# Presentation: 695347

## Center for Prevention

**Employer Coverage for Immunizations**
**Helen Darling, President****	**
**Elizabeth Greenbaum, Program Analyst**

**February 7****th****, 2006**

**C****enter for Prevention**
**           **

**           ****and Health Services**

## National Vaccine Advisory Committee: Question

- How does employer-sponsored health plan coverage expand to include new/newly recommended vaccines?
- Process
- Influencing Factors
- This requires first understanding how most employers define preventive service coverage generally.

## Business Group Membership

- 242 Employers
-  Fortune 500 companies and large public         sector employers
-  50 million beneficiaries                                        (U.S. employees, retirees, and their families)
-  National and Global
-  Most are self-insured
-  Covered by ERISA (Employee Retirement Income Security Act of 1974)

## Business Group Research:  Preventive Service Coverage

- _Research Project_
- Conducted qualitative interviews with 26 benefit managers at member companies (Oct-Nov 2005)*
- Questions included:
- How do large employers structure their clinical preventive service coverage?
- What influences large employer decision-making regarding coverage for clinical preventive services?

- * Research was supported by a research grant from sanofi pasteur

## Preventive Service Coverage

- Historically, preventive services were considered part of routine care, not insurable events.
- Managed care as prepaid care introduced the concept of coverage for preventive services as “health maintenance organizations’ paid (rewarded) for keeping people healthy.
- Preventive services coverage not a topic of much discussion.
- Employers would be hard pressed to outline the details of what they consider preventive.

## Findings: What immunizations are being covered?

- All employers cover at least some immunizations for children and adolescents.
- Greater perceived value
- Closer association with ‘prevention’
- Constraints on coverage are limited to age and dollar amounts
- All employers *also *cover at least some adult immunizations, although with more conditions - coverage is more restrictive and variable.
- Less understood
- Seen more as optional health care
- Coverage very often limited by age specifications, risk factors, dollar amounts, vaccine types, and/or access points
**	**

## Findings:  What immunizations                               are likely to be covered?

- Lessons from Meningococcal vaccine.
- Everyone is now covering it.
- The message is key.
- “Children and adolescents are especially vulnerable.”
- Health information can travel quickly through many different mechanisms.
- Internet, 24/7 media, shared health stories
- Problems with supply complicated delivery.  Need to be wary of fostering cynicism.** **** ****	**

## Preventive Service Coverage

- How is the preventive benefit being defined?

## Preventive Service Coverage

- Where are employers getting their prevention-specific information?

## Other Recent Research*

- Percent large employers (>1000 employees) reporting the following as an “important reason for covering clinical preventive services:”
- 96% - Potential savings (lower HC costs, improved productivity)
- 94% - Employee requests
- 85% - Recommendation of consultant or medical expert
- Large employer immunization coverage rates:
- Childhood - 94%; Flu - 68%
- 20% of all employers offered onsite adult vaccination (flu)
- Employer size is an important factor in coverage for clinical preventive services.

- * Bondi MA, et al. (2006) Employer Coverage of Clinical Preventive Services in the United States.  *American Journal of Health Promotion*. 20(3)214-222.

## Impact of Consumer-Directed Health Plans?

-     HDHPs may provide IRS-defined preventive services (including immunizations) with no cost sharing or with a deductible that is lower than for other services.
-  65% of surveyed companies offered a HDHP
-  46% of those that offer a HDHP cover prevention at 100%
- Improved consumerism?
- 76% of companies with a HDHP just providing a particular plan design.  They are not *seeking *plans with comprehensive models for supplementing health education, health information, decision-support, and/or wellness programs.

## Our Recommendations:

- For Members:
- Follow Advisory Committee on Immunization Practices (ACIP) & US. Preventive Services Task Force (USPSTF) guidelines.
- Employers can have confidence in ACIP and USPSTF recommendations because they are based on scientific evidence.
- Cover all recommended vaccines at 100%.
- Educate employees and dependents about importance of prevention.

## Our Recommendations:

- For the National Vaccine Advisory Committee:
*Improve vaccine financing system.* We need a system that guarantees we have access to the vaccines we need.
*Increase communication*.  Employers are especially interested in information about cost and efficacy
*Create user friendly, targeted communications *that answer the question “What’s in it for me?”
*Share often, share widely.  *Employers get their information from a variety of sources.