Using Claims Data to Measure and Improve the MMR Immunization Rate in an HMO

Abstract

Health maintenance organizations (HMOs) are increasingly being expected to show evidence of the quality of care provided. One such quality measure is the measles, mumps, and rubella (MMR) immunization rate. This article describes how Blue Choice, an individual practice association (IPA)-model HMO, located in Rochester, New York, with more than 350,000 members, set up a three-phase study to improve immunization compliance rates. The first phase of the study amounted to calculating baseline compliance figures consistent with the American Academy of Pediatrics Immunization protocol using paid claims and membership databases. The second phase was to recalculate the MMR immunization rate based on survey information gathered from primary care physicians and to analyze and address reasons for any observed discrepancies. The third phase was to use Blue Choice Quality Assurance nursing staff to follow up with the remaining noncompliant members and determine the impact of intervention on the MMR immunization rate. Our baseline MMR immunization compliance study yielded a rate of 91.7%, which, as a first check of quality, is quite good in comparison to the nationally reported MMR compliance figures of 79.3%. Phase II analysis demonstrated that by seeking chart information, the overall MMR compliance rate was actually 96.7% Reasons for noncompliance are described, as well as the process used and improvements made, in phase III.