Employer Coverage for Immunizations Helen Darling, President Elizabeth Greenbaum, Program Analyst February 7 th, 2006 C enter for Prevention and Health Services

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. National Vaccine Advisory Committee: Question

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 Membership

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? Business Group Research: Preventive Service Coverage * Research was supported by a research grant from sanofi pasteur

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. Preventive Service Coverage

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 being 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. Findings: What immunizations are likely to be covered?

How is the preventive benefit being defined? Preventive Service Coverage

Where are employers getting their prevention- specific information? Preventive Service Coverage

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

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. Impact of Consumer-Directed Health Plans?

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. Our Recommendations: