Benefits of Immunization Information System Data to Health Plans in New York State March 30, 2011 Presenter: Michael Flynn Co-authors: Munyaradzi Masawi, Loretta Santilli

Covered In Presentation Review process of how NYSIIS data is made available to health plans Describe how health plans use NYSIIS data Share results of ‘Customer Satisfaction Survey’

NYSIIS Background Early 1990’s – started as regional registries, required informed consent 2008 – Public Health Law 2168 mandated reporting of immunizations administered to those under 19 years of age 2008 – launched a single, statewide web-based system March 2011 – 3.7 million patients, 43.6 million immunizations Over 10,000 users NYSIIS excluded NYC

NYSIIS & Health Plans NYS PHL 2168 authorized health plan access to NYSIIS Access is read only through user interface (UI) Health plans may request electronic extracts NYSIIS does NOT accept imms reported by health plans PHL specifies who can have access to NYSIIS data and for what purpose. Law specifically written to define NYSIIS as public health application and excluded from HIPPA requirements. NYSIIS does not accept shots from Health Plans as a matter of policy.

Health Plan Participation The exact number of health plans in NYS is unknown (estimated 60-100) Health plan linkage originally slated for 2010 roll out Then came H1N1 and PRISM project We wanted to be sure there was enough data in NYSIIS before offering the extract. We didn’t want them to extract and not have data. Would have been a bad experience. During the H1N1 outbreak there was a request to participate in a project to monitor the new vaccine

PRISM Post-Licensure Rapid Immunization Safety Monitoring (PRISM) Collaboration among America’s Health Insurance Plans (AHIP), IIS, Harvard Medical School, Health & Human Services, and Public Health Informatics Institute (PHII) Purpose was to develop a system for monitoring the safety of H1N1 vaccine in near real time This was the opportunity to work with some plans. At first we were concerned due to the strain that H1N1 had on our staff to begin with. But all good

PRISM Continued Linking H1N1 administration data from IIS to vaccine exposure and outcome data from health plans Although the results showed no significant associations with H1N1 and adverse events, it was a successful partnership PRISM II to focus on Rotovirus vaccines and HPV The process was a success. Having the IIS’s work with health plans and independent researcher was great.

Opening the door Offered NYSIIS data to other NYS health plans Currently, 11 health plans are getting NYSIIS data through extracts An additional 8 health plans are using the NYSIIS user interface Now that we had a few health plans working, we were read y to open the doors

Health Plan Data Extraction Process Provided health plan with file specification Worked with NYSIIS staff on initial submission File submitted is of all health plan subscribers Exact matches are associated with health plan Request made for ‘organizational extract’ Files specs are for flat file only. We are considering allowing HL7. NYSIIS staff review format and help identify errors Health Plans are not allowed to see possible matches like a UI user would (3% are adults) One the link between Health Plans and NYSIIS record is made, they request an organizational extract. Based

Health Plan Survey Did the health plans have trouble following the format? Was NYSIIS data of value to the health plans? Would the health plans continue to use NYSIIS data? Survey was self reported with some calls for clarification. Did NYSIIS benefit? We wanted to know if Health Plans really did benefit from the NYSIIS data? Was it easy enough for them to do? Survey sent to the 10 Health Plans who used the Organizational extract. Obviously not enough for a ‘scientific study’ but considered valuable ‘customer survey’

Response/ Results All eleven health plans responded NYSIIS provided information on 675,169 unique patients Approximately 19% of patients in NYSIIS Total of 708,616 associations were made between patients and health plans Some patients were associated with more than one health plan. The 675,169 represent approx 19% of the patients in NYSIIS Client had multiple associations to Health Plans Encouraging to see that high a number for the few Health Plans that participated.

Results Q – ‘Did you have problems accessing the NYSIIS system or obtaining data?’ No one reported that access was a problem. Q – ‘Did you search only for enrollees less than 19 years of age?’ All plans searched for those less than 19 2 plans also searched for adults Access Access would be critical to having Health Plans’s use the data. The format didn’t cause any problems. NYSIIS staff worked closely with Health Plans on the first submissions. Age - NYSIIS requires consent for those 19+. As such, NYSIIS is less likely to have all the information. Health Plans’s might get imms they didn’t have but were warned that for those over 19, not likely to have complete record.

