Well-Child Visits Get a Weekend Win

Leaders of Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) were enthusiastic about launching a campaign aimed at enhancing well-child visits. They planned to leverage their understanding of the network for Medi-Cal (California's Medicaid program) and Health Plan’s benefits to boost these important check-ups. Health Plan is the community health plan in San Joaquin, Stanislaus, El Dorado, and Alpine counties. At first, leaders had the idea for a texting campaign aimed at teens in the community with the goal of drawing more adolescents to well-child visits. However, after trying the campaign, the numbers remained flat.

Health Plan team members used quality measures to determine which clinic had the greatest disparity in well-child visits. This analysis led them to identify Golden Valley Health Center as their strategic partner for collaboration, because the Center had already booked every available appointment slot through the end of the calendar year.

It was a conundrum, but the team at Health Plan quickly came up with an effective intervention — what if Golden Valley opened for weekend appointments? Health Plan worked with Golden Valley to secure a locum tenens provider to see patients on Saturdays from 8:00 AM to 5:00 PM. A locum tenens is a physician, nurse practitioner, or other medical provider that works in a practice temporarily. While lack of continuity of care could be a challenge with this arrangement, it can also expand flexibility, capacity, and access.

“It was kind of a light bulb moment, realizing that there was an underlying issue that we just didn’t have enough providers,” said Nicole Branning, Health Plan’s Accreditation Manager. “What we did was leverage a locum grant to hold Saturday clinics,” a cost covered by Health Plan under generalized quality improvement budgeting. Health Plan’s population health outreach team called the families with adolescent members who had not received preventive care and assisted them to schedule appointments at the Golden Valley clinics.

The weekend appointments grew out of the Child Health Equity Collaborative, a 13-month initiative led by the Institute for Healthcare Improvement (IHI) and funded by the California Department of Health Care Services. All managed care plans in California are participating in the program, and the Center for Care Innovations (CCI) is an implementation partner. The goal of the first phase of work is to improve the completion of well-child visits in infants and adolescents through five different interventions with tools, guidance, and coaching. Well-child visits, which cover children from birth to 18, are critical to child and teen health. However, studies show that parents tend to take their children to the doctor only when they show visible signs of illness and not for all preventive health visits.

Saturday clinics started in November 2024, and by January 2025, more than 100 patients had already been seen for a wellness visit. Weekend appointment availability has been especially desirable to working parents. Additionally, while not all patients who come to the Saturday appointments fit into Golden Valley’s target population for this effort, slots left unfilled are extended to all children in the family. “One Saturday, a family of five came and not all of them were in our teenage [target] group but they all got their well visits,” Branning said. “So, it is still a success.”

Excited about the initial results of Saturday appointments, Health Plan is preparing to support Golden Valley in ramping up its outreach for well-child visits. For years, Health Plan has educated parents about well-child visits with flyers and articles in member newsletters. It has also offered incentives for completing a well-visit. “Going forward, we will supplement these efforts by taking a much more hands-on approach to building strong relationships,” said Branning. To help publicize the importance of well-child visits, the team is planning to enlist more community partners, with potential collaborators such as barbershops, school districts, and agencies doing events for holidays like Halloween. “It would be really nice to have an army of people supporting this work,” Branning said.

The biggest challenge for Golden Valley and Health Plan is that the no-show rate started to increase over time, with December being the month with the highest no-show rate. This can be attributed to families traveling out of town for the holidays. To improve this, Health Plan started scheduling appointments closer to the appointment day itself. “The closeness to the actual appointment was improving people’s show rate, [while] scheduling too far in advance seemed to be connected with no-shows,” Banning noted. Health Plan’s team has also encouraged the health center not to schedule early morning visits for teen patients on Saturday, as patients have expressed preference for later appointments.

Another major challenge is transportation. Many of the patients live in distant rural communities. “To get to a connecting bus, rural Stanislaus County families with kids may have to walk a long way to Hatch Road — one of the primary streets in Ceres, CA, which lacks sidewalks and connects to several bustling intersections,” said Francheska Dominguez, HEDIS & NCQA (National Committee for Quality Assurance) Coordinator. “It’s not very ideal for families.” She explained that the first bus then takes them to another stop, where they must wait 30 minutes before boarding a second bus that takes 45 minutes to arrive at the health center. The return commute presents the same issues. Health Plan offers free door-to-door transportation services to mitigate the transportation barrier. However, the team points out that in the rural areas, access to such services is limited. (Children under 18 must be accompanied by an adult for well visits unless they are emancipated minors).

Despite these challenges, offering Saturday appointments has been a big success. Golden Valley has now scheduled these events as a regular occurrence with their locum providers.

Photo by Herzon Carranza on Unsplash

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