IMPROVING CHILDHOOD AND

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IMPROVING CHILDHOOD AND ADULT IMMUNIZATION
RATES Blue Cross Blue Shield of
Illinois Collaborative Efforts Carol Wilhoit,
M.D., M.S. June 15, 2001
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Background Illinois

• Delays in implementation of the voluntary
  immunization registry in Illinois mean that the
  registry has not been a sufficient data source.

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Background HMO Illinois and BlueAdvantage HMO

• Commercial HMOs of BCBSIL
• 870,000 members
• The HMOs contract with about 100 medical groups
  and IPAs, not with individual MDs
• MG/IPAs are capitated so HMO does not receive
  claims
• MG/IPAs perform UM

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We want to be your health plan. Not your doctor.

• More than merely a saying used for advertising,
  this phrase reflects the HMOs approach to care.
• This approach is supported by medical literature,
  which suggests that a patient is far more likely
  to have a preventive service when it is
  recommended by their physician.

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Collaboration in Quality Improvement

• In 1996, we met with MG/IPAs to discuss
  approaches to quality improvement.
• The MG/IPAs were interested in QI activities, but
  felt that they did not have the resources to
  develop and implement QI projects independently.
• Therefore, a collaborative process was developed.

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Collaborative Approach to Quality Improvement

• HMO
• develops criteria
• identifies population
• selects random samples
• performs data analysis
• reports results, provides feedback
• rewards performance
• provides tools such as flowsheets, medical record
  stickers, postcards
• sends member mailings

• MG/IPAs
• review claims and medical records
• provide abstracted data and supporting
  documentation to the HMO
• may develop and implement local interventions

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Influenza Vaccination

• Asthmatics, Diabetics,
• Members age 65 and older

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Influenza Vaccination QI Project

• For measurement of 1996-1998 influenza
  vaccination rates, MG/IPAs that submitted data
  and documentation received QI Fund payment from
  the HMO. MG/IPAs received feedback about their
  group rate, with comparison to network results.
• 1996 rate 21.8
• 1997 rate 22.7
• 1998 rate 22.8

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Impact of a Change in the QI Fund

• In 2000, the Influenza Vaccination portion of the
  QI Fund was paid based on performance (the 1999
  MG/IPA flu shot rate) instead of participation.
• For 1999, the network influenza vaccination rate
  increased to 24.8.
• Preliminary 2001 results suggest that the 2000
  influenza vaccination rate increased
  approximately 5 percentage points.

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1998 and 1999 MG/IPA Influenza Vaccination Rates
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1997 Survey of Diabetics and Members 65 years
old

• HMOs of BCBSIL member survey data
• If MD explained the importance of influenza
  vaccination 79 of members had a flu shot.
• If MD did not explain the importance of a
  influenza vaccination 19 of members had a flu
  shot.

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Impact of Flowsheets

• Since 1998, BCBSIL has been promoting and
  distributing preventive care flowsheets and
  diabetes flowsheets.
• Impact of flowsheets for diabetics in our HEDIS
  sample for 2000
• Influenza vaccination rate for diabetics with
  flowsheet 32
• Influenza vaccination rate for diabetics with no
  flowsheet 17
• Of diabetics with an influenza vaccination, 64
  had a flowsheet.
• Of diabetics with no influenza vaccination, 47
  had a flowsheet.

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Childhood Immunization
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HEDIS DATA COLLECTION

• The HMOs rely on MG/IPA review of medical and
  administrative records.
• 1996, 1997, 1998 results One component of the
  HMO QI Fund was paid for MG/IPAs complying with
  requests for HEDIS data.
• Starting in 2000 (1999 HEDIS data) the Special
  HEDIS Payment was implemented, with a payment for
  each member in the HEDIS sample for whom the
  MG/IPA provides documentation of service or
  exclusion.

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The Special HEDIS Payment

• The HEDIS Special Payment was designed to
  encourage the provision of services AND to
  improve MG/IPA provision of documentation.
• For 1999, 9/10 of the HEDIS Effectiveness of Care
  measures reported showed improvement.
• For 2000, 9/9 of the HEDIS Effectiveness of Care
  and Access/Availability of Care measures showed
  improvement.

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1999 Childhood Immunization Focus Groups

• Message from MG/IPAs
• We want to improve our childhood immunization
  rates - help us by providing lists of children
  and easy to use reminder cards.
• Message from parents with children
• Immunizations are too complicated for me to keep
  track of. I want my childs doctor to tell me
  what I need to do.

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1997 Survey Sent to Parents of Incompletely
Immunized Children

• Survey was sent in 1997 to parents of the 83
  children in the 1996 HEDIS sample who did not
  meet criteria for Combination 1.
• 47/83 parents completed the survey.
• 46/47 parents incorrectly thought that their
  child had been fully immunized by age two.

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Children Not Meeting 1999 HEDIS Combination 1
Immunization Criteria
BlueCross BlueShield of Illinois
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Impact of Immunization Flowsheets

• 2000 HEDIS results
• Combination 1 immunization rate for children with
  flowsheet 70
• Combination 1 immunization rate for children with
  no flowsheet 15
• Of children with all Combination 1 immunizations,
  97 had a flowsheet.
• Of children who did not meet criteria for
  Combination 1, 69 had a flowsheet.

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HMOI/BlueAdvantage Childhood Immunization
(1998-2000)
Percent of 2-year-olds with Complete Immunization

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HMOI/BlueAdvantage Adolescent Immunization
(1998-2000)MMR/Hepatitis B Combination
Percentage of Adolescents with Complete
Immunization
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Conclusions

• Flowsheets are highly correlated with complete
  immunization.
• Additional compensation can motivate improved
  immunization rates.