The family, which completes the ASQs, mails them back to ICHAP, and is

involved in early intervention referral decisions.

To enroll a child in the ICHAP ASQ program, the child must:

Be 0 3 years of age;

Live in New York City; and 

Have one or more ICHAP risk factors.

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ABC created a registry of high risk 0 3 year old members based on claims data indi 

cating ICHAP risk factors.  With parent permission, members on the registry were

enrolled in the ICHAP ASQ program at the provider site.  

ABC and ICHAP found that a large proportion of participating families returned the

questionnaires on a regular basis. ICHAP's ASQ approach supports ongoing develop 

mental screening, is integrated into the child's primary care medical home, spares

the pediatrician's time and resources, is cost efficient, and fully involves the family in

developmental assessment.

Targeting Providers for Maximum Impact

BlueCross BlueShield of Tennessee maximized resource use by stratifying its  high 

leverage  providers for a quality improvement intervention. Through claims data,

the plan identified the percentage of providers who were conducting a standardized

developmental screen in their EPSDT preventive visit.  Only 8.9 percent of the pre 

ventive visits showed a documented developmental screen, suggesting significant

opportunity for improvement.  BCBST stratified PCPs serving six  to 36 month olds

by the number of preventive visits, and by the percentage of preventive visits with

standardized developmental screen using the following definitions:

 High Volume  = PCPs with 100 or more preventive visits per year.

 High Opportunity  = PCPs with fewer than 50 percent of preventive visits with   

standardized developmental screen.

 High Leverage  = PCPs stratified as both high volume and high opportunity.

Through this innovative stratification approach, BCBST determined that 34 PCPs

performed close to 80 percent of preventive visits and also had a preventive visit

developmental screening rate of less than 50 percent.  BCBST targeted its outreach

efforts on these high leverage PCPs to maximize the potential of improvement activ 

ities, and saw improvement in screening rates at these sites.

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Provider Outreach

Managed care organizations can support providers through trainings on the impor 

tance of developmental screening and new tools available.  Several plans in the

BCAP workgroup piloted approaches to increase provider/office staff awareness and

offer training for early childhood development screening. 

58

The ICHAP ICD 9 list is available in the online toolkit at www.chcs.org.

59

See the case study on page 51 for more information.

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