Well visits give providers an important opportunity to deliver immunizations, offer anticipatory guidance, and identify and treat disease. Research shows that hospitalizations and emergency department use decrease when children and adolescents regularly attend well visits. They serve an especially important role during the early months and years of a child's life, when they allow pediatricians to assess growth, monitor development, and identify and address any problems early on.
HPSM’s well visit rates from 2021 and 2022 show that, there have been rate increases in some age groups. Overall however, there are still some areas in need of improvement.
Measure1 | 2021 rate2 | 2022 rate3 | Minimum performance level4 |
0 to 15 months (6 or more visits) | 28% | 50% | 55% |
16 to 30 months (2 or more visits) | 69% | 72% | 71% |
3 to 21 years (1 or more visits) | 57% | 52% | 45% |
Figures in this table are rounded to the nearest whole number.
We continue to focus on increasing well visits and want to partner with you on getting patients under 21 in for well visits and closing health care disparities. Our 2022 Population Needs Assessment found disparities in well visit rates among two member subgroups: those who identify as Black and members who speak non-threshold languages5.
It’s time to catch up! Reach out to your patients to come in for well visits and vaccines.
- Schedule the required number of well visits in advance. To accommodate families’ busy schedules, offer extended weekday evening hours or see patients on weekends. If the timing is right, schedule visits during times when children and adolescents are not in school (such as summer/winter breaks).
- Let families know what kind of well visits you offer (phone, video or in-person). Emphasize that HPSM members get all these types of well visits at no cost.
- Open vaccine clinics to help your patients get caught up on overdue vaccines.
- If a patient comes in because they are sick and they are due for a well visit, integrate both — complete the well visit and evaluate their symptoms. At every visit, offer and administer any vaccines they are due for.
- Sports physicals that include a physical examination — including body mass index (BMI), developmental assessment and anticipatory guidance — can be billed as well visits if all three components are clearly documented on the same date.
- Reschedule make-up visits as needed. When patients miss appointments, follow up with letters and phone calls.
- Identify patients with multiple missed appointments and send them extra visit reminders.
- Submit electronic health records (EHRs) with the correct codes and provider information.
When patients have limited English proficiency (LEP), use HPSM interpreter services
HPSM providers are required to provide linguistically appropriate services to members with LEP. You can use these services both for appointment scheduling and during visits (both in-person and telemedicine). To ensure you can communicate effectively with LEP patients, we offer interpreter services at no cost.
- HPSM phone interpreter services are available on-demand in over 250 languages. Call Certified Languages International (CLI) at 1-800-225-5254 anytime, 24/7. Use provider access code 64095.
- HPSM also offers interpreter services by video and (in certain circumstances) in-person.
Measure definitions:
- 1 - Well visits in the first 15 months (W306+): Six or more well visits with children who turned age 15 months during the measurement year.
- 1 - Well visits for ages 16 to 30 months (W302+): Two or more well visits with children who turned age 30 months during the measurement year.
- 1 - Well visits for ages 3 to 21 years (WCV): One or more well visits with a primary care provider (PCP) or an OB/GYN practitioner during the measurement year.
- 2, 3 - These are HPSM rates.
- 4 - The minimum performance level is based on the 50th percentile for all managed care plans nationally.
- 5 - The California Department of Health Care Services (DHCS) requires Medi-Cal plans to provide written member materials in the threshold languages of the population they serve. Threshold languages are identified as the primary language spoken either by more than 3,000 beneficiaries or 5% of the member population (whichever is lower), as indicated in Medi-Cal Eligibility Data System (MEDS) records. HPSM’s threshold languages are English, Spanish, Chinese and Tagalog.