# Presentation: 478352

## 2005 AHIP Immunization Assessment Summary

- National Vaccine Advisory Committee
- November 29-30, 2005
- Steve Black, MD, AHIP Liaison to NVAC
- Bob Rehm, Director of Public Health Strategies, AHIP

**Notes:**
(Logo board exercise)

## 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 | 

37.5
48.5
86.0 | 

5.6
46.8
52.4 |
| 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 | 

18.6
25.2
9.8
53.6 | 

76.3
6.9
11.1
94.3 |

## 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

6.8
17.1
88.0 | 

54.4

34.6
10.8
99.8 |
| 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 B | 100.0 | 100.0 | 100.0 | 94.3 | 97.6 | 85.0 |
| DTaP/Td | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 98.1 |
| Hib | 100.0 | 100.0 |  |  |  |  |
| IPV | 100.0 | 100.0 |  |  |  |  |
| MMR | 100.0 | 100.0 | 100.0 | 100.0 | 94.9 | 86.0 |
| Varicella | 100.0 | 100.0 | 100.0 | 94.3 | 93.3 | 86.0 |
| Pneumococcal | 100.0 | 100.0 | 97.4 | 90.2 | 99.8 | 98.1 |
| Influenza | 100.0 | 100.0 | 99.4 | 94.3 | 100.0 | 98.1 |
| Hep A | 92.2 | 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 | 

90.0
58.6 | 

96.5
78.2 |
| Types of activities health insurance plans collaborate:
  Quality improvement initiatives
  Vaccine-specific campaign (i.e., influenza)
  Aggregate immunization rate comparisons | 
74.9
92.8
45.3 | 
71.9
79.2
40.0 |
| Percent of health insurance plans that have established improvement goals for immunization rates for the following populations:
  Pediatric
  Adolescent
  Adult | 

93.4
93.3
83.3 | 

91.2
91.1
73.2 |

## 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 | 

77.9
8.1
81.6 | 

76.4
22.5
83.6 |
| Types of organizations health insurance plans collaborate with to address vaccine shortages:
  Other health insurance plans
  Provider groups
  Public health agencies
  Employers | 

70.6
88.2
46.8
76.9 | 

33.6
64.7
91.4
59.0 |

## 2005 AHIP Immunization Assessment Summary

**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 |