1. 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

2. 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

3. 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

4. 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

5. 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

6. 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 immunization85.488.4

7. Benefit Design PediatricAdolescentAdult HMO(%)PPO(%)HMO(%)PPO(%)HMO(%)PPO(%) Hep B 100.0 94.397.685.0 DTaP/Td 100.0 98.1 Hib 100.0 IPV 100.0 MMR 100.0 94.986.0 Varicella 100.0 94.393.386.0 Pneumococcal 100.0 97.490.299.898.1 Influenza 100.0 99.494.3100.098.1 Hep A 92.298.492.793.993.585.4 Meningococcal **92.893.0 * Not recommended by ACIP for adolescents at the time of the assessment

8. Immunization Registries HMO (%) PPO (%) Percent of health insurance plans that are currently involved in immunization registry initiatives74.273.8 Percent of health insurance plans that are currently sharing with an existing immunization registry in their service area/state85.085.8

9. 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

10. Vaccine Shortages HMO (%) PPO (%) Percent of health insurance plans that provide communication outreach to concerned parties when vaccine shortages occur99.295.0 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

11. Thank You. 2005 AHIP Immunization Assessment Summary

12. Supplementary slides

13. Immunization Improvement Programs Approaches/strategies health insurance plans utilize to improve immunization rates among their enrollees: PediatricAdolescentAdult HMO (%) PPO (%) HMO (%) PPO (%) HMO (%) PPO (%) Data collection and analysis99.095.899.081.792.483.6 Enrollee education98.990.997.976.999.582.1 Physician education59.986.455.378.854.781.1 Physician/Patient reminders and recalls53.988.151.774.142.756.1 Vaccine-specific activities21.542.022.531.850.340.1