Immunization Delivery in Arizona

Transcription

1 Immunization Delivery in Arizona Leadership Team: Jeanene Fowler Public Information Officer Maricopa County Public Health Jennifer Tinney Program Manager AZ Partnership for Immunizations Kristen Landry Public Information Officer Madison School District Rebecca Nevedale Associate Director AZ Chapter, Academy of Pediatrics

2 Background 3 of us are members of immunization coalition: The Arizona Partnership for Immunizations Wanted a school perspective so recruited Kristen We are the Immunization Champions in our organizations We are responsible for guiding more senior health leadership in our community to think through complex problems with new perspectives (leading up; leading down)

3 Population

4 Team Leadership Goals Success Organization and focus Utilize new techniques to focus meetings on action Different perspectives not considered Utilized our coach (Dr. Art) Breaking down project when landscape continues to change Shifted project focus due to change in federal funds Utilizing all resources at our disposal Use all partners data to tell the story Facilitative leadership Incorporated into personal goals

5 Team Leadership Goals not so successful Incorporated personal and team leadership goals late in the game Competing organizational priorities (like rabid bats) Difficult to schedule time with coach and team members Needed to resurrect the project after weeks of having to focus on another crisis

6 Personal Leadership Goals Highlights Jeanene, Jennifer and Rebecca: The Brain Reframing thoughts before speaking Improving skills so communication is more influential Speaking with inclusion De-briefed and provided feedback to one another after meetings (even those unrelated to project) Utilized new phrases I m thinking out loud Let me understand if this is what I m hearing I have a question, just because I don t know I wonder if

7 Personal Leadership Goals - Unanticipated Jeanene, Jennifer and Rebecca: the Brain Winning over tough crowds who don t agree with our subject but are agreeing to work with us Joint Legislative Budget Committee, Arizona Department of Administration, County Health Officers Shared goals helped us cover for one another in meetings when someone fell into old habits Cued our teammates to alter their communications Transferred skills to other work and debriefed with teammates about those experiences

8 Personal Leadership Goals Highlights Kristen: Crepe-Loving Introvert Improving Facilitation Skills Keeping 3 extroverts (i.e. The Brain) focused on tasks Helped with How to Run a Meeting techniques Debriefed how skills were growing in managing school district team and communicating with disgruntled peanut moms

9 Personal Leadership Goals - Unanticipated Kristen: Crepe-Loving Introvert Experience helped improve facilitation skills in personal relationships Unwillingness on the part of co-workers Falling in love with crepes And Henry Scott! First NLAPH baby! Henry Scott Landry was born December 10th weighing in at 8lbs 13 oz and 20 inches long

10 Community Health Improvement Project 1 Developing a system for School-Based Flu Vaccinations

11 Community Health Improvement Project 2 OCTOBER, 2012: Group had to CHANGE our project to: Reimbursement to clinicians and health depts for vaccines Challenge: stakeholders working together

12 Immunization Financing System Uninsured 317 State $ - NOT AHCCCS Providers VFC CDC IHS Co-pays Underinsured ACA Schools ADHS? Kids Care Pvt Insurance FQHCs County $ - NOT Pts -Dr. Bob England, Maricopa County Public Health

13 TAPI: Public Private Partnership Governor s Office of Women & Children Arizona Association of Community Health Centers Arizona Children s Action Alliance Schaller Anderson Blue Cross Blue Shield Arizona Medical Association Arizona Health Care Cost Containment System Maricopa County Community Health Nursing Pima County Health Department Flinn Foundation BHHS Legacy Mercy Care Arizona Department of Health Services, Bio-Terrorism AHCCCS Scientific Technologies Corporation Phoenix Fire Department Arizona Academy of Pediatrics Health Logic Health Services Advisory Group Arizona Pharmacy Association Banner Health ASU College of Nursing Care 1st Health plan AZ State Division of Developmental Delays Health Links, Phoenix Day Arizona State Immunization Information System Arizona Family Practice Association Arizona Osteopathic Medical Association CIGNA Health Plan Phoenix Health Plan SCAN Health Plan Governor s Council on Aging United Health Care Mesa Fire Department GlaxoSmithKline Sanofi Pasteur Medimmune Merck Novartis Active Health Leadership working in trusted relationships

