The rate of children and youths with a preventive visit is divided into two age categories: children ages 3-6 and youths ages 12-19 (Figures 1-4). According to the American Academy of Pediatrics (AAP) periodicity schedule, children should receive annual visits at ages three, four, five and six, and biannual visits at ages eight and ten. Annual visits should again be made during adolescence for ages 11 through 21. Preventive visits do more than address the medical needs of the child; they can provide an opportunity for anticipatory guidance to parents and children.

Figure 1 compares data for children in the three hawk-i plans to data from a report by the American Public Human Services Association (APHSA), which provides a national benchmark for this HEDIS measure for children three through six years of age in Medicaid plans in 1999 and 2000. This comparison indicates that all three hawk-i plans have rates of preventive visits for this age group that are below the national averages for Medicaid programs. In a previous report, Evaluating the Iowa Medicaid Managed Care Program: Outcomes of Care , we reported preventive visit rates for children ages 3-6 in the Iowa Medicaid program. These rates ranged from 52% for United Health Care to nearly 80% for children in the MediPASS program. Preventive care rates for children in all of the Medicaid plans were above the APHSA rates for 1999 and well above the rates for the plans within hawk-i . In fact, over 60% of children ages 3-6 in the Medicaid program enrolled in Iowa Health Solutions for at least 11 months had a preventive visit during 2000, while only 35% of children 3-6 in hawk-i enrolled in Iowa Health Solutions for at least 11 months had a preventive visit. The differential for John Deere was 63% versus 43%. As Wellmark does not participate in the Medicaid managed care program, comparable figures are not available. These findings indicate either that the plans or their providers are not as effective in providing access to preventive care for children within hawk-i or that limitations of this data such as differential rates of missing data across the plans, the systematic use of inappropriate codes, or the miscoding of diagnoses may have affected the rates.

Figure 1. Rate of preventive medical visits for children 3-6 years of age
enrolled for at least 11 months by plan and compared to APHSA rates

 

Figures 2 and 3 indicate the percentages of children receiving preventive care at each age in the group (ages 3, 4, 5 and 6) during FY 2001. Figure 2 shows rates for all children in hawk-i , while Figure 3 includes only children who were eligible for 11 or 12 months during 2001. In general, children seem to receive the most preventive care visits during the fourth and fifth years of life, as parents prepare to send them to school. Within all ages there is variation among the plans; however, the variation was most apparent for rates when only those children who were eligible for 11 and 12 months were included in the calculations (Figure 3).

Figure 2. Percent of children with a well child visit in fiscal year 2001 by age and plan

Figure 3. Percent of children enrolled in a plan for at least 11 months
with a preventive medical visit in fiscal year 2001 by age and plan

The rates of youths enrolled for at least 11 or 12 months during FY 2001 with at least one preventive medical visit are shown in Figure 4. The rate of preventive visits for youths in John Deere is comparable to the national average; however, the rates for youths in Iowa Health Solutions and Wellmark are well below this average. John Deere and Iowa Health Solutions also have rates for youth preventive care that are below the rates found for youths enrolled in these plans through the Medicaid program. Generally, the rates for preventive care are low within the three hawk-i plans, especially when compared to the AAP guidelines for annual visits during adolescence.

As with the rates for preventive medical visits among children 3-6 years, the rate differentials for the same plan across the two programs ( hawk-i and Medicaid) are worrying. hawk-i is a new program with a larger percentage of enrollees who have not been enrolled before. These results may indicate that those within a long-established program may find it easier to link to providers and obtain preventive care. The results also indicate that feedback to the plans and monitoring will be necessary to assure future improvement.

Figure 4. Rate of preventive medical visits for youths 12-19 years of age
enrolled for at least 11 months by plan and compared to APHSA rates

 

American Academy of Pediatrics. Policy statement on Recommendations for Preventive Pediatric Health Care. Pediatrics. Vol. 105, Number 03, March 2000, pp. 645. Available at http://www.aap.org/policy/re9939.html . Most recently accessed October 3, 2003.

American Public Human Services Administration. Available at http://www.aphsa.org/ . Most recently accessed October 3, 2003.

Momany ET, and Damiano PC. Evaluating the Iowa Medicaid Managed Care Program: Outcomes of Care. Final report to the Iowa Department of Human Services, January 2003. University of Iowa, Public Policy Center, Iowa City, IA.