Adults’ Access to Preventive/Ambulatory Health Services (AAP)

The percentage of persons 20 years of age and older who had an ambulatory or preventive care visit. The organization reports three separate percentages for each product line. 

• Persons enrolled in Medicaid and Medicare who had an ambulatory or preventive care visit during the measurement period. 

• Persons enrolled in a commercial product who had an ambulatory or preventive care visit during the measurement period or the 2 years prior to the measurement period. 

Why It Matters

This measure looks at whether adult members 20 years of age and older receive preventive and ambulatory services visits which occurred in-person, via synchronous telehealth (which requires real-time interactive audio and video telecommunications), telephone visits and online assessments.  This measure excludes acute inpatient encounters and emergency department (ED) visits.  

Health plans accept a premium for their members. This measure reinforces the concept that plans are responsible for providing care to all members. Members who do not access preventive health care are more likely to develop advanced or preventable disease, at higher personal and financial cost ^(1,2). Although patients have a responsibility to take care of themselves, health plans need to take an active role in educating members about the importance of routine care and in reminding them when routine care is needed.  

This measure answers the following questions:  

• How many patients never access the system?  

• What services do they receive?  

• How does preventive care and counseling occur for these members?  

• Without a patient visit, they do not receive counseling on diet, exercise, smoking cessation, seat belt use and behaviors that put them at risk. If the organization’s services are not being used, are there barriers to access?  

Plans with relatively high rates can document that members are seen at least once every three years for commercial and once every year for Medicaid and Medicare. In general, lower rates suggest an access problem: members cannot access care, or they do not understand the importance of routine care, and therefore do not seek it. In both cases, the health plan can make a difference by increasing access (increase the size of the network or set standards for office hours that make care more accessible to members) or by developing systems that identify persons who need care and reaching out to them. 

Historical Results – National Averages