One aspect of care that is measured in our quality program at Blue Cross and Blue Shield of Texas is Adult Access to Preventive/Ambulatory Health Services. The Medicaid Quality Department collects data through claims submission and works collaboratively with our providers to improve the quality of care for our members.
What is AAP:
- Preventive care visit during the measurement year
- AAP is a Healthcare Effectiveness Data and Information Set (HEDIS®) measure
- Measured for STAR and STAR Kids product lines, members 20 years of age and older
- Visit our Medicaid Provider website for more details on the HEDIS AAP Tipsheet
Why is AAP important:
- Preventative health visits can reduce the risk for disease and premature death with early detection and treatment
- Per National Committee for Quality Assurance (NCQA) data, AAP visits have been on the decline from
- 2013 result 82.9% to 2022 result 72.7% NCQA HEDIS AAP
- There are evidence-based interventions available to address this high-priority public health issue
Providers can:
- Schedule preventive care appointments for members
- Utilize the attribution reports provided by your Provider Network representative to identify members needing a wellness/preventative visit. If unsure who your PN representative is, you may contact the BCBSTX Medicaid Network Department, 1-855-212-1615 or via email at TexasMedicaidNetworkDepartment@bcbstx.com
- Educate members on the importance of preventive care including age-appropriate screening tests and lifestyle counseling (diet and exercise)
- Utilize correct billing codes to receive credit for this important visit
- Assess barriers to care. BCBSTX is here to assist with Service Coordination. For assistance with identified barriers such as transportation and Non-Medical Social Determinates of Health contact:
- STAR/CHIP Service Coordination 1-877-214-5630
- STAR Kids Service Coordination: 1-877-301-4394
- Nonemergent medical transport (NEMT) 1-866-824-1565 or
- Email TX_Medicaid_HC@bcbstx.com
For more information, visit NCQA HEDIS Measures and Technical Resources.
Resources
For Texas Medicaid Provider Quality Improvement, review the following resources ranging from quality measures data to current vaccine schedules:
- Preventive Care Guidelines
- Clinical Practice Guidelines
- ImmTrac2
- Quality Improvement (QI) Toolkit and Tip Sheets
- Texas Health Steps for Medical Providers
HEDIS is a registered trademark of NCQA. Use of this resource is subject to NCQA’s copyright, found here. The NCQA HEDIS measure specification has been adjusted pursuant to NCQA’s Rules for Allowable Adjustments of HEDIS. The adjusted measure specification may be used only for quality improvement purposes.
The above material is for informational purposes only and is not intended to be a substitute for the independent medical judgment of a physician. Physicians and other health care providers are encouraged to use their own best medical judgment based upon all available information and the condition of the patient in determining the best course of treatment.