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 people regularly attend well visits1. They allow providers to identify and address many problems early on.
HPSM’s annual visit rates from 2022 and 2023 show that there have been rate increases in most age groups. However, there are still areas that need improvement, as almost half of HPSM’s membership has not seen a primary care provider in the past 12 months.
| Measure2 | 2022 rate | 2023 rate | Minimum performance level3 |
| Well-child visits in the first 15 months of life - 6 or more visits | 49.62% | 58.58% | 58.38% |
| Well-child visits for members between 15 & 30 months of life - 2 or more visits | 72.38% | 72.96% | 66.76% |
| Annual well-child visits - ages 3-21 | 52.00% | 54.81% | 48.07% |
| Adult preventive & ambulatory health services - ages 20+ | 67.59% | 68.76% | N/A |
We continue to focus on improving visit rates and want to partner with you on getting patients in for care and closing health care disparities. Our 2024 Population Needs Assessment found significant disparities in well visit rates among multiple member subgroups, including those who identify as Black or Caucasian.
It’s Time to Catch Up! Reach Out to Your Patients to Come In For Well Visits and Vaccines.
- Schedule well visits in advance. To accommodate people’s busy schedules, offer extended weekday evening hours or see patients on weekends. For children, if the timing is right, schedule visits during times when they are not in school (such as summer/winter breaks).
- Let patients 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 each visit, offer and administer any vaccines they are due to receive.
- Sports physicals for children and youth 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 perform targeted outreach.
- Submit electronic health records (EHRs) with the correct codes and provider information.
HPSM Members Can Get No-Cost Transportation to Well Visits
Medi-Cal and CareAdvantage members who have no means of transportation to approved healthcare visits can use HPSM’s Ride Benefit at no cost – learn more.
When Patients Have Limited English Proficiency (LEP), Use HPSM Interpreter Services
HPSM providers are required to provide linguistically appropriate services to members with LEP. To meet this need, 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.
Learn more about HPSM Language Assistance Services.
Footnotes
1. Holland, J. E., Varni, S. E., Pulcini, C. D., Simon, T. D., & Harder, V. S. (2022). Assessing the Relationship Between Well-Care Visit and Emergency Department Utilization Among Adolescents and Young Adults. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 70(1), 64–69. https://doi.org/10.1016/j.jadohealth.2021.08.011
2. Measures are based on the Healthcare Effectiveness Data and Information Set (HEDIS) HPSM is responsible for reporting on an annual basis. Measure definitions can be found at www.ncqa.org/hedis/.
3. HPSM is held to the minimum performance level for a number of HEDIS® clinical quality metrics. The minimum performance level is based on the National Committee for Quality Assurance (NCQA) Quality Compass® Medicaid HMO 50th percentile rate. The list of quality measures HPSM is held to the minimum performance level for can be found at https://www.dhcs.ca.gov/dataandstats/reports/Pages/MgdCareQualPerfEAS.aspx.
