Many members of Senior HMOs continue to receive their annual flu shot at a community clinic. This results in community agencies that cannot bill Medicare for these immunizations, and for the HMOs which cannot track senior members immunized at theses clinics.
In 1997 representatives from Medicare, HMOs and community agencies decided that there was sufficient interest to develop a project that addressed the needs of both the agencies and the HMOs. The plan: have community agencies collect and submit data on HMOs members they immunized for influenza, and have HMOs process this information and provide the agencies with reimbursement at the Medicare rate. Following a successful pilot test, the program was expanded statewide.
The presentation will include a description of identifying community agencies, obtaining agreement from HMOs, and collecting the claims data and submitting the data to the HMOs. The reimbursements provided by the HMOs for 1997-1999 are as follows:
|
|
|
|
|
|
|
| 1997 | 6 | 8 |
12,937
|
1,640
|
5,552
|
| 1998 | 6 | 31 |
38,868
|
5,945
|
22,353
|
| 1999** | 5 | 48 |
47,510
|
7,658
|
28,790
|
* Massachusetts purchases vaccine for these agencies, so agencies bill only for administrative costs.
**Data on 33 of 48 participating agencies
This project confirms that HMOs and community agencies can work together on public health programs to achieve their individual objectives. The program has now expanded to include pneumococcal pneumonia shots, and some HMOs now inform their members to consider obtaining a flu shot from one of the participating community agencies.
Learning Objectives: At the end of this session the participant will be able to: 1.Identify issues confronting community agneices conducting immunization programs. 2. Understand the steps in developing colaborative relatins with HMOs and community agencies. 2
Keywords: Immunizations, Community Health Programs
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.