Workshop Overview Support Medicaid Managed Care Services The New - PDF document

Using Immunization Registry Data to Workshop Overview Support Medicaid Managed Care Services The New York City Experience • Background • The New York Citywide Immunization Registry (CIR)/managed care collaborations Noam H. Arzt, PhD 1. Batch Data Exchange for QA reports HLN Consulting, LLC 2. Recall Pilot arzt@hln.com 3. Immunization Recall Project Martha Rome, BSN, MPH • Benefits Medical and Health Research Association of New York City, Inc. • Discussion of key issues / strategies mrome@health.nyc.gov Benefits of Registry/Managed Care The Problem Collaboration • Measles epidemics • Provides access to additional data – >130 deaths nationwide • Saves money • Low immunization coverage rates nationally • Saves time • Documentation fragmented • Improves outreach – health care providers unable to track immunization status for patient population • Improved data quality – many parents unable to maintain a consolidated record – children with fragmented care, lack of “medical home” National Milestones The Registry Solution • All Kids Count (AKC) I and II -- 7 years of RWJ • Consolidate records by computerizing data Foundation funding, 16 demonstration projects • Ensure that the complete immunization history is • Centers for Disease Control and Prevention (CDC) available to health professionals support through funding and technical assistance • Monitor vaccination levels in populations • Healthy People 2010 objective -- Increase the • Link with other data systems proportion of children who participate in fully – WIC operational population-based immunization – Schools registries – Managed care organizations – target: 95% of children under age 6 years 1

CDC Functional Standards National Challenges • Enable providers to retrieve information from the • On-going funding registry on all vaccination encounters at the time of • Data quality - matching and merging records encounter • Data completeness • Automatically determine the vaccination(s) needed • Private provider participation when a person seeks vaccination based on ACIP – technology barriers recommendations – time constraints • Consolidate vaccination records from multiple – lack of incentives providers, using duplication and edit checking procedures to optimize accuracy and completeness Moving Forward Overview -- NYC • All Kids Count (AKC) III • 125,000 births annually – integrated data systems • 1,200 pediatric provider sites – continued development of a national registry vision –104 public • American Immunization Registry Association –1,083 private (AIRA) • 30 managed care organizations serving NYC – national membership organization children – advocates for the support of registry development –18 serve Medicaid patients – promotes and facilitates information exchange • Health Care Financing Administration (HCFA) funding for registries 2

New York Citywide Immunization CIR Access/Use of Data Registry • Citywide Immunization Registry (CIR) contains • Providers -- on-line or via telephone 1.9 million records, 10 million immunizations – child by child look-up • Reporting immunizations is mandated by City – print-outs Health Code – recommendations for immunizations due • Reporting options: • Parents -- written application – paper, electronic and on-line – parent brochure • Web-based Intranet application – paper application – child-by-child look-up – record faxed or mailed to parent – designed for immunization screening and printout CIR / MCO Collaborations 1. Batch Data Exchange to supplement chart review data for NYS QA measures 2. Recall Pilot – 3 MCOs – ~ 950 children – recall letters sent to families 3. Immunization Recall Project – all 18 NYC Medicaid managed care plans 3

Batch Data Exchange Recall Pilot • A collaborative pilot to recall of children in • Managed care plans provide lists of enrolled children in sample for NYS QA need of immunizations using registry/managed • Automated and manual matching of records care plan combined data • CIR provides immunization records in flat file – 3 Plans -- voluntary participation format – N= ~ 950 children • 10 Plans sought CIR data in 2000 – recall letters sent for all children not UTD • Plans able to raise scores by 5% or more with out-of-plan immunizations Objectives Process • To pilot recall of children in need of Recall Generator Recall Generator Smart Search PowerBuilder immunizations using registry/managed care File from MCO File or Provider De-duplication Verification CIR Update Recall Output combined data • To improve CIR data quality File to Letters CIR De-dup Reports Verification • To design and develop an automated process to MCO or and Report Provider Labels create recall letters using the CIR immunization forecasting algorithm Process (continued) Process (continued) • Report returned to DOH, data updated in CIR • File de-duplicated using Smart Search • For children not UTD, past immunizations and • Report of immunizations (Verification Report) in immunizations currently due are automatically the CIR created by Recall Generator generated for a file or paper printout • Managed care plan personnel review report, • Letters or file sent to the managed care plan correct and add immunizations from medical record • Plans or DOH mail recall letters to members 4

Process (continued) Confidentiality Products • Plans identify children per NYC Health Code regulations • Smart Search : Visual Basic client that • Plans identify PCP and family address accesses CIR database – Office of Vital Statistics does not allow release of address • Recall Generator : Visual Basic product from birth records that accesses file generated by Smart • Strict matching algorithms and manual review Search guarantee that records returned are the same children • No demographic information released Process (continued) Process (continued) Smart Search Parameters Smart Search Options Process (continued) Process (continued) Smart Search Record Review Recall Generator Parameters 5

Process (continued) Process (continued) Recall Generator Options Verification Report Process Pilot Results Letter Generation • MCO #1 – CIR contained 899 immunizations for 130 children – 329 immunizations added on 72 children from medical record review • MCO #2 – CIR contained 2,191 immunizations for 411children – 3,725 immunizations added on 338 children from medical record review • MCO #3 – CIR contained 3,454 immunizations for 354 children – 1,707 immunizations added on 256 children from medical record review Immunization Recall Project Results (continued) • Average of 53% not up-to-date • A collaborative effort between the NYC – 4th DTaP Department of Health Citywide Immunization – Varicella Registry, the Division of Health Care Access, – intervals not accepted Medicaid Managed Care Plans, and Primary Care • Letters sent in July/August 2000 Providers (PCPs) • Preliminary results from CIR • Builds on the Recall Pilot -- all Medicaid managed care plans, ongoing • Need more in-depth follow-up – evaluation – outreach 6

Objectives Methods • Submission received from 18 Medicaid managed • To identify and recall all 2-year-old children in care plans in NYC NYC enrolled in Medicaid managed care not up- to-date on immunizations • Each file contains demographic data of all currently enrolled children born in 1998 and • To improve immunization coverage of 2-year- primary care provider (PCP) old children at risk for vaccine preventable disease in NYC • Files size: Total=17,871 children, range of 65- 3100, average file size ~1000 • To increase completeness of CIR records Methods Methods Phase I: Data Processing Phase II: PCP Verification • Data matched against CIR, multiple/fragmented • PCPs verify immunization records and report records merged additional immunizations to the CIR – ~90% of children’s records found in CIR • Each child’s record is updated manually • Immunization record generated for each child (and • Customized recall letters generated for children not UTD status calculated) UTD • Commissioner of DOH contacting each PCP by • Recall letters sent to families letter • MCOs informed of children not UTD • Each child’s record sent to their PCP for verification • MCOs to undertake further outreach/recall activities Challenges Progress to Date • All 18 files received and data cleaned • Understand competing priorities for Plans • Phase I: Data Processing • Determine if recall should continue to be a – all files processed centralized function – children’s records sent to PCPs • Medical chart and registry data is needed – time frame 6 weeks for turnaround • Need for more record review at the provider level • Phase II: PCP Verification and Recall – in process – estimated time 6-8 weeks 7

Conclusions • Potential for multiple benefits is high – data in the CIR more complete and useful – PCP incentive to participate in registries increases – health plans can use registry data to improve ability to outreach to children in need of services – health plans can use registries to save costs and improve efficiency – regular recall should improve immunization coverage 8