Examining First Dollar Insurance Coverage for Vaccines Michael J. O’Grady, Ph.D. NORC at the...
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Examining First Dollar Insurance Coverage for Vaccines Michael J. O’Grady, Ph.D. NORC at the University of Chicago Meeting of the National Vaccine Advisory Committee Hubert Humphrey Building Washington, DC February 3, 2010 1 DRAFT - Not for Quotation or Attribution
Transcript of Examining First Dollar Insurance Coverage for Vaccines Michael J. O’Grady, Ph.D. NORC at the...
Examining First Dollar Insurance Coverage for
Vaccines
Michael J. O’Grady, Ph.D.NORC at the University of Chicago
Meeting of the National Vaccine Advisory CommitteeHubert Humphrey Building
Washington, DCFebruary 3, 2010
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Presentation
• Project overview
• Approach
• Expert interviews
• Cost analysis
• Discussion
• Questions
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Project Overview
• Working hypothesis: cost is a barrier to vaccination.
• NVPO contracted with NORC to estimate the costs of extending first dollar coverage for ACIP-recommended vaccines
• Focus on benefit design implications
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Approach
• Literature review– Background on vaccination rates and cost sharing
policies across payer types
• Expert interviews– Interviews with payers, researchers, federal officials
and private sector leaders
• Cost analysis– Merging of federal and employer-based data
sources on vaccination rates by cost-sharing design.
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Expert interviews• Interviews will address issues like the effects
of first dollar coverage on premium costs, immunization rates, and other topics
• Experts include:– John Bertko, RAND (Retired Chief Actuary,
Humana).– Douglas Hadley (Chief Medical Officer - Director
Coverage Policy Unit, CIGNA).– Ronald Gresch, (Chief Health Actuary, FEHBP).
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Cost Analysis• Three key areas
– Data• 2008 National Immunization Survey (NIS)
• 2006 MarketScan employer claims data
– Analysis• Use the claims data to estimate the coverage
differential between cohorts with 1st $ and cohorts with cost-sharing.
• Simulate the implementation of the recommendation.
• Estimate the new post-implementation coverage rate.
• Estimate the cost of implementation.
• Transparent and replicable.6DRAFT - Not for Quotation or Attribution
Distribution of Children Ages 18 to 35 Months by Insurance Coverage
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Table 1 - MMR Vaccination Indicator by Health Insurance Coverage*
MMR Vaccination
Indicator
Employer Health Coverage
Medicaid/SCHIP
Indian Health
Service
Military Health
System
Other Health
CoverageUninsured Total
First Dollar
Some Cost-
SharingTotal
No Shots Recorded
180,120 55,142 235,262 183,553 3,935 9,505 33,756 62,393 528,403
6.0% 24.3% 7.3% 7.3% 3.9% 6.6% 8.0% 15.8% 7.7%
Up to Date
2,831,203
171,517 3,002,720 2,344,168 97,544 134,678 388,810 332,931 6,300,851
94.0% 75.7% 92.7% 92.7% 96.1% 93.4% 92.0% 84.2% 92.3%
Total 3,011,323
226,659 3,237,982 2,527,722 101,478 144,183 422,567 395,324 6,829,256
* There maybe some minimal double counting due to children having multiple forms of insurance.Source: National Immunization Survey (NIS) 2008 and the Watson Wyatt MarketScan. 2006. 8
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Employee costs
Employer costs
Not Vaccinated
(24.3%)
MMR Financing Relationships – Employer Provided Coverage (with cost-sharing)
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Employer Costs
Not Vaccinated
(6.0%)
MMR Financing Relationships – Employer Provided Coverage (without cost-sharing)
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Original Employer Costs
Not Vaccinated
(6.0%)
MMR Financing Relationships – Employer Provided Coverage (eliminate cost-sharing)
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Table 2 - DTP Vaccination Indicator by Health Insurance Coverage*
DTP Vaccination
Indicator
Employer Health Coverage
Medicaid/SCHIP
Indian Health
Service
Military Health
System
Other Health
CoverageUninsured Total
First Dollar
Some Cost-
SharingTotal
No Shots Recorded
11,940 29,690 41,630 31,845 180 1,254 6,222 10,415 91,546
0.4% 13.1% 1.3% 1.3% 0.2% 0.9% 1.5% 2.6% 1.3%
Some Shots Recorded
12,143 30,195 42,338 83,575 3,422 4,810 5,671 22,916 162,732
0.4% 13.3% 1.3% 3.3% 3.4% 3.3% 1.3% 5.8% 2.4%
Up to Date
2,987,240
166,774 3,154,014 2,412,301 97,877 138,119 410,674 361,993 6,574,978
99.2% 73.6% 97.4% 95.4% 96.5% 95.8% 97.2% 91.6% 96.3%
Total3,011,323
226,659 3,237,982 2,527,722 101,478 144,183 422,567 395,324 6,829,256
* There maybe some minimal double counting due to children having multiple forms of insurance.Source: National Immunization Survey (NIS) 2008 and the Watson Wyatt MarketScan. 2006. 12
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Original Employer Costs
Not Vaccinated
(0.8%)
DTP Financing Relationships – Employer Provided Coverage (eliminate cost-sharing)
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Discussion
• Implications of extending first dollar coverage to those already paying cost sharing for vaccinations.
• Understanding of costs to other stakeholders.
• Moving into older age cohorts.
• Other compliance mechanisms?
• Other issues to address?
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Contact:
Michael J. O’Grady, Ph.D.
Senior Fellow
NORC at the University of Chicago
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