AHIP: How payers can overcome immunization-access barriers

Adults 65 years and older are at an increased risk of contracting influenza, pneumococcus and hepatitis B. However, health insurers, providers and pharmacies can help consumers access the care they need through a variety of methods, according to a new report from America's Health Insurance Plans (AHIP).

The report comes from AHIP's earlier National Vaccine Roundtable, which discussed the barriers to boosting adult immunization rates, and how to encourage vaccination into adulthood. Here's a brief overview of the recommendations:

  • Maintain a payer-provider relationship. Health plans need to work directly with physician practices to ensure that doctors issue age-appropriate vaccines during office visits.
  • Practice continuity of care. Payers can and should consistently track and monitor preventive services for adults, which include vaccines.
  • Implement value-based care. Payers must work in tandem with providers to incorporate value-based payment models that will reward preventive care and improve performance.
  • Build awareness. Payers can issue positive messages about vaccine safety and health benefits to adults so they understand the importance of vaccination. Additionally, consumers must be made aware of which vaccines are available to them.

While it was believed the Affordable Care Act would improve adult immunization rates by eliminating cost barriers, the preventive services coverage policies don't apply to the entire population, notes the report. For instance, such policies exclude individuals covered by traditional or grandfathered plans, Medicare and some Medicaid plans.

Yet despite certain challenges, AHIP recommends adult immunization can greatly improve through certain steps. For starters, health plans must have access to important health IT tools, since it's difficult to assess immunization status via claims alone. Additionally, health plans must use immunization information system databases to validate gaps in immunization care.

For more:
- here's the report (.pdf)

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