Reaching Medicaid Children to Achieve Timely Immunizations--How One Plan Went From "Okay" to "Great"

In 2008, the Health Plan of San Mateo (HPSM) had unexceptional, average rates for HEDIS childhood immunization measures. Results ranged from the mid 70-80 percentiles for the nine immunization items. By 2010, all these measures' results were in the mid to high 90 percentiles, and HPSM was the highest rated Medicaid managed care plan in the nation for childhood immunizations. How did this happen? HPSM made three specific changes to its quality program between the 2008 and 2010 HEDIS measurement years (2007 to 2009 calendar years) that we believe led to this important milestone. These changes included: 1) being active proponents of a county immunization registry to our private physicians, instead of leaving its use to just county clinics; 2) addition of the immunization registry's usage as a pay for performance incentive for providers seeing children; and 3) member incentives and member birthday card reminders focused on timely immunizations that were culturally sensitive. Throughout our campaign, we have received positive feedback about our interventions from providers and members. We believe that the combination of these three interventions, aligning member, physician and plan incentives, have led to the achievement that HPSM has accomplished. We continue to outreach about the benefits of the immunization registry to additional providers. Most importantly, we are delighted that the results of our campaign have led to so many children in our community being protected from otherwise serious or deadly diseases.