In winter, many of the children on a pediatric schedule are there because they are sick. Every one of those visits is about helping a child feel better, which is exactly what it should be about. Some of the children on that schedule, though, have not been in for a checkup all year, and the visit their family booked for a sore throat may be the best chance anyone has to change that before the year closes.
Why winter matters for the well visit
Flu season runs through the fall and winter, and most of the time flu activity peaks between December and February [1]. That timing lines up with something our quality guide says plainly: most often, children see their primary care provider when they are already sick, which can make that visit the only opportunity the provider has to complete the well visit [2].
The calendar adds a second reason to pay attention in these weeks. Well-child visits are counted inside a measurement year that ends on December 31 [3]. For children three and older, the measure looks for at least one comprehensive well visit during that year, and on January 1 the wellness opportunities for Medicaid children open again in the CareEmpower® worklist [4]. So a checkup completed during a December sick visit counts for this year, while the same checkup in the first week of January begins the next one. For a child who has not had a well visit yet this year, a few weeks can decide whether this year has one at all.
What this season adds
We have written before about turning a sick visit into a well-child visit, and your Practice Performance Advisor can walk your team through the full workflow [3].
What winter adds is timing. The same ideas matter more in the weeks when flu season is at its height and the year has the least time left, and they tend to work best when they are small enough to fit into a busy day rather than asking a team to rebuild its schedule.
A few ideas that fit a winter day
Our Sick to Well quality guide offers a handful of ideas that are simple enough to fold into an ordinary clinic day [2].
The first one happens before the child arrives. When a parent calls about a sick child, the person taking the call can check whether the child is also due for a well visit and, if so, leave a little extra time on the schedule so the provider has room to do both [2]. CareEmpower can make that check quicker, because the Scheduled Visits page prints the Chart Prep Tool in bulk for the day’s upcoming visits, and Chart Prep lists each patient’s preventions and screenings [5]. For the youngest patients, the W15 and W30 visit tiles show a counter, so the team can see how far along a child’s early visit series has come [5].
Whether the checkup happens that day remains the provider’s call, made for the child in front of them, and it makes sense only when the child is well enough and the family has the time. The guide’s own phrase, “when appropriate,” carries a lot of weight [2]. When the answer is not today, the visit can still move the checkup forward, because check-out is a natural moment to book the next well visit, so the family leaves with a date on the calendar instead of a reminder to call back later [2].
Two more ideas from the guide reach a little further. When a visit is being booked, it helps to check whether a brother or sister is also due for a well-child visit and to schedule that at the same time [2]. And if a patient arrives late, the guide suggests still trying to fit the well visit in [2], which can matter more than usual in December, when there may not be another opening before the year ends.
How payment fits
Many Medicaid managed care organizations provide payment for a combination of certain services completed on the same day, including sick visits and well visits [2]. Through ECIP, our activity-based payment program, Equality Health (EH) accepts sick-visit-to-well conversions toward W15, W30 and WCV where the payer’s reimbursement policy allows, with modifier 25 [4]. Because policies differ from plan to plan, the coding detail, including where modifier 25 belongs on the claim, is something your Practice Performance Advisor (PPA) would be glad to walk through with your team [3].
Where we come in
Our part is to make these small habits a little easier to keep. CareEmpower helps the front desk see who is due before the day starts, and PPAs can help a team set up the workflow that fits its own schedule [3]. On the family side, our Care Specialists and community health workers stay in touch with families who have lost contact with primary care, and they help with practical things, such as finding an appointment time, sending a reminder, or arranging a ride [6]. When a sick visit ends without a checkup, that support can help the family come back for one.
The Year-End Quality Playbook gathers the rest of our well-child material in one place, including member guides in English and Spanish that a practice can share with families [3].
To the front-desk teams who check one more chart before a crowded morning, and to the providers who make room for a checkup when a child is well enough for one, thank you. Winter is a demanding season in pediatric primary care, and we are grateful to work alongside you through it.
References
[1] Centers for Disease Control and Prevention. “Flu Season.” Updated September 26, 2025. https://www.cdc.gov/flu/about/season.html
[2] Equality Health. “Pediatric Sick to Well Visit” Quality Guide. February 2025, p. 1.
[3] Equality Health. “Here’s Your Year-End Quality Playbook.” September 2, 2026. https://equalityhealth.com/blogs/year-end-quality-playbook/
[4] Equality Health. “2026 ECIP Reference Guide” (provider-facing), slide 3.
[5] Equality Health. “CareEmpower User Guide.” February 2026, pp. 19, 21, 26.
[6] Equality Health. “A Child’s Road to Wellness Runs Through the Pediatric Office.” October 2026. https://equalityhealth.com/blogs/well-child-visits-pediatric-primary-care/
