Post on 13-Jan-2016
Employer Coverage for Immunizations
Helen Darling, PresidentElizabeth Greenbaum, Program Analyst
February 7th, 2006
Center 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
0%
10%
20%
30%
40%
50% Employer does it
Employer relies on Health Plan
Employers works cooperativelywith the Health Plan
Historically Determined
Where are employers getting their prevention-specific information?
Preventive Service Coverage
0%
25%
50%
75% From the Health Plan
Assemble it themselves
Professional Organizations
US Preventive Services Task Force
Unknown
• 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)214-222.
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: