As children gear up to return to school this fall, parents often rush to catch up on missed wellness visits and recommended vaccines. However, recent trends have shown that less than 50% of U.S. adults and children received the influenza vaccine during the past 12 months. This is especially alarming as millions of people are facing potential Medicaid coverage loss during the state redetermination process that began in April 2023, which could lead to even lower immunization rates.
During National Immunization Awareness Month this August, health plans can help to address the barriers to immunization and bolster provider support. Measuring and benchmarking quality measures related to immunizations for HEDIS® reporting provides health plans with a blueprint on how to improve immunizations. The electronic clinical data systems (ECDS) measure standard also offers a method to better collect and report structured electronic clinical data for HEDIS quality measurement, enabling plans to better understand where to allocate resources and what members to target to improve quality.
As part of this observance, let's explore the key quality measures and data sources related to immunizations.
HEDIS and Star Ratings immunization measures
The HEDIS program includes numerous measures for immunization status for both children and adults, all of which have transitioned or will soon transition to the National Committee for Quality Assurance’s (NCQA) ECDS standard. These include:
- Childhood Immunization Status (CIS, CIS-E): This measure assesses the percentage of children who have received numerous recommended vaccines by their second birthday, including DTaP, polio, MMR, chicken pox, and more. The measure calculates rates for each vaccine and specific combination rates. NCQA has proposed to transition this measure to ECDS only and retire hybrid reporting for Measure Year (MY) 2025.
- Adult Immunization Status (AIS-E): This measure evaluates the percentage of members 19 years and older who are up to date on recommended routine vaccines including flu, Tdap, zoster, and pneumococcal. The AIS-E measure utilizes r the ECDS reporting standard and uses data from electronic sources such as administrative claims, HIEs, case management registries, and EHRs.
- Immunizations for Adolescents (IMA, IMA-E): This measure assesses adolescents who have received one dose of meningococcal vaccine, one Tdap vaccine, and the complete HPV series by their 13th birthday. NCQA has also proposed to transition this measure to ECDS only and retire hybrid reporting for MY 2025.
- Prenatal Immunization Status (PRS-E): This measure calculates the percentage of deliveries in which women received flu and Tdap vaccinations during the measurement period. It was the first ECDS-reported measure to be publicly reported in MY 2020.
Meanwhile, Annual Flu Vaccine is a Star Ratings measure that evaluates flu vaccination rates. It aims to encourage seniors to receive the influenza vaccine annually to protect themselves and others from the flu.
Preparing for the ECDS transition
Reporting on immunizations is crucial for addressing barriers. NCQA plans to drop the hybrid reporting component for IMA and CIS beginning in MY 2025. This means all immunization measures will transition to ECDS-only by MY 2025, given that PRS-E and AIS-E are already ECDS-only measures.
In anticipation of this shift, it is vital for plans to have robust data access to support immunization programs as hybrid review will no longer be permitted. We recommend that plans tap into additional supplemental data sources and formulate a comprehensive strategy for sourcing such data. One high-performing Cotiviti client recently noted that having a strong data strategy is key to their success, adding that the plan saw the most lift from supplemental data by accessing out of state immunization registries for the CIS, IMA, AIS-E and PRS-E measures.
While immunization registries can be a helpful source of supplemental data, they may already be highly utilized by some plans, along with other traditional supplemental sources. Plans should explore new supplemental sources such as Continuity of Care Documents (CCDs) to augment their claims data and boost rates. A strong focus on supplemental data drives down the need for in-season chart review and will make the transition to ECDS smoother.
By strengthening immunization programs and building trust with members through consistent education, health plans play a crucial role in safeguarding health, improving HEDIS scores, and enhancing Medicare Advantage Star Ratings.
Cotiviti is ready to help health plans close care gaps. Members engaged with our Eliza® consumer engagement solution saw a nearly 8% higher rate of gap closure for the Child and Adolescent Well-Care Visits HEDIS measure. Plans adding secure digital outreach to communicate with their members also saw up to a 4.4% increase in gap closure for key measures compared to interactive voice response and email alone.*
Learn more about how Cotiviti’s Quality Intelligence, Star Intelligence, and Eliza leverage integration to improve HEDIS results, drive higher Star Ratings performance, and reach members where they are to help ensure they receive the right care at the right time.
Catch up on our Closing the Gap series with our new eBook and learn how to improve care gap identification and closure with a focus on:
- Improving cervical cancer and osteoporosis prevention
- Taking preventative measures for better heart health
- Driving better colorectal cancer screening rates
- Performing better outreach to underserved communities
- Overcoming barriers to engaging with male members
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
*Results may vary by members and plans.
