IOM IMMUNIZATION FINANCE WORKSHOP: TEXAS OVERVIEW AUSTIN 101201

1
IOM IMMUNIZATION FINANCE WORKSHOP TEXAS
OVERVIEWAUSTIN 10/12/01

• Jane D. Siegel M.D.
• University of Texas Southwestern Medical Center
• Dallas

2
(No Transcript)
3
HOSPITAL CHARGES GENERATED DURING MEASLES
OUTBREAK DALLAS COUNTY 1989-90 (2,372 CASES)

• Inpatient
  
• Children 2,663,582.10 (196/198
  adm.)
• Adults 561,088.66
  (60/63 adm.)
• Total 3,224,670.76
• Outpatient 227,581.10 (1,275
  pts.)
• Total 3,452,251.86
• CMC, PMH only

4
DALLAS AREA INFANT IMMUNIZATION INITIATIVE PLAN
9/20/91

• GOAL
• By the year 2000, ensure that at least 90 of all
  two year olds who live in Dallas County receive
  recommended immunizations on schedule

5
IMMUNIZATION RATES FOR CHILDREN 19
TO 35 MONTHS OF AGE (431 SERIES)
6
U.S. IMMUNIZATION RATES 2000

• Children 19-35 mos. (2/96-5/98 births) U.S.
• gt 3 DTaP/DT 94 gt 3 HBV 90
• gt 3 Hib 93 gt 1 varicella 68
• gt 3 polio 90 gt 4 DTaP/DT 82
• gt1 MMR 91 4313 series 76
  
• 4313 series state specific 68 to 87
• Texas 69 Dallas 67 Houston 65
• Vaccines NOT refused for shots
• Decreased from 1999 29 (97), 43
  (98), 58,(99)

7
LAG TIME AFTER INTRODUCTION OF NEW VACCINE

• Improved
• Timing of ACIP rec, VFC resolution
• Consistency among ACIP, AAP, AAFP
• Needs work
• Contract negotiation
• Allocation of state funds in anticipation of
  increased needs, e.g. PCV-7
• Variability in coverage by insurance companies
  parents may do everything right, but their
  child remains unprotected
• Fear ? safety of new vaccine desire to wait and
  see negative publicity

8
VARICELLA MORBIDITY IN TEXAS1995 2000
Source Bureau of Immunization and Pharmacy
Support
9
VFC TARGETED INTERVENTIONS

• Focus VFC education and recruitment toward family
  physicians
• Direct attention toward private provider
  enrollment
• Promote immunizations within a medical home
• Establish state/local immunization registries
• over-/under- immunization
• changing coverage/provider
• tracking post-exposure prophylaxis in outbreak,
  e.g. smallpox
• sale of immunization records

10
BENEFITS OF IMPROVED PUBLIC-PRIVATE COLLABORATION
VIA VFC

• Improved recoupling of immunization with primary
  care
• Allow allocation of public health resources to
  assist all providers in practicing according to
  Standards for Pediatric Immunization Practices
• Vaccine storage, handling procedures
• Reminder/recall systems
• Immunization coverage assessments
• Family, provider, staff education to assure
  standardized practices and responses to
  immunization crises

11
LACK OF PARTICIPATION OF LICENSED MDS IN TEXAS
VFC 10/2000 9/14/01
Licensed MDs that are designated Family
Practice, General Practice, Pediatrics, Internal
Medicine.
12
BARRIERS TO PRIVATE PROVIDER PARTICIPATION IN VFC
PROGRAM

• Little or no knowledge of program
• Not all combination vaccines available, e.g.
  Comvax?
• Fear of labor-intensive paperwork
• Vaccine not delivered to office
• Decreased reimbursement rates
• Concern that patients may come to expect other
  health services without reimbursement

13
BARRIERS TO IMMUNIZATION MANUFACTURING
PROCESS

• DTaP, PCV-7, influenza
• Development
• Licensure
• Production delays
• Distribution patterns
• Price
• Liability

14
BARRIERS TO IMMUNIZATION COMMUNICATION GAPS

• Education
• Families/pts., decision makers, providers in
  practice, providers in training
• Consistent messages effectiveness, safety,
  continued financial support required to sustain
  improvements in coverage
• Public-private
• Policy-making
• Manufacturers-consumers
• Payor-patient

15
EVIDENCE-BASED STRATEGIES FOR IMPROVING AND
SUSTAINING IMMUNIZATION COVERAGE

• Immunization services in WIC
• Provider assessments and feedback, recall and
  reminder systems, immunization registries
• Controversies over opt-in/opt-out
• Role of registry in era of bioterrorism maintain
  health of children, track interventions
• ? Role for adult immunization
• Financial barriers and access
• Public and provider education combine with
  other strategies

16
(No Transcript)
17
(No Transcript)