14 Vaccine Congress I, II and III 80 health organizations Set recommendations to improve rates Bill for the Counties Increase reimbursement rates Train Providers on Business Practice

15 Wild West Values

16 Conservative Politics

17 Tell the story with data Once Upon a Time In the wild wild west of Arizona we had a broken vaccine system private sector payments were inadequate public health funding cuts prevented some from getting shots (sigh) Need Measurable outcomes tied to economics

18 Making System Change 100% 90% Arizona National Immunization Survey Results Children 19 to 35 Months Old with 4 DTaP, 3 Polio, 1 MMR, 3 Hib, 3 Hep B, and 1 Varicella Healthy People 2020 Objective is 90% Working in partnership = 50% coverage level increase to 75% for babies 80% Percent of Coverage 70% 60% 50% 40% July July July July July Sep August Sep AugustSep 2010*August Confidence 55.1% 62% 63.9% 72.8% 77.5% 80% 75.2% 81.9% 82.7% 76% 82.2% Interv al 45.7% 53.2% 54.1% 64% 68.5% 69.8% 65.8% 68.5% 70.1% 63.8% 70.4% Cov erage Lev el 50.4% 57.6% 59% 68.4% 73% 74.9% 70.5% 75.2% 76.4% 69.9% 76.3% Month and Year of NIS Data Release *Please note: Hib vaccine shortage is reflected in the September 2010 coverage level for 4 DTaP, 3 Polio, 1 MMR, 3 Hib, 3 Hep B and 1 Varicella. Prepared by Arizona Immunization Program Of f ice, Assessment Unit. Based on National Immunization Surv ey Data.

19 Pima County Measles Outbreak by Exposure Location 2/2/08 Arrival in US Index Case 1 37 yo, Swiss Unvaccinated 2/13 rash Travel to AZ & Mexico Measles IgM- Positive Measles IgG- Positive RT PCR- Positive Lab confirmed Epi-linked First Generati on Hosp A 2 50 yo F Unvaccinat ed Asthma on steroids Exposed 2/12 Hosp A Rash 2/28 (atypical) Measles IgM- Positive Measles IgG-Positive RT-PCR- Positive Source: ADHS Second Generation Hosp A 3 41 yo F, Exp 2/25 PCT in Hosp A Nonimmune, Vax 2/25 Rash 3/9. RT PCRpositive Hosp A 4 11 mo M, Unvax, Exp 2/24 Hosp A ED, Rash 3/10. Measles IgM- Positive. Measles IgG- Negative RT-PCR- Positive Hosp A 5 3 yo F, Unvax Exp 2/24-2/25 Hosp A, Rash 3/5. Measles IgM- Positive Measles IgG- Negative. No virals sent to CDC Hosp A Sib to yo M, Unvax Exp 2/24-2/25 Hosp A, Rash 3/9. Measles IgM-Positive Measles IgG-Positive No virals sent to CDC 5/8/08 Third Generation Hosp A 8 47 yo F, Unk vax, Exp 3/7 Hosp A ED, Rash 3/20 RT PCR-Positive, Measles IgM-Positive Measles IgG-Negative Home 9 41 yo M, Vax 3/10, Exp home, Rash 3/21. RT- PCR- Negative. Measles IgM- Not done (post exposure vaccine) Ped s office 7 1 yo F, Vax 3/10, Exp 3/10 Ped s office, Rash 3/20. Measles PCR- Negative. Measles IgM- Not done (post exposure vaccine)? yo M, self-reported Vax, Exp?, Rash 3/25. Measles IgM-Positive Measles IgG-Negative RT-PCR- Not done Fourth Generation? 13 8 mo M, Unvax, Exp?, Rash 4/10. Measles IgM Capture EIA- Negative Measles DFA- Positive on Urine and NP RT- PCR-Negative? mo M, Unvax, Exp?, Rash 4/7. Measles IgM-Positive Measles IgG- Negative RT-PCR-Positive Hosp A mo F, Unvax, Exp 3/23 Hosp A ED, Rash 4/8. Measles IgM- Negative RT-PCR- Negative Fifth Generation Hosp C 14 7 mo F, Vax 4/10, Exp 4/11 Hosp C ED, Rash 4/21. Measles IgM- Positive Measles IgG-Negative.? yo F, UnVax, Exp?, Rash 4/16 Measles IgM- Negative at ASL. RT-PCR-Positive (NP) RT-PCR-Negative (Urine) Hosp B yo M, Vax 4/9, Exp Hosp B 4/7 and 4/8, Rash 04/21. Measles IgM EIA- Negative Measles IgG IFA- Positive RT-PCR-Negative? 17 9 mo M, Vax 3/29, Exp?, Rash 04/24 Measles IgM EIA- Positive Measles IgG IFA- Negative? mo F, Vax 4/18, Rash 4/25. Measles IgM- Positive Measles IgG-Negative RT-PCR Positive (NP, urine)? mo M, Vax 4/17, Rash 4/27. Measles IgM- Negative RT-PCR positive (urine)? 20 9 mo M, Rash 5/2. Measles IgM- Positive Measles IgG-Positive. Cost to hospitals for outbreak control- $800,000

