Welcome

1
Welcome

• Welcome Linda Rudolph, MMCD
• Who we are Tammy Pilisuk, IZ Branch
• DHS Immunization (IZ) Branch
• in collaboration with
• DHS Medi-Cal Managed Care Division (MMCD)
• Objectives
• Learn about immunization registries
• Learn how to build effective partnerships with
  registries
• Enhance provider recruitment

2
Agenda

• 1 hr PowerPoint presentation Parts I-IV
• 3 speakers
• QA at the end, as time permits

3
Medi-Cal Managed Care and Immunization
Registries
CA Department of Health Services Immunization
Branch Statewide Immunization Information
System September 2003
4
Overview

• Registry Basics What? Where? Implementation
  status
• Tammy Pilisuk, CA DHS, Immunization Branch
• Registry benefits, how it works,
  how to submit data
• Catherine Martin, CVIIS (Central Valley)
• III. Example of a partnership
• Abigail Ryan, VaxTrack (S. Bernardino County)
• Steps for MMCO - registry partnering and
  conclusions
• Tammy Pilisuk, CA DHS, Immunization Branch

5
Part I

• Registry Basics Implementation Status
• Tammy Pilisuk, MPH

6
What is an immunization registry?

• Regional database of shot records accessed via a
  secure Internet site
• Software varies in some regions, but common
  features.
• Reliable. Proven track record in clinics and
  medical offices throughout the state.

7
A registry

• Forecasts and reminds on shots due/overdue (with
  algorithm based on ACIP, CDC recommendations.)
• Links providers to instantly share patient IZ
  history
• Generates IZ records (yellow blue cards) and
  reports on who missed shots
• Helps track vaccine inventory in
  stock

8
Sample registry screen
9
Registry application is user-friendly
10
There are 9 registries in CA

• Bay Area Regional (BARR)
• Central Coast Regional (CCIR)
• Central Valley Immuniz. Info. System (CVIIS)
• Los Angeles Immuniz. (LINK)
• San Joaquin Valley/ No. CA. Reg. Immuniz. Data
  Exch. (NCRIDE)
• Northern CA. Regional (coming soon!)
• San Diego Regional (SDRIR)
• Inland Region (VaxTrack)
• Sacto/gold country (Shots for Tots)
• uses State CAIR registry software

11
New region forming
Together, 9 regions will cover the state
12
How it will work statewide
MMIS/ Dept of Health Services State Hub
connects regional registries and maintains
statewide data
Large HMOs (e.g., Kaiser)
Regional Registries
State WIC
Schools Day care
Public sector Providers
Local WIC, CalWORKS offices
Private sector Providers and HMOs
13
How Many Providers Participate?

• As of early 2003, about 900 provider offices,
  hospitals, clinics and local health departments
  participate in regional registries.
• Over 1.7 million immunization records included.

14
Status of registry implementation

• 9 CA registries are in different stages of
  development.
• All regions are enrolling providers. However,
  recruitment is limited in some counties due to an
  extended start-up phase.
• Contact your regional registry to determine when
  enrollment will be possible.

15
Part II

• Registry benefits,
• How registries work
• Catherine Martin, CVIIS Registry (Central Valley)

16
Why do we need a registry?

• Patients move, change physicians
• Parents dont always bring yellow cards to
  appointments
• Provider office must try to re-create
  record, contact previous providers, etc
• Providers often over-immunize or miss an
  opportunity to immunize

17
Registries benefit

• Public health
• Parents
• Providers
• Health plans

18
Public health benefits

• Reduces vaccine-preventable diseases
• Identifies high-risk and under-immunized
  populations
• Provides data on county and state coverage rates
• Helps streamline vaccine recalls

19
Parents benefits

• Consolidates childs shots into one record
• Generates reminders when child is due for a shot
• Eliminates repeat shots if yellow card is lost
• Prints up-to-date IZ record instantly

20
Providers benefits

• Includes free hands-on training, help desk
  support
• Verifies IZ history instantly
• Minimizes duplicate shots or missing
  opportunities to immunize
• Facilitates automated reminder/recall

