Improving timely childhood immunizations through pay for performance in Medicaid-managed care

Abstract

Objective: To evaluate the impact of a "piece-rate" pay-for-performance (P4P) program aimed at rewarding up-to-date immunization delivery to 2-year-olds according to the recommended series.

Data sources/study setting: Plan-level data from New York State's Quality Assurance Reporting Requirement and claims data from Hudson Health Plan for 2003-2007. In 2003 Hudson Health Plan, a not-for-profit Medicaid-focused managed care plan, introduced a U.S.$200 bonus payment for each fully immunized 2-year-old and provided administrative supports for identifying children who may need immunization. This represented a potential bonus of 15-25 percent above base reimbursement for eligible 2-year-olds.

Study design: Case-comparison and interrupted times series.

Principal findings: Immunization rates within Hudson Health Plan rose at a significantly, albeit modestly, higher rate than the robust secular trend noted among comparison health plans. Supplementary analyses suggest that there was no significant change in preexisting disparities during the study period, and that children with chronic conditions have significantly greater odds of being fully immunized during the entire study period.

Conclusions: This study suggests that a piece-rate P4P program with appropriate administrative supports can be effective at improving childhood immunization rates.

Figure 1

Immunization Rates: Hudson versus Non-Hudson Medicaid Health Plans Notes. Data based on plan-level claims records supplemented by audited chart review. * Immunization trend 2003–2007 significantly greater for Hudson Health Plan p <.01.