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March 16, 2021

Here’s Why Self-Insured Employers Won’t Be Able to Track COVID-19 Vaccinations

Artemis Health

COVID-19 vaccination rates are speeding up around the world. In Artemis Health’s home state of Utah, anyone 50 and older, healthcare workers, first responders, teachers, and people with certain pre-existing conditions are all now eligible to sign up for a shot. As of this writing, roughly 95 million doses have been given nationwide, and the Biden administration is promising enough supply for every American to get vaccinated by the end of May. 

If you want to cry a few tears of joy at this hopeful news, please read this article from the Washington Post, which gets on-the-ground stories from healthcare professionals working the vaccine clinics all over the country. However, many self-insured employers may instead be crying tears of frustration at the lack of data available on COVID-19 vaccination for employees and their families. 

We get it. Artemis Health is a collection of data nerds, too, and we really wish we could dive deep into employee populations and vaccine rates. But there is one simple reason that we won’t be able to see COVID-19 vaccine claims in our client’s data: this life-saving vaccine is NOT coming through medical claims. 

COVID-19 vaccines are all currently being supplied by the federal government, and will not be charged to payers or insurance companies. The government’s goal is to vaccinate as many people as possible, as quickly as possible, to stop the spread of COVID-19. Billing health insurance companies and dealing with administrative fees and processes would only slow the process down. Those working the mass vaccination clinics (health departments, medical volunteers, and non-medical volunteers) are able to focus on getting the shots into as many arms as possible instead of spending time on medical billing. 

If employers were to see any claims data on COVID-19 vaccination, it would be for the actual “poke,” the administration of the vaccine. The vaccine in the vials is paid for by the federal government, but providers may bill for the procedure of injecting it into arms. 

For this reason, the majority of self-insured employers, including Artemis’ customers, will see almost no COVID-19 vaccine information in their data. We advise our partners not to rely on (or have high expectations for) any COVID-19 vaccine claims in your data. It, sadly, will likely not be actionable. 

Now, this can be a little confusing to both employers and those seeking vaccine appointments. Artemis Content Director Haley Eckels recently wrote about her experiences helping friends and family members get coveted vaccine appointments, and many of the signup systems ask for insurance information. This is likely because some providers may bill health insurance for giving the shot, but most are not bothering with this step. Private providers like retail pharmacies may be another story, but no patient will see a bill or cost to receive the vaccine. 

At this point, the vast majority of vaccines are still being distributed through government agencies, including local and state health departments. In the future, if a patient sees a primary care doctor for their COVID-19 vaccine, you would expect to see that visit turn up in your medical claims data. 

Let’s dive into a few FAQs Artemis has fielded from customers and partners. 

COVID-19 Vaccine Data FAQs

What COVID-19 vaccine data may we expect to see in the data?

The short answer is “little to none.” You may see some data come in through retail pharmacy providers or health systems, but many states are providing vaccines at public clinics using volunteers and health department staff. Organizations that administer the vaccines are allowed to bill health insurance for the administration (“poke”), but most states and facilities are not doing this.

What codes may we expect to come through? What do they mean if they do come through? 

Few, if any, COVID-19 specific vaccine codes will come through your medical claims. If you do see them, they often mean that an individual has received a dose of a vaccine. However, that does not mean that people without the code haven’t received the vaccine since the majority of vaccination facilities are not charging anything to the individual’s insurer.

Can we see the vaccine manufacturer in the data?

If the vaccine is being billed under insurance, you would be able to see the manufacturer. However, since the vaccine is largely not being charged to the insurance carrier, the manufacturer is often unknown.

What is the cost of the vaccine?

To the health insurer and the patient, it is $0. It is supplied by the Federal Government. The price that the government is paying is not something Artemis is able to track in our customer’s data.

What happens if people don’t receive their second round or dose?

If an individual doesn’t receive the second dose, their immunity will not be as strong as if they took both doses. For the Pfizer COVID-19 vaccine, early indications are that there is a high immunological response four weeks after the first dose. Some nations are actually giving the first and second doses more than the suggested 21 days apart to try to get more people inoculated with at least one shot, though other experts disagree with this strategy. The CDC’s current guidance is to strive for 21-day and 28-day spacing for the Pfizer and Moderna vaccines respectively, but if a delay is unavoidable, they indicate that a 6-week window (42) days is ok.

Individuals who have received one vaccine should be encouraged to get their second dose. However, an employer or insurer will not know from their data who has or has not received the first dose of the vaccine.

If we see a cost come through on a medical or Rx claim, what is it?

It’s more than likely the procedure of administering the shot (the actual jab), not the cost of the vaccine. You should never see a cost come through for the vaccine itself, only for the administration of the vaccine.

How will the vaccine administration differ from state to state? How can I find out each state’s approach?

Your best option is to look at each individual state’s health department website. Things will get more complicated as time goes on. In the initial stages, some states have limited points of service (such as a state and/or county health departments). As more vaccine becomes available, many states have plans to expand mass vaccination sites and distribute doses to local retail pharmacies, clinics, and doctor’s offices. Some states have already expanded to retail pharmacies, and we expect this trend to continue as the vaccine efforts ramp up. 

If I can’t look at the data, what can I do? 

We work with data-driven decision makers who rely on insights in their data in order to take action. The COVID-19 vaccination efforts present a frustrating lack of data, but that doesn’t mean there’s nothing employers can do to help. 

Employers can launch member education campaigns to overcome vaccine hesitancy, offer vaccine management help to assist people in making appointments, send out reminders about the necessity of the second shot, and even organize vaccine clinics if and when shots become more widely available. Some employers are focusing on access and convenience by providing PTO and transportation help to employees travel to vaccine appointments. Keep in mind that while vaccine data would be a great tool to help during this emergency, the speed of vaccinations is more important. Employers can help by encouraging employees to get vaccinated, assisting with planning, and making it easy for them to get to appointments. 

Want to learn more about Artemis Health and our efforts to provide data insights to employers and advisors? Watch our 2-minute demo video here. 

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