II

BlueCross BlueShield of Tennessee

Change:

BlueCross BlueShield of Tennessee implemented the following strategies to improve

tracking of preventive visits and developmental screens performed by PCPs for chil 

dren age six 36 months of age:

Conducted quarterly queries of claims database.  Analysis of the claims data includ 

ed PCP number, PCP name, PCP specialty description, # of preventive visits with

standardized developmental screen by same PCP, # of preventive visits, date and

region.  

Used CPT codes (99381, 99382, 99391, 99392) to identify preventive visits and CPT

96110 to identify standardized developmental screen for children six to 36 months of

age.

Made analytical comparisons for each provider whose name appeared in the quarter 

ly claims queries.

Accomplishment:

Through this effort, BCBST was able to identify the percentage of providers who were

and were not conducting a standardized developmental screening in their EPSDT 

preventive visit.  Of the 5,934 preventive visits performed by 114 PCPs, only 528 (8.9

percent) documented a standardized developmental screen at the time of the 

preventive visit, suggesting an opportunity for improvement.

STRATIFICATION 

BCBST set a stratification goal to identify  high leverage  providers, that is those

providers with high volume of preventive visits each year and a weak track record of

performing standardized developmental screening. Through this unique stratification

approach, the plan identified 34  high leverage  providers to target for additional

intervention. 

Aim:

Stratify 100 percent of PCPs by number of preventive visits and by percentage of pre 

ventive visits with standardized developmental screen to determine  high leverage 

PCPs, those physicians stratified as both high volume and high opportunity.

Working Definitions:

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

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

standardized developmental screen.

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

Measures:

# of  High Volume  PCPs

# of  High Opportunity  PCPs

# of  High Leverage  PCPs = High Volume PCPs + High Opportunity PCPs

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