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Strengthen the Evidence for Maternal and Child Health Programs

New: MCHbest strategies database for sample ESMs

Evidence Tools
MCH Best. NPM 10: Adolescent Well-Visit

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Strategy. Improve State/Systems-Level Policies and Practices

Approach. Partner with Medicaid and private payers to encourage adoption of annual well-visits standards and offer incentives.

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Overview. Increasing partnerships with Medicaid to encourage the adoption of annual well-visits as an Early and Periodic Screening, Diagnostic and Treatment (EPSDT) standard as well as offering incentives has been found to be effective. Partnering with Medcaid and private payors to receive reports on the percentage of pateints who received well-visits has been effective in increasing access and utilization.

Evidence. Emerging Evidence/Expert Opinion. There is some evidence that practice-wide interventions,1 policy changes (inlcuding Medcaid),2-7 increased reimbursement,8 and offering incentives9 are effective in increasing access to and utilization of adolescent well-visits.The results trend positive overall. More research is needed for conclusive results. Access the peer-reviewed evidence through the MCH Digital Library. In addition, experts in the field have supported this strategy. See webinar on emerging evidence (Read more about understanding evidence ratings).

Target Audience. Payer.

Outcome. Percent of adolescents, ages 12 through 17, with a preventive medical visit in the past year. For detailed outcomes related to each study supporting this strategy, click on the peer-reviewed evidence link above and read the "Intervention Results" for each study.

Examples from the Field. Access descriptions of ESMs from across all states/jurisdictions that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.

The Role of Title V. Title V agencies can support schools that offer comprehensive bullying prevention programming:

Sample ESMs. Using the approach “Support partnerships between primary care clinics and local school-based health centers,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies):

Quadrant 1:
Measuring Quantity of Effort
("What/how much did we do?")

  • Number of public providers that adopt the Bright Futures standards for adolescent well-visits statewide.
  • Number of public providers that offer incentives for adolescent well-visits.

Quadrant 2:
Measuring Quality of Effort
("How well did we do it?")

  • Percent of public providers that adopt the Bright Futures standards for adolescent well-visits statewide.
  • Percent of public providers that offer incentives for adolescent well-visits.

Quadrant 3:
Measuring Quantity of Effect
("Is anyone better off?")

  • Number of public providers that adopt the Bright Futres standards who report an increase in adolescents well-visit completed.
  • Number of adolescents who received incentive for attending a well-visit.

Quadrant 4:
Measuring Quality of Effect
("How are they better off?")

  • Percent of public providers that adopt the Brigh Futures standards and report an increase in annual adolescent well-visits completed.
  • Percent of adolescents who received incentive for attending a well-visit.

Note. ESMs become stronger as they move from measuring quantity to measuring quality (moving from Quadrants 1 and 3, respectively, to Quadrants 2 and 4) and from measuring effort to measuring effect (moving from Quadrants 1 and 2, respectively, to Quadrants 3 and 4).

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.


References:

1 Institute for Child Health Policy at the University of Florida. Florida Pediatric Medical Home Demonstration Project Evaluation. Updated: 2014.

2 Harrington, M., Kenny, G.M., et al. CHIPRA Mandated Evaluation of the Children's Health Insurance Program: Final Findings. Report submitted to the Office of the Assitant Secretary for Planning and Evaluation. Ann Arbor, MI: Mathematica Policy Research; August 2014.

3Smith, K., Dye, C. 2012 2012 Congressionally Mandated CHIP and Medicaid Survey: Findings on Access and Use for Primary and Preventative Care Under CHIP and Medicaid. Memo to the Office of the Assistant Secretary of Planning and Evaluation. Mathematica Policy Research. December 20, 2013.

4Adams, S.H., Park, M.J, Twietmeyer, L., Brindis, C.D., & Irwin, C.E., Jr. Association between adolescent preventive care and the role of the Affordable Care Act. JAMA Pediatr. 2018;172(1):43-48.

5Dick, A.W., Brach, C., Allison, R.A., et al. SCHIP's impact in three states: how do the most vulnerable children fare? Health Aff. 2004;23(5):63-75.

6Kenney, G.M. The impacts of the State Children's Health Insurance Program on children who enroll: findings from ten states. Health Serv Res. 2007;42(4):1520-1543.

7Klein, J.D, Shone, L.P., Szilagyi, P.G., Bajorska, A., Wilson, K., & Dick, A.W. Impact of the State Children's Health Insurance Program on adolescents in New York. Pediatrics. 2007;119(4):e885-892

8Kenney, G.M., Marton, J., Klein, A.E., Pelletier, J.E., & Talbert, J. The effects of .Medicaid and CHIP policy changes on receipt of preventive care among children. Health Serv Res. 2011;46(1 Pt 2):298-318.

9Greene, J. Using consumer incentives to increase well-child visits among low-income children. Med Care Res Review. 2011;68(5):579-593.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.