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
1DRAFT - Not for Quotation or Attribution
Presentation
• Project overview
• Approach
• Expert interviews
• Cost analysis
• Discussion
• Questions
2DRAFT - Not for Quotation or Attribution
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
3DRAFT - Not for Quotation or Attribution
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.
4DRAFT - Not for Quotation or Attribution
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).
5DRAFT - Not for Quotation or Attribution
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
7DRAFT - Not for Quotation or Attribution
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
DRAFT - Not for Quotation or Attribution
9
Employee costs
Employer costs
Not Vaccinated
(24.3%)
MMR Financing Relationships – Employer Provided Coverage (with cost-sharing)
DRAFT - Not for Quotation or Attribution
10
Employer Costs
Not Vaccinated
(6.0%)
MMR Financing Relationships – Employer Provided Coverage (without cost-sharing)
DRAFT - Not for Quotation or Attribution
11
Original Employer Costs
Not Vaccinated
(6.0%)
MMR Financing Relationships – Employer Provided Coverage (eliminate cost-sharing)
DRAFT - Not for Quotation or Attribution
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
DRAFT - Not for Quotation or Attribution
13
Original Employer Costs
Not Vaccinated
(0.8%)
DTP Financing Relationships – Employer Provided Coverage (eliminate cost-sharing)
DRAFT - Not for Quotation or Attribution
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?
14DRAFT - Not for Quotation or Attribution
Contact:
Michael J. O’Grady, Ph.D.
Senior Fellow
NORC at the University of Chicago
15DRAFT - Not for Quotation or Attribution