WellCare of Florida, Inc HealthEase of Florida, Inc. Well-Child visits in the Third, Fourth, Fifth and Sixth Years of Li

1. WellCare of Florida, IncHealthEase of Florida, Inc.Well-Child visits in the Third, Fourth, Fifth and Sixth Years of Life External Review Quarterly meeting Best Practices January 14, 2009

2. Well-Child visits in the Third, Fourth, Fifth and Sixth Years of life Reform WellCare rates 2007

3. Well-Child visits in the Third, Fourth, Fifth and Sixth Years of life NonReform WellCare rates 2005-2007

4. Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life • Identified Barriers • Members: non-compliance, lack of knowledge • Providers: lack of tracking systems, lack of knowledge, incomplete data submission, not performing all services for a well-child exam • Systems: incomplete data capture of claims/encounters from providers, member demographic information not current thus reminders/educational materials not received * HEDIS 2009, Volume 2

5. Well-Child visits in the Third, Fourth, Fifth and Sixth Years of life • Provider Interventions • Network Improvement Program (NIP) visits to targeted PCP’s with high non-compliant HEDIS rates • Distribution of non-compliant reports to PCP’s listing members non-compliant with targeted HEDIS measures including well-child visits • Monthly membership lists mailed to PCP’s which includes preventive care needed for each member • Newsletter articles regarding the importance of well-child visits • Distribution of training material and Well-child forms for physicians

6. Well-Child visits in the Third, Fourth, Fifth and Sixth Years of life • Member Interventions • Special mailing to noncompliant members during 4th quarter • Contracted with different HEDIS data collection vendor due to identified challenges with previous vendor; nurses with new vendor were trained on specifically assigned measures • Trained contracted WellCare nurses on-site to perform overreads on HEDIS sample of non-compliant records to determine if visits done or to identify alternate sites • Automated member outreach phone calls to non compliant members reminding them to obtain a well-child visit • Calls to noncompliant members in the sample to determine where services were received. • Periodicity letters mailed to parents of members non-compliant with well-child visits reminding them of the importance of well-child visits

7. Well-Child visits in the Third, Fourth, Fifth and Sixth Years of life • 2008 Interventions to continue to improve the rate of well-child visits: • Database developedto include non-compliant members for well-child in all age groups; reports generated from this database included provider specific non-compliant scores and listing of non-compliant members. As a result of working these lists, capitated providers were identified who had not submitted encounters to WellCare • Workgroup established to identify providers submitting encounters and monitor submission of encounters monthly • Hiring of additional quality improvement staff per plan region to intensify collaborative quality efforts with providers

8. Well-Child visits in the Third, Fourth, Fifth and Sixth Years of life • 2008 Interventions to continue to improve the rate of well-child visits: • Well-child educational materials developed for distribution to providers to include coding ‘cheat sheet’ and other well-child requirements such as examples of anticipatory guidance • Provider resources developed such as a medical record tracking tool for well-child visits and a well-child provider toolkit for posting on the provider web portal • Targeted provider office education on HEDIS measures to include well-child visits requirements