Look ahead: Preparing for new child health measures
If the goals of the Children’s Health Measurement Initiative come to fruition, the number of HEDIS measures for children will expand greatly in the next two years. Physicians can prepare for this development by looking at administrative and clinical process in their practices, says Joe Thompson, MD, an Arkansas pediatrician and former NCQA assistant vice president of research and measures development.
Here are some efforts that would be helpful, regardless of how the measures are drafted, Thompson says:
o Make sure every child has a unique identifier.
When health plans enroll new members who are parents, they frequently don’t identify every child in the family who is covered by that insurance product, he says. "There is a need for [health care] delivery systems to take a head count and make sure they have a unique identifier for every person who might use services under that program."
Identifiers help track preventive care
Physicians who accept capitated payments need a tracking system for each potential patient, including the children, says Thompson. "Frequently, physicians don’t establish an identifier until the child comes in for care," he says. "In the future, it’s going to be an advantage to physicians to have an identifier as soon as they take payment and assume responsibility for that patient’s care."
For example, if a mother with three children signs up with a health plan but hasn’t come for any well-child visits, the physician may not know how many children they are responsible for caring for and won’t be able to demonstrate that the children are up-to-date on their immunizations. "There’s a real need for both the health plans and the providers to know about the population of individuals they need to take care of," he says.
o Address family risks, both clinically and socially.
Family issues have a direct bearing on the child’s environment and therefore on health. For example, "physicians should know if there’s a smoker in the house," says Thompson. "There’s clear evidence that a smoker in the house increases upper respiratory infections in the kid."
Tapping into family issues may enable physicians to provide education about risks and prevention, such as proper storage of firearms. Physicians also may learn about the impact of a child’s illness on the family.
o Recognize guidelines that could become quality measures.
There are numerous preventive health guidelines that apply to children, such as the U.S. Preventive Health Task Force recommendations and Healthy Children 2000. Various organizations, such as the American Academy of Pediatrics in Oak Grove Village, IL, also have developed guidelines for treating specific conditions.
Those guidelines ultimately will shape accountability measures, says Thompson. Physicians could begin now with quality improvement projects based on established guidelines, he says.
"Those providers who address how they’re going to ensure they provide high quality care will benefit in the long run," he says. Aside from the obvious advantage to their patients, "they’re going to be the ones the health plans want to contract with," he says.
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