Implementation of an Elementary Schoollocated Influenza Vaccination Program

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Implementation of an Elementary School-located Influenza Vaccination Program with Billing of Third-Party Payers 44

Implementation of an Elementary School-located Influenza Vaccination Program with Billing of Third-Party Payers 44 th National Immunization Conference April 19 th, 2010 J. Shlay, C. Busch, A. Hammer, M. Riis, J. Lyons, S. Romero, J. Pyrzanowski, M. Daley, S. Hambidge, D. Rinehart, E. Mc. Cormick, S. Rodgers, T. Vogt, H. Fang, A. Kempe

Background • Delivering annual influenza vaccination services to all children presents challenges – Most

Background • Delivering annual influenza vaccination services to all children presents challenges – Most influenza vaccination for children occurs in public health or private settings – Traditional settings unlikely able to meet demand • Schools recognized as potential sites to deliver influenza vaccines to school-age children – Offer platform to vaccinate large numbers of children efficiently – Provide vaccinations to children who are not seen for regular medical care – However, school-located programs have not traditionally billed insurance companies limiting programmatic sustainability

Objectives of Project • • • To implement a school-located influenza vaccination program in

Objectives of Project • • • To implement a school-located influenza vaccination program in selected elementary schools of Denver Public Schools (DPS) To develop a process for billing 3 rd party payers To evaluate the acceptability of this program To evaluate the feasibility of conducting this program To evaluate the costs of conducting this program To determine vaccine uptake and barriers to participation

Community Collaboration is Critical Denver Public Schools * Health Services * Do. Ts SUCCESSFUL

Community Collaboration is Critical Denver Public Schools * Health Services * Do. Ts SUCCESSFUL PROJECT! Kaiser Permanente Denver Health *Community Health * Denver Public Health * Health Services Research * Billing and Contracts * Data Warehouse Initiatives University of Colorado *Colorado Children’s Outcomes Research School of Public Health

Project Description • Setting: Subset of elementary schools affiliated with DPS • Services provided

Project Description • Setting: Subset of elementary schools affiliated with DPS • Services provided at 20 schools during 20092010 school year – Two clinics per school conducted – Offered seasonal (intranasal and injectable) and H 1 N 1 (injectable)(2 nd clinic only) influenza vaccinations – Second dose offered to children <9 years of age • Insurance information collected with the consent • Commercial and government insurances were billed

School Locations

School Locations

Project Start-Up Description • Start Up: • Project team developed processes needed to establish,

Project Start-Up Description • Start Up: • Project team developed processes needed to establish, implement, and evaluate the program • Implementation team established • Paraprofessionals hired and trained by project staff • Contracts negotiated with stakeholders and 3 rd party payers • Consents, protocols, billing sheets developed • Marketing tools developed including website and project logos • Pilot clinic conducted to assess processes • Implementation plan finalized

Process for Parental Consents distributed to school by Project Staff Immunization histories* entered into

Process for Parental Consents distributed to school by Project Staff Immunization histories* entered into registry & vaccine eligibility determined Consent, health info, and history reviewed for each student Teacher/office sends consents home with students Immunization history reviewed for every consent received Eligibility verified & marked on administration form Consents returned to school and checked for completeness Routing form completed for every consent received Entire packet reviewed by nurse prior to administering vaccine * Systems used for tracking immunization history include Vax. Trax (Denver Health’s immunization registry system – exports directly into CIIS (Colorado Immunization Information System state registry)

Project Description Pre-Clinic v. Consents distributed v. Vaccine records obtained and updated v. Insurance

Project Description Pre-Clinic v. Consents distributed v. Vaccine records obtained and updated v. Insurance verified v. Processes for clinic initiated v. Staff oriented v. Supplies including vaccines secured Clinic Post Clinic v. Consents reviewed for completeness v. Identity verified v. Vaccines provided to consented patients v. Evaluation information collected v. VIS sheets provided to students/parents v. Administered vaccines entered into registry v. Students registered into hospital system v. Rendered services billed v. Evaluation information entered v. Updated vaccine history provided to schools v. Student records maintained for future clinics

Results: Summary Statistics • Eligible for program: 9856 students – Student population demographics at

Results: Summary Statistics • Eligible for program: 9856 students – Student population demographics at baseline: • Median age of students: 7. 6 years • Male – 51% • %FRL – 77% • Race: African-American 10. 0%, Hispanic 64. 0%, White 22. 4%, Asian/Pacific Islander 2. 3% • 40 clinics conducted between 11/09 – 3/10 • Students immunized: 3181(32. 3%) • Vaccines given: 4163 – Seasonal flu vaccines: 2530 • 1 st clinic: 1997 • 2 nd clinic: 533 – H 1 N 1 flu vaccine given 2 nd clinic: 1633 • 53. 7% received both H 1 N 1 and seasonal flu vaccine

H 1 N 1 – Impact • H 1 N 1 vaccine (injectable only)

H 1 N 1 – Impact • H 1 N 1 vaccine (injectable only) offered only at 2 nd influenza clinics – H 1 N 1 vaccine not available till after 1 st clinics completed – Separate H 1 N 1 consent developed – Resulted in much larger participation in 2 nd clinics than had been anticipated • Of 1633 H 1 N 1 vaccines given, 756 students (46. 3%) consented and vaccinated for H 1 N 1 only (no seasonal flu participation)

Billing Information Upon completion of clinic, students were registered in hospital system, assigned a

Billing Information Upon completion of clinic, students were registered in hospital system, assigned a medical record number, and billed for services • SIGNATURE® program used for billing • Two billing codes used: one for the vaccine (seasonal only) and one for the administration ($12 charge) • 17 third party payers currently identified that are being billed •

Type of Insurance among Subset* of Students Immunized and Billed for Services Type of

Type of Insurance among Subset* of Students Immunized and Billed for Services Type of insurance Commercial Government Uninsured Percent of students 25. 8% 39. 7% 34. 5% * N=1906 (91%) of 1 st clinic students vaccinated

Lessons Learned • Engaging partners early in the process is critical • Important to

Lessons Learned • Engaging partners early in the process is critical • Important to choose schools that are invested in program • Detailed training of staff is important • Development of billing process is time consuming

Conclusions • Developing strong collaborative partnerships with schools leads to successful implementation of schoollocated

Conclusions • Developing strong collaborative partnerships with schools leads to successful implementation of schoollocated vaccination clinics • Providing influenza vaccinations in schoollocated clinics is feasible • Schools offer a suitable location to provide influenza vaccinations

Plans for the Future • Conduct a third year of influenza clinics in the

Plans for the Future • Conduct a third year of influenza clinics in the target schools without needing to provide H 1 N 1 vaccine mid-program • Conduct a cost-benefit analysis • Conduct focus groups • Conduct parent and provider survey to assess acceptance of program

Funding This project was funded by a grant from the Centers for Disease Control

Funding This project was funded by a grant from the Centers for Disease Control and Prevention (PI – Dr. Judith Shlay) entitled: Implementation of an Elementary School Located Influenza Vaccination Program with Billing of Third Party Payers.

Questions? Additional information: Judith Shlay, MD, MSPH jshlay@dhha. org 303 -602 -3714

Questions? Additional information: Judith Shlay, MD, MSPH jshlay@dhha. org 303 -602 -3714