2005 AHIP Immunization

Assessment SummaryNational Vaccine Advisory CommitteeNovember 29-30, 2005

Steve Black, MD, AHIP Liaison to NVACBob Rehm, Director of Public Health

Strategies, AHIP

Demographics and Methods• Forty questions were developed by AHIP to assess the immunization practices and policies of its member health insurance plans

• Survey administered February-March 2005

• 140 plans were invited to participate in the immunization assessment - 15 plans (11%) refused to participate - 63 plans (45%) did not respond - 61 HMO and PPO plans responded – 44% response rate

• Of those that responded: - 59% have HMO as their best selling product while 41% have PPO - 60% are state organization while 40% are multi-state organization - Total combined enrollment: 57.6 million All findings are weighted by enrollment to best reflect the experiences of health insurance plan enrollees

2005 Immunization Assessment Survey Focus Areas-Vaccine Benefit Design

-Reimbursement: Vaccine and Vaccine Administration

-Pediatric, Adolescent and Adult Benefit Design

-Immunization Registries

-Immunization Improvement Programs

-HEDIS Reporting

-Vaccine Shortages

Decision-Making for Vaccine Benefit Design

  HMO(%)

PPO (%)

Best description of the role of employer groups/ purchasers in determining inclusion of vaccine in the preventive benefit design:

• Purchasers rely on benefit design recommendations from the health insurance plan• Shared role by purchaser and health insurance plan

89.2

10.2

40.9

25.3

Process that health insurance plans follow in vaccine coverage determination:

• ACIP recommendations are reviewed by P& T (or similar) committee for consideration• Conduct a cost-benefit analysis if more than one vaccine is recommended for the same disease (e.g., FluMist nasal spray and the injectable vaccine)

77.7

25.4

96.7

73.8

Vaccine Reimbursement

  HMO (%)

PPO (%)

Length of time health insurance plans act on new/ revised recommendations after ACIP announced vaccine schedule:

• Less than a month• Greater than 1 month and less than 3 months• Sub-Total

37.548.586.0

5.646.852.4

Process health insurance plan utilize in vaccine reimbursement determination:

• Average Wholesale Price listed in the AAP RED BOOK and/or other similar publications• Discounted AWP• Combination of the two processes above• Sub-Total

18.625.29.8

53.6

76.36.9

11.194.3

Administration of Vaccine Reimbursement

  HMO (%)

PPO (%)

Process health insurance plan utilize in reimbursement for vaccine administration:

• Based on appropriate CPT code• Resource Based Relative Value Studies (RBRVS) Fee Schedule• Standard Medicare Reimbursement Methodology• Sub-Total

64.1

6.817.188.0

54.4

34.610.899.8

Percent of health insurance plans that do not require a co-payment for an office visit if the only service provided is a routine immunization 85.4 88.4

Benefit Design

  Pediatric Adolescent Adult

HMO(%) PPO(%) HMO(%) PPO(%) HMO(%) PPO(%)

Hep B100.0 100.0 100.0 94.3 97.6 85.0

DTaP/Td100.0 100.0 100.0 100.0 100.0 98.1

Hib100.0 100.0

IPV100.0 100.0

MMR100.0 100.0 100.0 100.0 94.9 86.0

Varicella100.0 100.0 100.0 94.3 93.3 86.0

Pneumococcal100.0 100.0 97.4 90.2 99.8 98.1

Influenza100.0 100.0 99.4 94.3 100.0 98.1

Hep A92.2 98.4 92.7 93.9 93.5 85.4

Meningococcal* * 92.8 93.0

* Not recommended by ACIP for adolescents at the time of the assessment

Immunization Registries

  HMO(%)

PPO (%)

Percent of health insurance plans that are currently involved in immunization registry initiatives 74.2 73.8

Percent of health insurance plans that are currently sharing with an existing immunization registry in their service area/state 85.0 85.8

Immunization Improvement Programs  HMO

(%)PPO

(%)

Types of organizations health insurance plans collaborate with on immunization programs:

• Community coalitions• Public health agencies

90.058.6

96.578.2

Types of activities health insurance plans collaborate:• Quality improvement initiatives• Vaccine-specific campaign (i.e., influenza)• Aggregate immunization rate comparisons

74.992.845.3

71.979.240.0

Percent of health insurance plans that have established improvement goals for immunization rates for the following populations:

• Pediatric• Adolescent• Adult

93.493.383.3

91.291.173.2

Vaccine Shortages

  HMO(%)

PPO (%)

Percent of health insurance plans that provide communication outreach to concerned parties when vaccine shortages occur 99.2 95.0

Groups health insurance plans communicate with during vaccine shortages:

• All enrollees (including high-risk)• High-risk enrollees only• Providers

77.98.1

81.6

76.422.583.6

Types of organizations health insurance plans collaborate with to address vaccine shortages:

• Other health insurance plans• Provider groups• Public health agencies• Employers

70.688.246.876.9

33.664.791.459.0

Thank You.

2005 AHIP Immunization Assessment Summary

Supplementary slides

Immunization Improvement Programs

Approaches/strategies health insurance plans utilize to improve immunization rates among their enrollees:

  Pediatric Adolescent Adult

HMO(%)

PPO(%)

HMO(%)

PPO(%)

HMO(%)

PPO(%)

Data collection and analysis 99.0 95.8 99.0 81.7 92.4 83.6

Enrollee education 98.9 90.9 97.9 76.9 99.5 82.1

Physician education 59.9 86.4 55.3 78.8 54.7 81.1

Physician/Patient reminders and recalls 53.9 88.1 51.7 74.1 42.7 56.1

Vaccine-specific activities 21.5 42.0 22.5 31.8 50.3 40.1