The Immunization Partnership. Immunization Stakeholder Meeting Houston, Texas June 27, 2012

Transcription

1 The Immunization Partnership Immunization Stakeholder Meeting Houston, Texas June 27, 2012

2 Overview Immunization Updates Affordable Care Act and Funding Updates National/state policy issues Legislative accomplishments Listening Session Advocacy Primer

3 Advisory Committee on Immunization Practices (ACIP) 2012 Recommendations ACIP provisional recommendations for adults aged 65 years and older on use of Tdap 2011 Recommendations Hepatitis B vaccine in adults with diabetes mellitus (type 1 and type 2) Use of quadrivalenthpv4 in males 11 or 12 years of age Updated use of Tdap in pregnant women and persons who anticipate having close contact with an infant <12 months Use of quadrivalentmeningococcal conjugate vaccine among children 9-23 months at increased risk of invasive meningococcal disease Licensure of a meningococcal conjugate vaccine for children aged 2 through 10 years and updated booster dose guidance for adolescents (routine vaccination of adolescents years of age, with a booster dose at 16 years)

4 2012 Child and Adolescent Immunization Schedule

5 2012 Adult Immunization Schedule

6 Patient Protection and Affordable Care Act (PPACA) Coverage and Affordability Extend dependent coverage to age 26 Cover ACIP-recommended vaccines with no cost-sharing >190 million privately-insured will have access to ACIPrecommended vaccinations Implement new ACIP-recommendations within a year of CDC adoption Medicaid/Medicare Expanded Medicaid eligibility to all non-elderly persons with incomes up to 133% FPL Improves access to immunizations under Part B of Medicare

7 Patient Protection and Affordable Care Act (PPACA) Federal Funding Section 317 program was reauthorized States permitted to purchase adult vaccines with state funds at CDC-negotiated rates Demonstration programs to improve immunization coverage through evidence-based interventions Prevention and Health Promotion Appropriates a Prevention and Public Health Fund Research and Evaluation Community Health Centers Federal govtto invest $11 billion to expand CHCs

8 Vaccine Funding

9 Vaccine Budgets Federal State VFC 317 GR CHIP Entitlement program Distributes all ACIP recommended vaccines at no cost to providers VFC Eligible: Medicaid, AI/AN, un/underinsured Purchase of vaccines for non-vfc eligible children and adults Inadequate funding support; not kept pace with the need Combination of funds received from legislation, Medicaid billing, Medicare, Rabies or other sources. Vaccines reimbursed from the CHIP for vaccinating eligible children Non-VFC eligible: CHIP, insured, underinsured not seen at FQHC and RHC

10 Prior to January 2012, TVFC covered: Underinsured unable to pay copay/deductibles Privately insured children who access public VFC sites CHIP enrollees Underinsured not seen in FQHC/RHC Children who started a vaccine series while VFC eligible and are now 19; complete series at ASN site

11 The Underinsured in Texas

12 Policy Changes to TVFC Program Effective January 1, 2012 Privately insured children no longer eligible for vaccines in public health departments Underinsured must receive care at FQHC/RHC; DSHS will pursue delegation agreements DSHS will adopt the federal criteria for "underinsured Individuals who begin a series while age 18 or younger (and TVFC-eligible), may finish series at public health clinics that are Adult Safety Net (ASN) providers, provided the series is completed prior to their 20th birthday

13 Adult Safety Net Program

14 Electronic Health Record (EHR)

15 Electronic Health Record (EHR) Texas one of top three states receiving most incentive money and with active registrations Over 17,000 EHR registrations by Medicaid and Medicare providers Over $500M in incentive payments already made to eligible professionals

16 EHR-IIS Interoperability

17 ImmTrac Enhanced to accept batch files of HL7 messages from healthcare providers Allows providers to extract data necessary for submitting immunizations to ImmTrac Increase the accuracy and timeliness of reporting Increase the number of reported events in ImmTrac in 30 days

18 Adult Immunizations

19 Adult Immunization Rates (National Health Interview Survey, 2010) Vaccine Coverage % Influenza 66.6% Pneumococcal 59.7% Tetanus 53.4% Zoster 14.4% ** ** Statistically higher than 2009 coverage rates

20 Main Reason for Non-Vaccination Adults 18 to 64 years: NIS-Adult 2007 Main Reason Flu Pneumococcal Tetanus Vaccine cost 4% 2% 1% Not needed 28% 19% 41% Did not know 4% 25% 10% Doctor did not recommend 7% 30% 17% Side-effects 21% 5% 1%