20 Private Sector Physicians Give Nearly 3/4 of Children s Shots 70% 30% Public Private Source: Arizona Department of Health Services 20

21 Calculation of Cost to Give Vaccine 44% percent of private practice overhead in vaccine stock Offices need to be paid 120% of retail cost to cover the expenses Thousands of $ in vaccine Cost calculators developed by AzAAP

22 Very Boring Pie Chart? County data also shows more than double number of insured kids in PH

23 Public Health is not the fix $0 in state funding to health depts. for imz. Changes to Federal vaccine funds Statue requires counties to provide immunization at no cost Costs County Health Depts $1.79 million per year Average LHD funding per person = $34 Maricopa = $3.50 (4 million residents)

24 Appeal to Health Plans Profit/Loss on Vaccine Acquisition: Profit 2 of 10 Practices Range: $28 - $37 per child Loss 8 of 10 Practices Range: $10 - $227 per child Increase private provider rates to 120% of retail Reimburse the public health departments for vaccine given to privately insured patients There are 6 payers with which every practice loses money Source: AzAAP

25 Net Yield for Private Purchase Vaccines Net Yield is insurance payment minus vaccine purchase price in dollars Legend: Green: max yield Blue: average yield Red: min yield Adapted from Gary Freed et al. Pediatrics 2008; 122: Each bar represents one vaccine

26 Public and Private

27 Privately insured patients at MCDPHd patients at MCDPH Coventry 0% Humana 2% AIG 0% no cards 43% Aetna 12% BCBS AZ 22% UHC 12% Mercy St johns 0% Tri Care for military 0% CHC 0% PHCS 0% Banner Health 2% Cigna Health Net 6% 1%

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29 Data driven Solutions. Appropriate messaging regarding access to vaccines Legislation Require all health plans to reimburse 120% of vaccine cost Require health plans to reimburse county health depts Eliminate personal exemption for schools

30 Available at WhyImmunize.org Tools for messaging

31 Data Determines the Path

32 Impact of NLAPH Coach provided new perspectives The power of our collaboration Personalized coaching between team members Framing the message for opposites sides Adding a team member from non-health-field opened our eyes

33 The Future and beyond Continue to work on our re-vamping the system Continue regular meetings as Team Awesome to discuss personal learning goals and support one another Safe place to bounce ideas and get caring feedback Convince Dr. Art to keep coaching us

34 2013 Legislative Session Project Completed: Getting the Data and Messaging together Up Next: Getting the Public and Private provider communities to SPEAK UP Stay tuned. Leg session starts January 14 th

35 Team Awesome! Jeanene Fowler Jennifer Tinney Kristen Landry Rebecca Nevedale Photo from the TAPI s Vaccines are Safe Campaign