Arizona’s School Readiness Action Plan: The AHCCCS Report Card on Children’s Preventive Health Initiatives Arizona Health Care Cost Containment System Anthony D. Rodgers, Director Prepared by the Division of Health Care Management May 2005 A ll children in Arizona enter first grade safe, healthy and ready to succeed. – The Vision of the Arizona School Readiness Action Plan A HCCCS – the Arizona Health Care Cost Containment System – has a major role in helping to prepare children for school by ensuring that many of them, especially those whose parents earn a minimal income and would otherwise have no medical insurance, receive the health care they need to grow up healthy. The first years of life are critical to the long-term health and well-being of children. Recent studies estimate that 15 to 17 percent of all children ― and one-third of low-income children ― are at risk of developmental or behavioral delays. Child health care professionals have unique opportunities to identify children with developmental and behavioral disorders, or those who are at risk of developing such problems, and to initiate appropriate interventions. Regular checkups for possible medical problems, vision and hearing screenings and preventive services such as immunization against childhood diseases and dental care further ensure that children are healthy and able to focus on learning. While virtually all children have contact with the health care system at some point, many problems may not be detected until children enter school. By offering low-income families and children access to health care and a regular point of contact, the AHCCCS program is uniquely positioned to provide high-quality, comprehensive preventive services that help assure the healthy development of children. HCCCS became the first statewide Medicaid managedcare system in the nation in 1982, and currently serves more than 1 million members through a variety of programs. The majority of AHCCCS members are served the acute-care program, which delivers services through eight publicly privately operated health plans. A through and Children covered under Medicaid are eligible to receive a comprehensive package of preventive and other services known as EPSDT, or Early and Periodic Screening, Diagnosis and Treatment. In Arizona, children covered under the State Child Health Insurance Program, known as KidsCare, may receive the same EPSDT services. These services include a comprehensive health and developmental history, including physical, nutritional and behavioral health assessments; a comprehensive physical examination; appropriate immunizations according to age and health history; laboratory tests, including blood lead screening at 12 and 24 months, tuberculosis screening appropriate to age and risk, and testing for anemia; appropriate vision, hearing and speech assessments; an oral health screening and regular dental care; and parental health education and guidance. EPSDT also covers necessary treatment of any problems found during checkups. As part of the Arizona School Readiness Action Plan, AHCCCS and its contracted health plans are working to increase well-child checkups, immunizations, dental visits and other important services. The following report card is based on measurements of services using the Health Plan Employer Data and Information Set (HEDIS). Developed by the National Committee for Quality Assurance (NCQA), HEDIS is the most widely used set of performance measures in the managed care industry. One of the HEDIS criteria for selecting members to be included in the analyses is that they be continuously enrolled for a minimum period of time with one health plan. Thus, members included in the results of each measure represent a significant portion of children covered under AHCCCS. For more information about AHCCCS or how these measurements were obtained, go to http://www.azahcccs.gov. The Dental Visits Performance Improvement Project and Acute Care Performance Measure reports can be accessed under Studies. For more information about the Governor’s Fiveyear School Readiness Action Plan, go to http://gocyf.az.gov.sr. The AHCCCS Report Card on Children’s Preventive Health Initiatives for School Readiness 2004 1 Target Current 2 Rate 2005 3 Goal Well-child checkups, birth to 15 months (6 or more visits) 58% 68.1% 70% Annual well-child checkups, 3 through 6 years 48% 52.0% 55% Children’s Access to Primary Care Practitioners (ages 1 through 6) 77% 86.5% 79% Annual Dental Visits (3 through 8 years) 45% 52.1% 55% no goal based on this series 70.3% 75% Measure Childhood Immunizations by 24 months (4:3:1:3:3 Series) 1 Minimum standards previously established by AHCCCS for internal performance monitoring The current AHCCCS rate is based on the most recent measurement; data are from the AHCCCS fiscal year ending 9/30/02 or 9/30/03, except Childhood Immunizations, which is from data for the period from 10/1/02 to 9/30/04. 3 Goals established in 2004 for monitoring progress related to School Readiness Board activities 2 Progress on Other Initiatives: Developmental Assessment Tool (PEDS). AHCCCS is working on implementation of the Parental Evaluation of Developmental Status (PEDS) tool recommended by the School Readiness Board for developmental screening. Healthy Weight (Reduce Childhood Obesity). AHCCCS has begun implementing the Childhood Obesity Medical Guideline, which includes four levels of education and intervention for nutrition/healthy eating, physical activity, behavior management and support for children who are, or are at risk of, becoming overweight and their families.