21 The Good News - Adult Immunizations

22 Influenza

23 Influenza

24 Influenza Vaccination among Healthcare Workers (HCW)

25 Adolescent Immunizations (NIS Teen, ) Percent of Adolescents Tdap MenACWY HPV-1 HPV Survey Year

26 Human Papillomavirus Vaccine

27 ACIP Recommendations for Human Papillomavirus Vaccine Quadrivalent Routine, females 11 or 12 yrs* Catch-up, yrs Quadrivalent or Bivalent Routine, females 11 or 12 yrs* Catch-up, yrs Quadrivalent May be given, males 9-26 yrs Quadrivalent Routine, males 11 or 12 yrs* Catchup, yrs June October October

28 HPV Vaccination Coverage among Females, Years (NIS Teen, 2010)

29 HPV Vaccination Coverage among Females and Males, Years (NIS-Teen, 2010) Females 48.7% initiated the series 32.0% received 3 doses 69.9% completion rate (those who initiated the series and had enough time to finish received 3 doses) Males 1.4% initiated the series 0.1% received 3 doses 41.6% completion rate (those who initiated the series and had enough time to finish received 3 doses)

30 Main parent-reported reasons for intent not to receive the HPV vaccine within the next 12 months among females, years, NIS-Teen, United States, Reasons for not intending to receive the HPV vaccine % (95% CI) Lack of knowledge 19.4 ( ) Not needed or not necessary 18.8 ( ) Not sexually active 18.3 ( ) Did not receive provider recommendation 13.1 ( ) Not appropriate age 7.3 ( ) Safety concern/side effects 7.3 ( ) More information /new vaccine 4.2 ( )

31 Meningitis

32 Vaccine Safety

33 Vaccine Exemptions

34 Vaccine Exemptions Policy Changes Vermont: Recent bill attempted to eliminate philosophical exemptions Washington state:exemption form now requires a signature from a health care practitioner and parent counseling California:Bill similar to Washington legislation introduced in Feb. 2012

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36 Pertussis

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38 Legislative Accomplishments Meningitis Vaccination for College Students (SB 1107) Sen. Wendy Davis (D -Ft. Worth) and Rep. Charlie Howard (R -Pearland) The Jamie Schanbaum and NicolisWilliams Act require all college students under 30 to be vaccinated against meningitis prior to school entry. Pertussis Education for New Parents (HB 3336) Rep. Garnet Coleman (D - Houston) and Sen.Bob Deuell(R Greenville) Parents of newborn children will receive information about the dangers of pertussis and about the importance of vaccinations against pertussis for anyone coming into contact with newborn children.

39 Legislative Accomplishments Healthcare Worker Vaccination (SB 7) Sen. Jane Nelson (R-Flower Mound) and Rep. John Zerwas(R -Simonton) Ensures that all Texas healthcare facilities have a policy in place regarding healthcare worker vaccination. Exciting Progress on Immunization Registry Reform (HB 574) Representative Donna Howard (D - Austin), Aimed to improve data quality and increase the privacy of the data stored in ImmTrac, received strong bi-partisan support, and was voted favorably from the Public Health Committee. Did not reach the floor.

40 Listening Session

41 Listening Session Summary of Topics ACIP Updates Immunization Schedules Patient Protection and Affordable Care Act Vaccine Funding Electronic Health Records (EHR) EHR-IIS Interoperability Immunization Registries (ImmTrac) Adult Immunizations Influenza Healthcare Worker Vaccination Adolescent Immunizations Human Papillomavirus (HPV) Meningitis Vaccine Safety Vaccine Exemptions Pertussis

42 Houston Notes -1 Adult Safety Net Changes and Meningococcal Vaccine: Hope Clinic immunizes 1000 individuals against Hepatitis B; concerned that FQHC are not purchasing private vaccine due to cost; have a huge demand for meningococcal vaccines due to requirement; concerned about influx of people who will require vaccine and can not provide through ASN; price is a barrier for many students. Access issue in East Texas and smaller towns; where do they find the vaccine? Colleges can provisionally enroll students for 10 days Shortage? Novartis vaccines working diligently to get information about access; contact Anne Ramsey; some colleges billing through financial aid; SanofiPasteur confirmed no problems with manufacturing

43 Houston Notes -2 Meningococcal Vaccine: Education: are colleges aware where vaccine can be accessed? Enrollment: some colleges seen drops in enrollment; however, colleges around country have seen drops. Wide variation for how legislation was implemented Recommendation: free vaccination for seniors going to college ImmTrac: What is the plan of action for next legislative session? With increasing demand of EHR/EMR and needed interoperability, will be greater interest in modifying the process for consent

