Immunization Information Systems as a Data Source for Health Plan Quality Measures

Background:
Studies have been conducted to determine the costs associated with Immunization Information Systems (IIS) and to illustrate that provider participation is critical for IIS success. Health plans may benefit from using IIS as a single point of entry for their members' immunization histories, yet despite this potentially advantageous relationship, there has been little documentation on the business case for health plans to use IIS as a data source.

Objectives:
A business case study of a health plan in Michigan was conducted to illustrate the use of IIS data in quality measurement and pay for performance programs for childhood and adolescent immunizations.

Methods:
Data were collected through key-informant interviews and the health plan's data systems. Immunization coverage rates, health plan quality measures and audits from 2004 through 2007 were simulated with and without the IIS data in addition to conducting a cost- benefit analysis.

Results:
While the health plan accrued cost savings that correspond to a 36% annual return on investment, the principal benefit was enhanced relations with providers who have a single point of data entry for populating the health plan's incentive and quality ratings programs. IIS data made health plan immunization records more comprehensive than reliance on claims data alone.

Conclusions:
Leveraging and supporting providers' IIS reporting mandate and using IIS data as the primary data source for its programs enabled the health plan to increase transparency of its practices. Timely and more comprehensive immunization records increased the health plan's assurance that its members were up-to-date on immunizations, irrespective of whether a claim was filed, and offered providers improved capabilities to identify care opportunities for providers.