Results Continued Q – ‘What proportion of the clients submitted by the health plan were found (matched) in NYSIIS?’ 3 plans matched 76% - 99% 2 plans matched 50% - 75% 3 plans matched less than 50% 2 plans did not measure how many were matched Q – ‘Were immunizations for the matches new to you?’ 1 plan did not have any of the NYSIIS imms 3 plans reported over 75% of the imms were new to them 3 plans reported less than 50% of the imms were new to them Smallest match was 26.6% One Health Plans did not count the matches. One Health Plans didn’t have any of the information that NYSIIS provided 3 didn’t check. Overall it was nice to see that we were providing meaningful data

Results Continued Q – ‘What purpose were the data used?’ 9/11 plans used the data for HEDIS and QARR 2/11 plans used the data for quality and completeness assessments Q – ‘Any other uses?’ Outreach to members and management of care In-house analysis of coverage rates Identify gaps in care Complement pay for performance program Assess link to other health care issues (i.e. adverse events) Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by more than 90% of America’s health plans to measure performance on important dimensions of care and service. Quality Assurance Reporting Requirements (QARR) - a set of measures that the NYS DOH uses to assess how well health plans care for Medicaid, CHP, and FHP members. QARR includes HEDIS measures. Imm is one of the measures that evaluate a plans performance .

Results Continued Q – ‘How useful was NYSIIS data overall?’ 7/11 plans found it very useful 3/11 plans found it useful All 11 plans felt that it saved time and money Q – ‘How has using NYSIIS data changed your process and/or policies?’ Most common answer was they will be using NYSIIS regularly One health plan will be using NYSIIS data to assess provider performance which is linked to their incentives back to providers

Results Continued Q – ‘How often do you plan on getting extracts?’ 5/11 monthly 3/11 quarterly 1/11 bi-annually 2/11 annually

Results Continued Q – ‘Has access to NYSIIS data assisted in your outreach to clients?’ One health plan told how they do outreach to members and use the NYSIIS data to be sure they are current. “Prior to the availability of NYSIIS data, providers and members were dissatisfied with the process, as we didn't always have data from prior to a member being enrolled with the plan, or if the provider did not submit a claim. Now, with NYSIIS data, we outreach to a much smaller population.”

Results Continued ‘Q – Has access to NYSIIS data assisted in your outreach to clients?’ One health plan said they did not have access to any immunizations they did not pay for. Access to NYSIIS provided full immunization history.

Conclusion Was NYSIIS data of value to them? Yes, in ways we didn’t anticipate Any trouble following the format? No, once set up extraction was easy Did it provide meaningful information to them? Yes, for complete reporting, outreach, cost savings We wanted to know if Health Plans really did benefit from the NYSIIS data? Was it easy enough for them to do? Survey sent to the 10 Health Plans who used the Organizational extract. Obviously not enough for a ‘scientific study’ but considered valuable ‘customer survey’

Conclusion Would they continue to use NYSIIS data? Some are doing so monthly! Was it worth our effort to assist? Absolutely We wanted to know if Health Plans really did benefit from the NYSIIS data? Was it easy enough for them to do? Survey sent to the 10 Health Plans who used the Organizational extract. Obviously not enough for a ‘scientific study’ but considered valuable ‘customer survey’

Plan is the ‘bad cop’. I’m the guy that can help the provider Nice presentation but wasn’t this session on increasing provider participation and not on health plan? Who is a provider more likely to listen to? IIS or Plan that pays them? Plan is the ‘bad cop’. I’m the guy that can help the provider 11 plans reached over 600,000 people and work with hundreds of providers We wanted to know if Health Plans really did benefit from the NYSIIS data? Was it easy enough for them to do? Survey sent to the 10 Health Plans who used the Organizational extract. Obviously not enough for a ‘scientific study’ but considered valuable ‘customer survey’ 21

Questions ? Contact Information Michael Flynn NYS DOH, Bureau of Immunization mkf06@health.state.ny.us (518) 473-2839