Study Topic Number 1: Childhood Immunization (Hybrid Study)

HMO and PSN

Technical Assistance

Activity 1

Study Design

Study Topic Number 1: Childhood Immunization (Hybrid Study)

Read the following study topic:

As of January 2003 Plan X had 16,593 Medicaid eligible children under the age of two. In measuring Plan immunization rates in past years, the Plan has scored below the median nationally for Medicaid plans. National Medicaid HEDIS Database Project Benchmarks for Measurement Year 2002 show a 90th percentile of 72% for Combo 1 and 56% for Combo 2. Baseline data for the Plan (HEDIS 2003) show a rate of 62.91% for Combination 1 and 52.31% for Combination 2. Based on this data, childhood immunization represents an opportunity for improvement for Plan X.

According to NCQA’s State of Managed Care 2006, immunizations are one of the safest and most effective ways to protect children from a variety of potentially serious childhood diseases. Currently, more than 20 percent of 2-year-olds within the United States are still missing one or more recommended immunizations. Successful childhood vaccination efforts have led to dramatic declines in many life-threatening diseases during the past century. Infectious diseases that were once common, including polio, measles, diphtheria, whooping cough, mumps, measles and meningitis are now controlled by vaccines. However, vaccine-preventable diseases do occur. During 198-2000, 824 cases of Hib were reported. If Hib immunizations were discontinued there would be approximately 20,000 of invasive disease per year with 600 associated deaths. NCQA’s State of Managed Care 2006 identifies the following financial benefits of immunization:

· For every dollar spent on HiB, vaccine saves $1.4 in direct costs and $2.00 in indirect costs.

· Every dollar spent on Hepatitis B vaccine saves $0.5 in direct costs and $3.10 in indirect costs.

· Every dollar spent on Varicella vaccine saves $0.9 in direct costs and $5.4 is in indirect costs.

· Childhood immunizations of DTaP, Hib, IPV, MMR, Hepatitis B and Varicella vaccines save $9.9 billion in direct costs and $43.3 billion indirect costs.

Childhood immunizations are a priority for Plan X because it is an area where the Plan can significantly impact the health of its pediatric population.

1. It is an area of past poor performance.

2. The Plan has a large number of pediatric members.

3. Appropriate immunization has clinical and financial impact.

Plan immunization activities support a national focus on childhood immunizations.

Write a study question.

Write at least one study indicator.

Write the eligible population.

Activity 2

Study Implementation

Identify causes/barriers.

Identify interventions.

Study Topic Number 2: Asthma (Administrative Study)

Read the following study topic:

Asthma is the leading chronic illness in childhood, responsible for more than 10 million lost school days annually. The incidence of pediatric asthma increased from 36 cases per 1000 children in 1980 to 62 cases per 1000 children in 1997. Asthma leads to two million emergency room visits and five thousand deaths per year in the US. Pediatric asthma costs from health care and lost productivity exceed $12 billion annually.

The health plan has identified 278 Plan X Medicaid enrollees between the ages of 5 and 19 with a diagnosis of asthma based on 2005 claims and encounter data. The analysis included all members with an asthma diagnosis and did not exclude members with special health care needs.

A significant amount of clinical literature exists that supports a wide range of interventions improve asthma outcomes.