06/12/2023
Many children missed routine childhood immunizations and well-child visits during the last several years, according to the Centers for Disease Control and Prevention (CDC). The CDC recommends doctors and health care professionals encourage families to schedule vaccines and visits to help children catch up. See our Children’s Wellness Guidelines for a routine immunization schedule.
Tracking our Members’ Care
We track these Healthcare Effectiveness Data and Information Set (HEDIS®) measures developed by the National Committee for Quality Assurance to help close gaps in our members’ care:
Child Immunization Status tracks the percentage of 2-year-olds who received the following vaccines by their 2nd birthday:
- Four diphtheria, tetanus and acellular pertussis (DTaP)
- Three polio (IPV)
- One measles, mumps and rubella (MMR)
- Three haemophilus influenza type B (HiB)
- Three hepatitis B (HepB)
- One chicken pox (VZV)
- Four pneumococcal conjugate (PCV)
- One hepatitis A (HepA)
- Two or three rotavirus (RV)
- Two influenza (flu)
Immunizations for Adolescents tracks the percentage of 13-year-olds who received by their 13th birthday:
- One dose of meningococcal vaccine
- One tetanus, diphtheria and pertussis (Tdap)
- The complete human papillomavirus vaccine (HPV) series
Child and Adolescent Well-Care Visits
- Well-Child Visits in the First 30 Months of Life measures the percentage of children who had at least six well-child visits with a primary care provider (PCP) during their first 15 months, and two or more well-child visits during their next 15 months
- Child and Adolescent Well-Care Visits tracks the percentage of children ages 3 to 21 who received at least one well-care visit with a PCP or OB-GYN during the measurement year
Tips to Consider
- Identify members who have missed vaccines or well-child visits. Contact their caregivers to schedule appointments.
- Check at each visit for any missing immunizations. Address common misconceptions about vaccines.
- To document well-child visits, note that the visit was with a PCP and include in the medical record:
- Date of visit; health history; physical and mental development history
- Physical exam; height, weight and body mass index percentile
- Health education or anticipatory guidance, including physical activity
- Diet and nutrition
- Dental Referrals
- We collect immunization data through claims and chart review. To document immunizations, you may include in the medical record any of the following: certificates of immunizations; diagnostic reports; Subjective, Objective, Assessment and Plan (SOAP) notes; office or progress notes
Resources
- Information on childhood vaccines and well-visits for our members
- CDC recommendations on COVID-19 vaccines and boosters for children and teens
- For Texas Medicaid Provider Quality Improvement, see our Quality Improvement (QI) Toolkit and Tip Sheets. Reference and review the BCBSTX Preventive Care Guidelines (PCGs), Clinical Practice Guidelines (CPGs), and Texas Health Steps (THSteps) for Medical Providers, which includes all current vaccine schedules, ImmTrac2 and other important guidance for treating your patients
The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.
HEDIS is a registered trademark of NCQA.