N.C. Insurers Direct Patients to Physicians for Flu Immunization

Primary care physicians in North Carolina might want to prepare for an uptick in patients seeking influenza immunizations. For the first time, BlueCross BlueShield of North Carolina, or BCBSNC, and WellPath Select Inc. have partnered with the North Carolina Medical Society, or NCMS, in a campaign to encourage patients to visit their primary care physicians for influenza immunizations beginning Oct. 1.

In recent years, a growing number of people have turned to retail outlets for their influenza immunizations, putting "get flu shot" on the grocery list with milk and bread.

Don Bradley, M.D., of Durham, N.C., chief medical officer of BCBSNC, said his organization has actively promoted influenza immunizations for the past few years and has been fairly successful, last year covering the cost of about 500,000 influenza vaccines across all of its delivery sites, including physician offices.

Not a bad number, said Bradley, "but since we cover about 3.4 million people in the state, that's not the immunization rate we're looking for." After working with retail outlets as delivery sites for the past three or four years, "we wanted to try another route to see if we couldn't boost rates," said Bradley, an AAFP member. "At the same time, docs were making it clear that they would like to have us help support the concept of the medical home."

FP Darlyne Menscer, M.D., of Charlotte, N.C., is president of the NCMS. She said collaborative relationships between the medical society and some insurance plans, particularly BCBSNC, have paid off.

"Because we have an (ongoing) dialogue with their medical director and their CEO… they were aware that we were not happy that the medical home of the patient was not respected" when influenza immunizations were given outside that setting, said Menscer. "We were very pleased that they were willing to say (to patients), 'Please get this (immunization) at your doctor's office.'"

Menscer stressed that although providing influenza immunizations is a service to patients and the right thing for physicians to do -- in part because it reinforces to patients that they should get their medical care in their medical home -- "giving flu vaccines is not a money maker for physicians."

Influenza vaccine can't be saved from year to year, so the insurance companies' revised influenza vaccine policies may help North Carolina physicians better prepare for the amount of vaccine they need to have on hand, said Menscer. That's important for a physician's office budget because "If you ordered 100 doses and half of your patients got their shots elsewhere, then you're left with 50 you can't return," but still paid for, said Menscer.

One immediate bonus to physicians will be their ability to track which patients have been immunized for influenza. Menscer said physicians are increasingly responsible for documenting quality of care in ways that affect their payment from Medicare and private payers. "If we're documenting quality data for the care of diabetic patients, COPD patients and all those over age 65 … we'll at least have the information that says, 'Yes it (the influenza vaccine) was offered and declined,' or 'It was given on this day,'" said Menscer.

As an added benefit, "in-office" influenza immunizations will give patients an opportunity to make an appointment for overdue well visits while they're there, said Menscer. And, she noted, physicians can immunize patients of all ages who are eligible to receive influenza vaccine -- as opposed to some vaccine administration clinics that set age restrictions for influenza immunization.

The NCMS would like to see physician offices administer influenza immunizations in a "clinic-type" fashion that would move patients through quickly and avoid copays, said Menscer. Physicians who want to host an influenza vaccine clinic in their offices can get information from the NCMS.

Whether the push from the North Carolina insurers will become a national trend is anyone's guess, but Bradley said that from the insurer's side, it's certainly less expensive to prevent influenza -- and the complications it can cause -- than to treat it. Every year, BCBSNC sees a peak in hospital admissions for respiratory illnesses in January and February, "and a significant portion of those (illnesses) are related to flu," he said.