Studies have shown that adolescence is one of the most dramatic periods of human growth and development, second only to infancy. While this age group is generally characterized by good health, adolescence is a key transition period in the life course that requires a unique set of health care services.
The Oregon Health Authority (OHA) is using adolescent well-care visits for patients between the ages of 12-21 as one of the quality health metrics to show how well Coordinated Care Organizations (CCOs) are improving care, making quality care accessible, eliminating health disparities, and curbing the rising cost of health care.
How do we rank today?
In 2013, OHA set the benchmark for adolescent well-care visits for all CCOs in Oregon as 53.2 percent. The final rate for our CCO, InterCommunity Health Network, was
22 percent. This disparity shows us our challenge.
What action is the CCO taking?
IHN-CCO has begun a year-round mailing campaign aimed at all adolescent members to remind them of their “FREE” check-up benefit and the value of establishing and maintaining a relationship with you as their primary care provider. Mailings go out quarterly, based on the patients’ birth month. You will receive a letter before any mailing goes out to prepare your front office staff for patient calls.
What are we asking you to do?
1. Understand what counts as an adolescent well-care visit. All three of the following components must be present for a visit to count as a well-care:
- A health and developmental history
- A physical exam
- Health education /anticipatory guidance
2. Consider how the adolescent well-care exam can be incorporated into other visits:
- Sick-care visits: Well-care visits can be reported in addition to the problem-oriented visit, as long as all three components noted above are documented in the medical record.
- Sports physicals: By themselves, though, sports physicals do not meet the components of an adolescent well-care. Make them count as a well-care exam by incorporating the three required elements listed above.
- School-based health center visits: Like sports physicals, these visits can count as long as they include all three components above and are billed to IHN-CCO.
- Review these OHA guidance documents and use the specified codes to ensure that these important visits are measured.
3. Continue with your reminder calls and mailings. The CCO mailings are a good supplement to your own adolescent patient communications. Keep up the good work.
For more information about well-care visits and what specific codes are measured, please review these OHA guidance documents:
OHA guidance document for adolescent well-care visits
Measure details for adolescent well-care visits
Read our Adolescent Well Care Reimbursement Guidelines for more information.