Catch Up on Routine Vaccines and Well-Child Visits

The COVID-19 pandemic continues to disrupt routine childhood immunizations and well-child visits, according to the Centers for Disease Control and Prevention (CDC). The CDC recommends doctors and health care professionals encourage families to schedule vaccines and visits to help children catch up. We’ve created Wellness Guidelines and vaccine information for our members to help.

Closing Care Gaps

To help monitor and improve our members’ care, we track these Healthcare Effectiveness Data and Information Set (HEDIS®) measures developed by the National Committee for Quality Assurance:

  • Child Immunization Status tracks the percentage of 2-year-olds who received by their 2nd birthday a total of:
    • Four diphtheria, tetanus and acellular pertussis (DTaP)
    • Three polio (IPV)
    • One measles, mumps and rubella (MMR)
    • Three haemophilus influenza type B (HiB)
    • Three hepatitis B (Hep B)
    • One chicken pox (VZV)
    • Four pneumococcal (PCV)
    • One hepatitis A (Hep A)
    • Two or three rotavirus (RV); all doses should be given before 8 months of age
    • Two flu vaccines
  • Immunizations for Adolescents tracks the percentage of 13-year-olds who received by their 13th birthday:
    • One dose of meningococcal vaccine
    • One tetanus, diphtheria and pertussis (Tdap)
    • The complete human papillomavirus vaccine (HPV) series
  • Well-Child Visits in the First 30 Months of Life measures the percentage of children who had:
    • Six or more well-child visits with a primary care physician during their first 15 months
    • Two or more well-child visits during their next 15 months

Tips to Consider

  • Identify members who have missed vaccines or well-child visits. Contact their caregivers to schedule appointments.
  • Check at each visit for any missing immunizations. Address common misconceptions about vaccines.
  • To document well-child visits, note that the visit was with a PCP and include in the medical record:
    • Date of visit
    • Health history
    • Physical and mental development history
    • Physical exam
    • Health education or anticipatory guidance
  • We collect immunization data through claims and chart review. To document immunizations, you may include in the medical record any of the following:
    • Certificates of immunizations
    • Diagnostic reports
    • Subjective, Objective, Assessment and Plan (SOAP) notes
    • Office or progress notes

Resources

 

The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.

HEDIS is a registered trademark of NCQA.