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

4. Study Population 11 Health Maintenance Organizations (HMOs) One provider service network (PSN) Medicaid Provider Access System (MediPass)

5. 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

6. Study Sample - Demographics Note: The Other category includes the following race groups: Oriental, American Indian, and Other.

7. 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

8. 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

9. Study Findings * Indicates Child Health Check-Up services used to define composite adolescent well-care services measure.

10. 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.

11. Study Findings Adolescent Well-Care Visits, by Age Group

12. Study Findings Adolescent Well-Care Visits, by Race/Ethnicity Race / EthnicityNumeratorDenominatorRate Adjusted Rate White15493516.5%19.5% Black3792,83213.4%17.1% Hispanic2371,17120.2%22.6% Other7040517.3%23.4% Overall MCO Aggregate 8405,34315.7%19.6% Note: The Other category includes the following race groups: Oriental, American Indian, and Other.

13. Distribution of the Number of Child Health Check-Up Services Provided Number of servicesN% 03,12158.4% 11362.5% 21102.1% 31993.7% 43175.9% 52464.6% 62715.1% 73306.2% 83767.0% 92374.4%

14. 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 GroupNumeratorDenominatorRate Adjusted Rate 11-14 years1331,8787.1%6.5% 15-18 years811,8754.3%4.8% 19-20 years231,5901.4%1.2% Overall MCO Aggregate 2375,3434.4%5.5%

15. Percent Receiving Selected Child Health Check-Up Services, by Race/Ethnicity RaceNumeratorDenominatorRate Adjusted Rate White369353.9%3.1% Black1002,8323.5%5.5% Hispanic841,1717.2%8.2% Other174054.2%5.2% Overall MCO Aggregate 2375,3434.4%5.5% Note: The Other category includes the following race groups: Oriental, American Indian, and Other.

16. 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 50 th percentile of 39.4 percent.

17. 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.

18. 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.

19. 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.

20. 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.

21. 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.

22. Questions and Answers