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Examining First Dollar Insurance Coverage for Vaccines

Examining First Dollar Insurance Coverage for Vaccines. Meeting of the National Vaccine Advisory Committee Hubert Humphrey Building Washington, DC February 3, 2010. Michael J. O’Grady, Ph.D. NORC at the University of Chicago. Presentation. Project overview Approach Expert interviews

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Examining First Dollar Insurance Coverage for Vaccines

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  1. Examining First Dollar Insurance Coverage for Vaccines Meeting of the National Vaccine Advisory CommitteeHubert Humphrey Building Washington, DC February 3, 2010 Michael J. O’Grady, Ph.D. NORC at the University of Chicago DRAFT - Not for Quotation or Attribution

  2. Presentation • Project overview • Approach • Expert interviews • Cost analysis • Discussion • Questions DRAFT - Not for Quotation or Attribution

  3. 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 DRAFT - Not for Quotation or Attribution

  4. 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. DRAFT - Not for Quotation or Attribution

  5. 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). DRAFT - Not for Quotation or Attribution

  6. 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. DRAFT - Not for Quotation or Attribution

  7. Distribution of Children Ages 18 to 35 Months by Insurance Coverage DRAFT - Not for Quotation or Attribution

  8. Table 1 - MMR Vaccination Indicator by Health Insurance Coverage* * 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. DRAFT - Not for Quotation or Attribution

  9. MMR Financing Relationships – Employer Provided Coverage (with cost-sharing) Employee costs Not Vaccinated (24.3%) Employer costs DRAFT - Not for Quotation or Attribution

  10. MMR Financing Relationships – Employer Provided Coverage (without cost-sharing) Not Vaccinated (6.0%) Employer Costs DRAFT - Not for Quotation or Attribution

  11. MMR Financing Relationships – Employer Provided Coverage (eliminate cost-sharing) Not Vaccinated (6.0%) Original Employer Costs DRAFT - Not for Quotation or Attribution

  12. Table 2 - DTP Vaccination Indicator by Health Insurance Coverage* * 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. DRAFT - Not for Quotation or Attribution

  13. DTP Financing Relationships – Employer Provided Coverage (eliminate cost-sharing) Not Vaccinated (0.8%) Original Employer Costs DRAFT - Not for Quotation or Attribution

  14. 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? DRAFT - Not for Quotation or Attribution

  15. Contact: Michael J. O’Grady, Ph.D. Senior Fellow NORC at the University of Chicago O’Grady-Michael@norc.UChicago.edu DRAFT - Not for Quotation or Attribution

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