II

BlueCross BlueShield of Tennessee

BlueCross BlueShield of Tennessee (BCBST) set an overall aim to encourage more

providers to perform standardized developmental screening in children, age six to 36

months, during preventive visits.  BCBST used the BCAP Typology to stratify  high 

leverage  primary care providers (PCPs) by number of preventive visits and by preven 

tive visits with standardized developmental screening.  BCBST defined high leverage

as providers identified as both  high volume  and  high opportunity.  High volume

equals PCPs with 100 or more preventive visits per year.  High opportunity equals

PCPs with fewer than 50 percent of preventive visits inclusive of a standardized devel 

opmental screening.

During the pilot phase, outreach nurses from BCBST, called Regional Clinical Network

Analysts (RCNA), visited 34 high leverage sites to train providers on how to administer,

score and submit reimbursement for the PEDS tool. The screening rate for these high 

leverage providers increased from 0 to 43.5 percent during the pilot phase.  Because

of the potential realized after the initial BCBST pilot, the Tennessee Chapter of the

American Academy of Pediatrics now trains on EPSDT at provider sites throughout the

state.

IDENTIFICATION 

BCBST set a goal to identify all preventive care visits for members, age six to 36

months, to determine which members were not receiving standardized developmental

screening, as well as which providers were providing preventive care. 

Aims:

1. Identify 100 percent of preventive visits for members age six to 36 months.

2. Identify the percentage of preventive visits by PCPs for members age six to 36

months for which standardized developmental screening was performed.

3. Identify the PCPs who perform preventive visits for members age six to 36 months.

Measures:

1. # of preventive visits for members age six to 36 months

=

5,934

2. # of preventive visits for members age six to 36 months with 

standardized developmental screening 

= 

528

# of preventive visits for members age six to 36 months 

5,934

Percent of preventive visits with concurrent screen = (528/5,934)*100 = 

8.9%

3. # of PCPs performing preventive visits in members age six to 36 months =

114 

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