Immunization stakeholders and policymakers have pursued various policy approaches to raise immunization rates. Historically, these approaches have primarily focused on vaccinating children, from guaranteeing access to childhood vaccines through vaccine financing programs to expanding care delivery settings and establishing school-entry requirements. While these approaches proved successful in boosting childhood vaccination rates, increasing uptake of recommended vaccines among the adult population has remained a persistent challenge.

A range of clinical, reimbursement and care delivery challenges unique to the adult population have hindered traditional approaches to improving adult immunization and led stakeholders to explore new ways to drive adult immunization uptake.

Quality measurement is emerging as a broad-based mechanism that has the potential to overcome some of the barriers associated with improving adult immunization rates. As the US healthcare system continues to shift away from fee-for-service payment toward rewarding higher-quality and higher-value care, the quality measures on which providers report, and which are increasingly tied to payment, must reflect well-established clinical recommendations. For vaccines, this has meant aligning immunization quality measures to the Advisory Committee on Immunization Practice’s (ACIP) recommendations.

Currently, quality measures for routine adult immunizations appear frequently, though inconsistently, in public and private programs. Measures for influenza and pneumococcal vaccine appear in some form across many of the Center for Medicare & Medicaid Service’s (CMS) major quality reporting and payment programs, including the Hospital Inpatient and Outpatient Quality Reporting Programs, Medicare Shared Savings Program, Medicare Star Ratings, Medicaid Adult Core Measure Set and the Merit-based Incentive Payment System. In contrast, measures for the herpes zoster vaccine, a vaccine which is routinely recommended for all adults 50 and older, are largely absent from Medicare programs, appearing only in CMS’ Home Health Value-Based Purchasing program. Measure developers and immunization stakeholders are working to fill these known measure gaps; however, continued action is needed to identify other existing gaps in the adult immunization space.

The trend toward a more value-based system will continue as healthcare leaders increasingly emphasize the importance of paying for high-quality care and outcomes. Furthermore, ongoing measure development initiatives, such as the proposed adoption of an adult immunization composite measure and a prenatal immunization composite measure into NCQA’s HEDIS in 2019 could transform the adult immunization measure landscape. As a result, immunization and healthcare stakeholders, including those who have traditionally focused on improving vaccination rates through public health interventions, must keep pace with broader policy changes to understand available quality levers and incentive mechanisms at both the state and national levels that can be used to drive adult immunization uptake.

Richard Hughes IV and Christine Liow will be presenting on the topic of “Understanding the Current Role of Immunization Measures in Quality-Based Policies” at the 48th Annual National Immunization Conference in Atlanta, GA. The presentation is part of a session focused on Opportunities in Immunization Quality Measurement: Prenatal and Adult Composite Measures, to be held on May 16 from 11:30 AM – 12:30 PM in Galleria 1.

To learn more about Avalere’s work in the vaccines space, connect with us.