at least 12 months, they do not meet the protocol for inclusion in the HEDIS measures that are commonly used to assess immunization coverage levels in private health plans. In contrast, children enrolled in SCHIP have continuous eligibility for a year, improving the chances that a single health plan can influence immunization coverage levels. Dr. Porto noted that although Medicaid contracts include monetary incentives for health plans that achieve specified immunization coverage levels, the payments are too small to have much influence on health plan activities.

Health plans invest resources in both provider- and member-oriented immunization activities. Efforts are made to help providers manage their immunization records and to produce reminder notices. Financial incentives have been offered to encourage providers to improve immunization coverage rates, but the availability of funds for incentive payments depends on the overall financial performance of the health plan. Member education materials have targeted compliance with the immunization schedule and immunization against influenza for high-risk groups, such as people with asthma.

Dr. Porto noted that health plans are keenly aware of immunization issues because under the HEDIS program they are required to report immunization rates among their members. She emphasized, however, that the HEDIS program was designed to monitor the quality of health plans and is not a substitute for the kind of population-based surveillance of immunization rates provided by NIS. Some health plans are willing to make some adjustments to achieve a better match between HEDIS and NIS measures, but HEDIS already requires a substantial investment for the collection and auditing of data. Dr. Porto suggested that it was not reasonable to expect health plans to collect additional data to try to approximate population-based surveillance.

Improvements in the state immunization registry would be welcome. If registry records were more complete, health plans might find that their immunization rates in the HEDIS program would improve. Adoption of an opt-out approach would help increase the rate of completeness of reporting. Under the current opt-in system, a health plan cannot automatically submit immunization records because information on parental consent to include a child in the registry may not be available. Dr. Porto also urged greater coordination among the various agencies and organizations that periodically review health plan and provider records, as in the AFIX program, to assess immunization coverage rates in a provider’s practice. Repeated requests for record reviews such as these can be disruptive for providers and staff.

Dr. Porto concluded with encouragement of support for a universal vaccine purchase program in Texas. She observed that the current system



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