21
Health plan benefits

• Reduces manual record review in doctor offices
• Improves QA and timeliness of shots
• Provides data for HEDIS (potential
  improved HEDIS results!)
• Supports preventive care efforts via routine
  reminder/recall system

22
How does a registry work?

• Data received from public and private health care
  providers, birth records, health plans
• Providers check the registry prior to giving
  shots
• Provider office enters shots
  they give
• ( history)

23
Setting up registry -- MMCOimmunization data
exchange

• Determine data exchange method
• Individual physicians submit data
• Direct data transfer (can decrease data entry
  burden for providers)
• MOU between MMCO and registry needed for direct
  data transfer

24
How health plans can submit immunization data

• Physicians submit billing form to MMCO as
  services are provided
• MMCO submits routine data
• Parent/guardian name, patient name, address, DOB,
  sex, vaccine name, series , date given
• Must follow registry guidelines for data format

25
Part III

• Example of one registrys working relationship
  MCMC
• Abigail Ryan, VaxTrack Registry (San
  Bernardino-Riverside counties)

26
Example of a successful partnership IEHP
VaxTrack

• Inland Empire Health Plan (IEHP)
• 500 Primary Care Physicians
• 265,000 members
• Began working with VaxTrack in 1999
• 3.8 million immunizations

27
IEHP immunization data submitted to registry
1999-2002

• Year Imms
• 1999 110,578
• 2000 145,508
• 2001 246,128
• 2002 276,190

28
IEHP Provider Incentive Program

• Payment to PCPs for immunizations
• All PCPs treating children are eligible
• PM-160 billing form
• 7-14 per shot

29
IEHP gains in admin data
HEDIS Childhood Immunization MeasureJune 2001
30
IEHP gains in admin data
HEDIS Childhood Immunization MeasureJune 2002
31
MCMC participation increases immunization rates

• IEHPs immunization rate increased from the 75th
  to the 90th percentile Dec. 1999 to Dec. 2002
• Molina Healthcare partnered with VaxTrack in
  2002. They have increased up-to-date rate
  from 52 to 76

32
Health plan key to high provider enrollment

• Direct data transfer less need for data entry
  at provider office
• MMCO help encourages provider participation
• High provider enrollment more data!

33
Part IV

• MCMCRegistry partnerships What you can do
• Tammy Pilisuk, CA. DHS

34
Step 1 Talk to your MCMC administration

• Bring registry brochure
• Provide contact info. for regional
  registry (www.ca-siis.org)
• Encourage Admin. to get on board

35
Step 2 Establish aregistry partnership

• Be a liaison to connect providers to a regional
  registry
• Provide registry staff with a list of MMCO
  providers for individual recruitment
• Attend registry meetings and events

36
Step 3 Promote the registry within your provider
network

• Schedule registry training for MMCO provider
  recruitment staff
• Promote registry (e.g., provider orientation,
  newsletter, physician meetings)
• Offer incentives to give shots on time
• Add information in patient materials

37
Step 4 Support Provider Participation

• Purchase/upgrade computers
• Provide Internet service
• Check out use of PM 160 form (for billing)

PM 160 ------------------------------
38
Registries will help you

• Contact providers individually
• Demo software in-office for physicians
• Assess technological readiness
• Provide training and on-going support

39
Conclusions

• MMCO Registry partnerships are
  mutually beneficial, when data
  are shared.
• Individual provider enrollment is possible.
  HOWEVER the more MMCOs that participate at the
  organizational level, the better the registry
  becomes.

40
Take home messages

• Contact registry find out when providers can
  enroll
• When time is right, lead the cheer encourage
  providers to participate
• When possible, facilitate direct data exchange
  (VaxTrack example)
• Partner with regional registries to support
  promotion, and provider participation

41
On behalf of California kids, we look forward to
collaborating!

• For more information
• www.ca-siis.org
• Tammy Pilisuk tpilisuk_at_dhs.ca.gov
• Catherine Martin catherinem_at_sjvhc.org
• Abigail Ryan aryan_at_dph.sbcounty.gov