Changes to Adult Immunization Measures and What it Means for Health Plans

We are headed into peak flu season and most health plans are well into their adult immunization campaigns. Quality Improvement leaders know that there are changes in vaccine prevalence by regions associated with COVID-19 and shifting attitudes about vaccines. Now more than ever, member engagement programs are critical for maintaining and improving vaccination rates. And with evolving data requirements and immunization measures, health plans must change how they approach immunizations.

In 2023, health plans will have to initiate a review of how they collect adult immunization status from new and multiple data sources as part of their flu shot campaigns and improvement strategies. With the release of the HEDIS® measurement year 2023 specifications, the National Committee for Quality Assurance (NCQA) will retire the following adult immunization measures based on member surveys after the next Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey:

• Flu Vaccinations for Adults
• Pneumococcal Vaccination Status for Older Audits

These two measures will be replaced with the HEDIS® Adult Immunization Status (AIS-E) measure. AIS-E measures the percentage of members 19 years of age and older who are up to date on recommended routine vaccines for influenza, tetanus, and diphtheria (Td) or tetanus, diphtheria and acellular pertussis (Tdap), zoster and pneumococcal. Results will be also stratified by race and ethnicity.

AIS-E is an Electronic Clinical Data Systems (ECDS) measure. The HEDIS® ECDS Reporting Standard provides health plans a method to collect and report structured electronic clinical data for HEDIS® quality measurement and quality improvement.

ECDS measures take advantage of access to members’ electronic health records (EHR) as a primary data source. However, health plans may still include data from existing administrative sources and health information exchanges (HIEs) or clinical registries and case management systems.

The problem for most health plans will be how to report a complete and accurate rate. If a health plan compares their rate of flu shots based on member reported data from the CAHPS Survey versus results based on their medical claims and pharmacy data, they will quickly realize the results are under reported. NCQA reported for measurement year 2020 that the data source contribution for influenza vaccination AIS-E rate was just 58% from administrative data in the form of claims. The remainder of the data came from state registries or 27% from HIEs and 15% from EHR data sets.¹

Steps to Collect the Right Data 

Health plans should first look to access any state immunization registries and ensure they are capturing adult vaccinations in the extracts typically only accessed for childhood immunizations.

Next, capturing more data via direct EHR data feeds should be a high priority for health plans. As NCQA and regulators push for quality reporting to evolve to digital quality measurement (dQM) this data becomes a standard data requirement not an optional supplemental data source.

Health plans with higher volumes of EHR feeds for other HEDIS measures will still need to examine what data elements are collected via this process. Too often the extracts are limited to a small set of HEDIS measures and health plans may be missing key elements, such as vaccination status.

Do not forget to connect with providers on this measure. Are they submitting their data for adults to the state registries? Are they also asking about immunization status in each visit and recording the data in a structured field to extract and share with the health plan?

Unfortunately, the current HEDIS rules for case management systems will not currently support collection of member reported status for the AIS-E measure. But NCQA might end up changing these rules and in the time being the data source can provide direct guidance for missing data to be captured via other sources, such as leading to a medical record pursuit.

Finally, it may be helpful for health plans to recognize that this flu season will affect two years of performance reporting. The flu shot measurement year 2022 will be captured via CAHPS survey in the spring of 2023. This same flu season will impact the results for measurement year 2023 since the AIS-E measure’s period is July 1, 2022, to June 30, 2023. It’s a great reason to lean into budgeting programs for improving adult vaccinations and adding a data pursuit project as part of existing projects.

Healthmine’s Expert Advisory Services team has decades of experience in helping health plans adjust to changing measurement requirements and transitioning to new methods of data collection. Reach out to me at Dwight.Pattison@Healthmine.com for support in the shift to ECDS and digital quality measurement.

Footnote:

1. NCQA: Special Report: Reporting Results for Measures Leveraging Electronic Clinical Data for HEDIS® (November 2021)