The 130th Annual Meeting of APHA

Abstract #39208

Dianna M. Daly, MSPH¹, Hang T. Nguyen, MPH², Nancy A. Fereria¹, and Nhu Hao Duong, MBA³. (1) Provider Operations Department, CalOptima, 1120 West La Veta, Suite 500, Orange, CA 92868, 714-246-8631, ddaly@caloptima.org, (2) Health Promotion and Wellness Department, CalOptima, 1120 W. La Veta Ave., Orange, CA 92868, (3) Customer Service Department, CalOptma, 1120 W. La Veta Ave., Orange, CA 92646

CalOptima is the sole Medi-Cal (Medicaid) managed care organization for Orange County, California, serving approximately 270,000 members. CalOptima membership includes approximately 40,300 members between 11 and 21 years of age. Approximately 1,000 primary care providers participate in CalOptima through a system of 11 contracted health networks. CalOptima is required to follow a comprehensive pediatric preventive services schedule that includes the provision of an annual well-care visit to all member 11-21 years of age. CalOptima’s performance on several pediatric preventive services is measured yearly through NCQA’s Health Employer Data Information Set (HEDIS), including the rate of adolescent well-care visits. In 1999, CalOptima’s HEDIS rate for adolescent well-care visits was 23%. An interdepartmental Pediatric Preventive Services (PPS) Team developed and implemented a multifaceted intervention with the goal of improving the adolescent well-care visit rate. The interventions included: a member incentive program that provides a $15 gift certificate to the member with the documentation of a well-care visit; a teen newsletter geared to topics relevant to teens and advertising the incentive program; a series of communications to and resources for providers; a recognition program for providers who display outstanding performance with CalOptima’s adolescent members. Through these interventions, CalOptima’s 2001 HEDIS rate for adolescent well-care visits was 40%, the highest of all 30 Medi-Cal managed care plans in California, and well above the national NCQA benchmark for commercial plans of 29%.

Learning Objectives:

• Discuss barriers to adolescents receiving preventive health services.
• Identify three member-based interventions to improve the rate of adolescent well care visits.
• Identify three provider-based interventions to improve the rate of adolescent well care visits.

Keywords: Adolescent Health, Health Care Quality

Related Web page: www.caloptima.org

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: CalOptima
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.