Immunization Information Systems as a Data Source for Health Plan Quality Measures Bobby Rasulnia § ; Alan C. O’Connor*; Christine M. Layton*; Todd Osbeck † ;Therese Hoyle ◊ § Centers for Disease Control and Prevention; *RTI International; † Priority Health, and ◊ Public Health Consultant (Published at A J Managed Care)

What Are Immunization Information Systems (IIS)?  IIS are electronic information systems designed to capture and manage data specifically related to immunization.  Some major IIS functions include: combine immunization information from different sources into a single record provide official immunization records for school, day dare, and camp entry requirements. protect privacy of all users, including children, families, and providers. remind families and health care providers when an immunization is due or has been missed. recommend what vaccinations are appropriate based on a child’s immunization history as recorded in the IIS. exchange immunization information with health plans, hospitals, and providers. help identify populations at high risk for vaccine-preventable diseases, detect under-immunized populations, and target interventions and resources efficiently during outbreaks. And many more….. 2

Percentage of children aged < 6 years participating in a grantee immunization information system -- United States, six cities §, and eight Territories †, 2008 § Chicago, IL (34%-66%); District of Columbia (95%–100%); Houston, TX (34%–66%); New York City, NY (95%–100%); Philadelphia, PA (95%–100%); San Antonio, TX (67%–94%). † American Samoa (No Report); Marshall Islands (67%-94%); Federated States of Micronesia (95% -100%); Guam (No Report); N. Mariana Islands (No Report); Palau (No Report); Puerto Rico (67%-94%); Virgin Islands (No Report). No Report In Transition* 0-33% 34-66% 67-94% % National Coverage: 75% (excluding Territories) Source: CY2008 IISAR * In transition is defined as a grantee implementing a new IIS product.

Case Study Objective To evaluate a health plan’s business case for using an IIS as the primary data source for members’ immunization histories. Why would a health plan leverage an IIS? Is there a business case for health plans to make use (“leveraging”) of IIS’ surveillance mandate? 4

Case Study Participants  Priority Health is a Michigan-based health plan with 480,000 members. rewards providers for meeting the up-to-date immunization coverage benchmark twice:  with a financial incentive  high-quality rating on their website quality measures are used heavily in marketing products.  The Michigan established the IIS (MCIR) in childhood immunization providers are required by law to record immunizations within 72 hours of administration. As of 2008, 100% of children under age 6 had 2 or more immunization records in MCIR. Provider participation rate is 94% and MCIR has approximately 12,000 users per day. 5

Why Did Priority Health Leverage MCIR?  Priority Health used of MCIR data facilitated its quality measurement activities.  MCIR is a single point of data entry and leveraged Michigan providers’ legal obligation to record childhood immunizations.  MCIR enabled providers to demonstrate progress in meeting immunization measures at no additional cost or reporting burden, irrespective of whether a claim was filed.  MCIR offered Priority Health an opportunity to acquire immunization data on members who receive immunizations outside the provider network. (encounter-based vs. population-based assessment)

How Did Priority Health Leverage MCIR? Physician incentive program (PIP)  $175 per completed series per child Internal quality tracking program (“Apples on the Web”)- provider report card External quality reporting program (HEDIS). 7

Pathways for Data Exchange

Methods  Data were collected through key informant interviews with Priority Health’s quality and information systems analysts over 2 site visits to Priority Health in  Immunization coverage rates, MCO quality measures, and physician incentive measures from 2004 through 2007 were analyzed with and without the IIS as a data source.  A cost-benefit analysis was performed by calculating the cost savings benefits of improved data comprehensiveness and assurance.

Higher Observed Immunization Rates Before Chart Reviews 2007 Data

Priority Health’s HEDIS Administrative & Reported Rates (Childhood Immunizations)

Change in HEDIS Administrative Rate for Childhood Immunizations with MCIR Data

Priority Health and MCIR: Avoided Chart Reviews for HEDIS

Priority Health: Avoided Chart Reviews for PIP

Summary of Costs, Benefits, and Net Benefits YearCosts HEDIS Chart Review Savings PIP Chart Review Savings Net Benefit 2003($10,662) 2004(914)$2,058$30,33631, (914)2,79038,88040, (914)2,94634,54836, (914)1,0929,5229,700 Total($14,318)$8,886$113,286$107,854

IIS as “Data Solutions Provider”  MCIR performed an electronic data exchange role, including data capture, management, and maintenance functions.  In a recent merge, only 100 out of 7,400 records were “manually” reviewed.  Cost to Priority Health: ~$10,700 and about ~$1,000 per year to maintain.  Each avoided chart review saves Priority Health $6.00.

Conclusions  Enhanced transparency of MCO practices and acquired immunization data that were more timely and comprehensive.  Priority Health believes the principal source of value is enhanced relations with providers.  A good investment: BCR = 8.06, IRR = 310%  IIS provided Health Plan with more timely and comprehensive data on members’ immunization status.  IIS data reduced chart reviews for the Healthcare Effectiveness Data and Information Set and physician quality and incentive programs by nearly 20,000 reviews in 2004 to 2007.

Implications and Next Steps  Health plans using a state IIS as a single point of data entry may realize cost savings  Have improved assurance of immunization coverage for health plans and public health surveillance.  IIS are population-based system that can provide immunization data for an entire population. Population mobility and continuous changes in acquiring a health plan  Studying relationships between additional health plans and their local IIS may offer further insights. 18

Resources  Contact LT Bobby Rasulnia, PhD, MPA, MPH, CHES  IIS Data Query Tool  IIS Publications Database O'Connor, A. C., Layton, C. M., Osbeck, T. J., Hoyle, T. M., Rasulnia, B. (2010). "Health plan use of immunization information systems for quality measurement." Am J Manag Care 16(3): th National Immunization Conference | April 19-22, 2010 | Atlanta, GA 19