INFLUENZA & PNEUMOCCOCAL VACCINATIONS

Transcription

1 INFLUENZA & PNEUMOCCOCAL VACCINATIONS ONE HEALTH PLAN S PERSPECTIVE Paige Reichert, MD Senior Medical Director of Quality May 2015

2 THE CIGNA-HEALTHSPRING FOOTPRINT o Cigna-HealthSpring serves the senior population in at least 15 states through Medicare Advantage and dual-medicaid products and services o In 2014, Cigna-HealthSpring provided services to over 450,000 beneficiaries o Additional customers in the stand-alone Part D Plan (PDP), raising the total number of beneficiaries to over two million o Fifth-largest special needs plan (SNP) by membership in the United States o Customers have multiple and varied needs due to different sociodemographic, cultural, and health factors

3 VACCINES Influenza Vaccination Refers to annual influenza vaccine in any form May be trivalent or quadrivalent May be standard dose or high dose May be administered via injection or intranasal Pneumococcal Vaccination Refers to 2 types of vaccination Pneumococcal Polysaccharide vaccine, 23-valent (PPSV23) Pneumococcal Conjugate Vaccine, 13- valent (PCV13) 3

4 HEALTH PLAN PERSPECTIVE ON VACCINATIONS Prevention is key to population health care. 4

5 HEALTH PLAN PERSPECTIVE ON VACCINATIONS We approach customers in many ways, offer vaccinations at multiple locations, and re educate every year. Repetition of Message & Convenience of Access 5

6 PARTNERSHIP FOR QUALITY Pay for Performance type program with embedded nurse care coordinator Quality measures focused on prevention and disease management Physician Engagement & Incentive Tool; up side only Based on nationally accepted clinical guidelines Measures may be added/removed/modified over time Influenza vaccine always part of program; Pneumococcal vaccine was included until

7 PARTNERSHIP FOR QUALITY Prevention Cancer screenings Vaccinations Medication Review Weight management Disease Management Diabetes Hypertension Congestive Heart Failure Medication adherence 7

8 PARTNERSHIP FOR QUALITY Growth Through the Years Primary Care Providers Provider Groups Customers 686 2, >66,000 >250,000 How is a customer assigned to the program? A customer is enrolled in the program if they choose a Primary Care Provider who is participating in the program.

9 PARTNERSHIP FOR QUALITY Role of the Embedded Nurse in Prevention Care Prompts providers and customers for needed services and records results Contacts patients regarding needed services and arranges appointments, transportation, medication delivery, etc. Organizes health plan days with physician offices Brings in health plan customers seeing that physician/group Meets various customer needs, such as vaccinations Provides education 9

10 PARTNERSHIP FOR QUALITY Evolution of pneumococcal vaccination rates Followed documentation of PPSV23 vaccinations in 7 small physician groups in 2 states 2006 (Baseline) % of approx patients 64.0% of approx patients 72.5% of approx patients Entry into Program 10

11 PARTNERSHIP FOR QUALITY Evolution of influenza vaccination rates Followed documentation of influenza vaccinations in 7 small physician groups in 2 states 2006 (Baseline) % of approx patients 43.4% of approx patients 77.1% of approx patients Entry into Program 11

12 PARTNERSHIP FOR QUALITY Claims-Only Physician Incentive Program For providers who do not have embedded nurse coordinator, due to Remote location Small patient population Multiple practice locations Can participate in pay for performance using claims-only data Influenza vaccination is part of that bonus structure

13 REIMBURSEMENTS 1. Provider receives payment for claim $ Accept any influenza or pneumococcal vaccine code Do not deny these claims 2. Provider receives bonus monies for quality performance on influenza vaccination rate Must meet baseline % to get any bonus Can get increased bonus for high level performance Counts for provider if patient receives vaccine at other location o Walk-In clinic o Pharmacy o Health Fair Paid annually 13

14 PNEUMOCOCCAL VACCINATION PROJECT New Recommendations on Pneumococcal Vaccination In June 2014,the results of a randomized placebo-controlled trial showing efficacy of PCV13 against community-acquired pneumonia among approximately 85,000 adults aged 65 years became available and were presented to ACIP. The evidence supporting PCV13 vaccination of adults was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework and determined to be type 2 (moderate level of evidence); the recommendation was designated as a Category A recommendation. Both PCV13 and PPSV23 should be routinely administered in series to all adults aged 65 years. The recommendations for routine PCV13 use among adults aged 65 years will be reevaluated in 2018 and revised as needed. Tomczyk S, Bennett NM, Stoecker C, et al; Centers for Disease Control and Prevention (CDC). Use of 13- valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged 65 years: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR, 2014;63(37):

