Aetna Inc. - The Early Childhood Immunization Program

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Background 

Patient reminders are an effective way to ensure children receive all recommended vaccinations at the right age. Reminders can be delivered to patients by mail, telephone, electronic systems or by a combination of these techniques. The multi-pronged approach of sending a reminder letter followed by a reminder call has shown the ability to increase vaccine rates over the use of a single mode reminder to improve childhood and pre-teen immunization.1  Through its Early Childhood Immunization Program, Aetna tested the effectiveness of a mailed reminder and automated call on increasing pneumococcal vaccination rates.

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Program Overview
Analysis
Results
Lessons Learned
About Aetna 

 


 

Program Overview 

In 2010, Aetna set out to increase the early childhood immunization rates of its members while testing the effectiveness of three different outreach models using automated call technologies, call scripts and mailings for reminders and follow-ups. A comprehensive reminder letter and comprehensive script were compared with the use of a brief, general reminder letter and script. These test models were used in conjunction with calls automated by interactive voice recognition technology or with touch tone prompts. 

 

Analysis  

The health plan separated members into two groups based on age and vaccination status. Children 8-months old who had received at least one but less than three pneumococcal vaccines were grouped separately from children 17-months old who had received at least one, but less than four pneumococcal vaccines. Members were then randomly assigned to one of four study groups where their vaccination rates were tracked.  

Members in Group A received a comprehensive reminder letter and an automated call with a comprehensive script using voice recognition technology. Members in Group B received a brief, general reminder card and automated call with general script using voice recognition technology. Group C received a brief, general reminder card and automated call with general script using touch-tone prompts and the control group, Group D, received no outreach at all.

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Results 

In total, 1,222 (38.8%) Group A members, 1,287 (40.6%) Group B members and 996 (32.5%) Group C members obtained an immunization within 60 days of the telephone call compared to 987 (31.4%) Group D (control group) members (Figure 1).

 

Figure 1 

Study Groups  Obtained an immunization w/in 60 days of call  
Group A Received a comprehensive reminder letter and automated call with comprehensive script using voice recognition technology 1,222 or 38.8%

 

Group B Received a brief, general reminder card and automated call with general script using voice recognition technology 1,287 or 40.6%
Group C Received a brief, general reminder card and automated call with general script using touch-tone prompts 996 or 32.5%
Group D Control group – received no outreach 987 or 31.4%

 

Results showed that members who received an interactive reminder call using voice recognition technology (Groups A and B), regardless of script or mailer, were much more likely to obtain a vaccination than members in the control group (Group D) or those who had received a general reminder call using touch-tone prompts and general mailer (Group C). 


 

Figure 2 

Study Groups  Obtained pneumococcal immunization w/in 60 days of call  
Group A Received a comprehensive reminder letter and automated call with comprehensive script using voice recognition technology 138 or 4.4 %

 

Group B Received a brief, general reminder card and automated call with general script using voice recognition technology 131 or 4.1%
Group C Received a brief, general reminder card and automated call with general script using touch-tone prompts. 104 or 3.4%
Group D Control group – received no outreach. 110 or 3.5%

 

In total, there were 138 (4.4%) Group A members, 131 (4.1%) Group B members, and 104 (3.4%) Group C members who obtained a pneumococcal immunization within 60 days of the telephone call compared to 110 (3.5%) Group D (control group) members (Figure 2).  

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Lessons Learned  

The study demonstrates the effectiveness of a multi-modal outreach approach in increasing immunization rates among children. Members who received automated calls using the voice recognition technology, regardless of call script or mailer (Groups A and B), were significantly more likely to receive a vaccination than either the control group (Group D) or members who received a general reminder call using touch-tone prompts and general mailer (Group C). Interactive voice recognition technology and/or the voice quality of the automated calls may be a factor in driving behavior. Aetna is currently exploring implementation on a broader scale, potentially testing the use of email messages over traditional mail.

 

About Aetna  

Aetna is one of the nation's leaders in health care, dental, pharmacy, group life, and disability insurance, and employee benefits. Aetna offers a broad range of traditional and consumer-directed health insurance products and related services. Aetna is dedicated to helping people achieve health and financial security, Aetna puts information and helpful resources to work for its members to help them make better-informed decisions about their health care.      

Aetna’s mission is to help people achieve health and financial security by providing easy access to cost-effective, high-quality health care. The company continues to be a leader in building a stronger, more effective health care system by working with doctors, hospitals, employers, patients, public officials and others.

 

Contact
Carla Espinoza, LVN, CPHQ
Healthcare QM Manager
National Quality Management and Measurement (NQMM)
Office of Chief Medical Officer
EspinozaCM@Aetna.com
Ofc: 281-807-7426
Fax: 860-262-9936

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1 TA Lieu, AM Capra, J Makol SB Black, HR Shinefield and for the Immunization Message Study Group. (1998). Effectiveness and Cost-effectiveness of Letters, Automated Telephone Messages, or Both for Underimmunized Children in a Health Maintenance Organization, Pediatrics, 101(4), 1-7.