Managed Care

 

Plans fall short on immunization rates

MANAGED CARE May 2007. © MediMedia USA
The Formulary Files

Plans fall short on immunization rates

MANAGED CARE May 2007. ©MediMedia USA













According to researchers at the Centers for Disease Control and Prevention, rates of immunization for children remained below 70 percent from 1999 through 2002 in commercial managed care plans. The researchers analyzed the plans' HEDIS scores, publishing the results in the American Journal of Managed Care.

They found that the childhood immunization rate was significantly below the 80 percent target in Healthy People 2010, a set of national health objectives issued by the U.S. Department of Health and Human Services. Despite improved rates from 1999 to 2002 (65.7 percent to 67.9 percent), MCOs need to address specific problems.

For example, immunization rates varied significantly by the type of patient visit. Health plans with more well-child visits than sick-child visits had higher rates of immunization than plans with more sick-child visits than well-child visits. Researchers recommended that MCOs encourage providers to ask about current immunizations during every visit.

The American Academy of Pediatrics predicts that the increasing costs of vaccines, combined with low payments from insurance companies, will lead to under-immunization. It said that payers are not recognizing the full cost, which is not just the acquisition price of the vaccine but includes ordering, storage, inventory control, and spoilage.

Factors associated with higher immunization rates
NCQA accreditation status, yes vs. no +2.6%
Public reporting status vs. nonpublic reporting status +3.2%
Proportion of Pacific Islanders +0.6%
Proportion of African Americans -0.2%
Proportion of Hispanics -0.2%
Proportion of enrollees ages 25 months to 6 years who made visits to their primary care physician +0.2%
Enrollment size >= 120,000 vs. < 120,000 +2.2%
Years in business +0.3%
All significant at P<.05
Source: Bardenheier, B, et al. Am J of Man Care. 2007;13:193–200.

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