44 Pertussis HPV Houston Notes -3 Ben Tauband other hospitals offering Tdap shot for mothers/caregivers (cocooning); how do we encourage other hospitals to adopt this process? Problem with insurance shot can be expensive ($60-$100); when an adult presents at hospital or MD office, they may not be covered and/or may not be a regular patient, so difficult to vaccinate; ASN does provide Tdap in some locations Many parents voicing negative comments about HPV Recommendation: TIP create TV/media spots to educate parents and combat myths and misperceptions about the vaccine OR create a DVD that can be used in doctors offices; encourage informed choices; how do we address misinformation? Educate about science and listen to concerns People who sign contract with Medicaid can not deny vaccines; need to confirm

45 Tdap vaccine Houston Notes -4 90% of patients have CHIP perinatalwhich does not cover Tdap vaccine; can these patients be covered under ASN program? CHIP enrollees are considered privately ensured so may not qualify ImmTrac ImmTrac record does not qualify for identification purposes (SS office); SS office requires record to be signed by physician so does not qualify For school purposes, ImmTrac record (with logo) is sufficient Statute: if a child <18 years receives a vaccine, required to input vaccine into ImmTrac; some are falling through the gaps Kids coming for one shot and moving; encourage providers to use ImmTrac so kids can be followed Experiencing double numbers; issue of data quality; ImmTrac planning to do data quality improvement project Switch the new system during winter time, not summer!

46 Houston Notes -5 Home-school and Exemptions Many home-schooled patients refuse to get shots; exempted students are still allowed to go to school; strict vaccine policies can contribute to lower exemptions rates; 10 fold increase in number of exemptions over past 10 years Process in Texas: doctors do not need to sign exemption forms; on campus contact DSHS; off campus contact THEB. Vaccines for Children What are the standards for cold chain protection? Specific refrigeration products? How to best implement new vaccine policy changes? Some providers are providing screening tools; patients are selfdeclaring immunization status; must educate about policy changes

47 Houston Notes -6

48 Houston Notes -7

49 Advocacy Primer

50 Immunization Advocacy? Who? Me!?!?

51 Overview Why advocate for systemic change? What is advocacy and who advocates? But I thought I wasn t allowed Steps for Effective Advocacy The 2013 Texas Legislature and Immunizations

52 Why advocate for systemic change? You are not just AN expert, you are THE expert. Your work is impacted by alllevels of government. Public systems demand and need constant feedback. Policy makers need and want to hear your thoughts both to improve your community and to get your support. Because the opposition is advocating effectively already (albeit in a fact-challenged manner).

53 What is advocacy and who are these advocates? Advocacy is the art of making other people understand that you are right (but also making them understand why and how to help). Advocacy is SO MUCH MORE than passing a bill or getting a city appropriation. Advocates can be lobbyists, public employees, nonprofits, professionals, and regular folks. YOU are an advocate, regardless of who you are and who pays your salary. Don t forget MEDIA ADVOCACY and the power of social media.

54 But I thought I wasn t allowed Every individual must determine for themselves how far and how fast to proceed with your advocacy strategy. Public sector employees CAN STILL ADVOCATE but may perhaps need to re-conceptualize what advocacy is. Nonprofit organizations are legally allowed to engage in all levels of advocacy.

55 Steps for Effective Advocacy FOCUS FOCUS FOCUS Have Good Numbers and Use Them Well Find your Unusual Suspects Maximize the Political Process to your Benefit Follow-Up AFTER your work Gathering Votes is Done

56 Immunization and the 2013 Texas Legislature Language matters. Be mindful of how we talk about immunization and the implementation of legislation related to increasing immunization rates and access. Meningitis vaccination mandate will likely be reviewed and modifications are possible. Ongoing Medicaid funding crisis will continue to put budget pressures on state support for vaccine purchasing, state administrative support, and other critical immunization supports More important than ever to reflect IMMEDIATE savings generated by immunizations 6/28/

57 For More Information Jason Sabo Frontera on Twitter (Mobile and Text)

58 Next Steps TIP Summer Webinar Series June 12 from 11am-12:30pm CT Vaccine Safety Concerns and How to Respond to Vaccine Hesitant Parents July 19 from 11am-12:30pm CT Tools for Effectively Engaging Members and Stakeholders Update to publication: An Ounce of Prevention: Texans Speak Up for Immunization

59 Next Steps 4 th Texas Immunization Summit September 27-28, 2012 The Westin Galleria Hotel, Houston, TX Registration is open! TIP Legislative Day at the Capitol (TBD) Be ready to write letters, make phone calls, testify and tell your story!

60 Please complete your evaluation! Anna C. Dragsbaek, JD President and CEO Nidhi M. Nakra, MPH Director of Education and Advocacy Linnea Nasman Public Health Advocacy Intern