15 PNEUMOCOCCAL VACCINATION PROJECT Step 1: Provider Outreach Educational Information CDC now recommends that adults 65+ be vaccinated with both Pneumococcal 13-valent Conjugate Vaccine [Diphtheria CRM197 Protein] and the Pneumococcal Polysaccharide Vaccine 23-valent, based on the findings of the Advisory Committee on Immunization Practices (ACIP). Tomczyk S, Bennett NM, Stoecker C, et al; Centers for Disease Control and Prevention (CDC). Use of 13- valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged 65 years: recommendations of the Advisory Committee on Immunization Practices (ACIP). 15

16 PNEUMOCOCCAL VACCINATION PROJECT Step 1: Provider Outreach Educational Information Pneumococcal Vaccinenaïve* adults aged >65 Administer PCV13 first 6 12 months later Administer dose of PPSV23 (or during the next visit) Adults previously vaccinated with PPSV23 at age >65 Administer PCV13 (at least 1 year after the most recent dose of PPSV23) Adults previously vaccinated with PPSV23 before age 65 years who are now aged >65 Administer PCV13 (at least 1 year after the most recent dose of PPSV23) 6 12 months later, administer subsequent dose of PPSV23 (no sooner than 5 years after the most recent dose of PPSV23) Prevnar 13 (Pneumococcal 13-valent Conjugate Vaccine [Diphtheria CRM197 Protein]) prescribing Information Wyeth Pharmaceuticals. Inc.;

17 PNEUMOCOCCAL VACCINATION PROJECT Step 2: Customer Outreach All Customers receive educational information in newsletter regarding two forms of pneumococcal vaccination and recommendation to discuss with healthcare provider. Re-measurement of Vaccinations Rates prior to Step 3. Determine what, if any, increase seen in vaccination rates. All Customers receive educational information in newsletter on importance of annual influenza vaccinations. 17

18 PNEUMOCOCCAL VACCINATION PROJECT Step 3: Targeted Customer Outreach Targets customers with: Chronic Obstructive Pulmonary Disease/Emphysema Asthma Outreach may occur through Partnership for Quality coordinators Call Center Direct mailings Re-measurement of vaccination rates in 2016 and yearly thereafter Institutional Special Needs Plan customers are all offered Influenza, PPSV23, and PCV13 vaccines regardless of having any respiratory disease, unless otherwise contraindicated or vaccination already documented. 18

19 OTHER INITIATIVES Comprehensive Annual Exam Performed by Primary Care Provider Provider incentivized Extensive review of current health status and any gaps in care Influenza and Pneumococcal vaccines are encouraged to be given, as needed, as part of exam Call Center Customers whose providers are not in Partnership for Quality Review claims data to identify gaps in care Establish phone relationships with customers and assist them in obtaining vaccines 19

20 OTHER INITIATIVES Health Risk Assessment Sent to all customers upon enrollment with health plan and to all Special Needs Plan customers annually Questions customer about influenza and pneumococcal vaccine status Educational material sent to customers who report vaccines are not up-to-date Home Visits for the Homebound Patient Health plan coordinates with primary care provider Sends physician and nurse practitioner Able to provide vaccinations during home visits 20

21 CHALLENGES Influenza Vaccines Patient Misconceptions Provider Focus Media All markets showed sudden plateau in influenza vaccination rates in November 2014, when media began reporting that Flu shot does not work. Emphasize dangers of influenza in children; less emphasis on adults Pneumococcal Vaccines Lack of Patient Awareness Inability to determine what vaccines customers received before joining our health plan 21

22 CONCLUSIONS Health plan wants to be a partner in health care Population Health and Preventive Medicine make a good marriage Vaccinations are a cornerstone of population health We welcome input from health care providers about our approach to prevention 22

23 Questions or Comments? 23

24 Offered by: Connecticut General Life Insurance Company or Cigna Health and Life Insurance Company. Cigna, the Tree of Life logo and GO YOU are registered service marks of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by or through such operating subsidiaries and not by Cigna Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, and HMO or service company subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc. All models are used for illustrative purposes only / Cigna. Some content provided under license.