Priorities for the National Vaccine Plan (2010) / Chapter Skim
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4 Vaccine Supply and Use
4 Vaccine Supply and Use
Pages 97-120
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From page 97... ...
why certain items were included in the plan and what remained on the "cutting room floor," (2) which items represent activities that are budgeted agency strategic priorities and expected to take place regardless of the National Vaccine Plan, and (3)
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Vaccination is a cost-effective, high-value component of preventive health care and is a good indicator of how well a health care delivery system functions. Under ideal circumstances, a health information system would indicate a patient's immunization status, remind a provider of needed vaccines for a given patient, record and facilitate the reporting of potential adverse events following immunization, help a provider obtain reimbursement for delivery of immunization services, allow public health officials and researchers to measure vaccine coverage, monitor rates of vaccine-preventable diseases, and facilitate studies of the relationship between vaccines and suspected adverse events.
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Another category of challenges relates to system performance in the delivery of immunization services. Health plans have had some success using pay-for-performance approaches to incentivize provider practices that led to increased immunization rates (AHIP, 2009)
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Gaps in local-level data are currently due to incompleteness of immunization registries and the expense of sample surveys; in the future widespread use of electronic health records and adequate national health information network infrastructure should facilitate monitoring coverage of immunization services. Exceptions that point the way forward may be found in the Veterans' Health Administration health information system and 1 A tool used by more than 90 percent of America's health plans to measure performance on important dimensions of care and service.
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From page 101... ...
In a public health emergency, such as a disease outbreak, the capabilities of public health agencies at all levels are tested, including all aspects of their ability to mount mass vaccination efforts, such as the availability of vaccine, distribution of vaccine, identification of unvaccinated individuals, administration to appropriate populations, and monitoring potential adverse events and the spread of disease. Not only are vaccine shortages a concern in a response to an outbreak, but a shortage may itself precipitate a potential public health crisis.
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From page 102... ...
. Note that one specific non-financial3 barrier, knowledge regarding the safety and effectiveness of vaccination, is discussed in Chapter 3. Sub-goal 4. evelop and adopt health information technology systems D that can advance clinical and public health immunization practice, measure clinical and system performance, advance knowledge about immunization status and system effec tiveness in achieving high immunization rates and reducing immunization disparities, and support research on alleged adverse events and the potential link to immunization (see discussion of vaccine safety in Chapter 2) . This sub-goal aims to assure better alignment between the National 3 Because "non-financial" may be used to describe a range of issues, thus overlapping with knowledge, communication, informed decision making, and with information system challenges, the committee has found it more useful to be specific about the two types of nonfinancial barriers that pertain to consumers and to providers, respectively.
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Strengthen the public health infrastructure to measure sys tem performance, support high quality clinical practice that maintains or improves rates of disease and vaccine cover age, facilitate study of alleged adverse events (discussed in Chapter 2) and intervene to address disparities in health and health care, as well as emerging naturally occurring and intentional public health threats.
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Furthermore, reimbursement of vaccine administration fees has remained extremely low and has not kept pace with the growing financial and administrative burden of practices that provide immunization services, such as the need for providers to carefully monitor vaccine inventories, ensure that vaccines are stored and transported at the correct temperature, purchase immunization supplies (e.g., syringes, needles, alcohol pads) , pay for insurance or maintain backup generators in case of power outages, ensure competent administration of vaccines by trained professionals, counsel patients about the risks and benefits of vaccination, and record information in medical records and in many cases with duplicate data entry of information for electronic immunization information systems.
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Rationale for Removing Financial Barriers Removing financial barriers to immunization could have a considerable impact on access to services, as shown by the 2008 update to the Guide to community preventive services, which found that reducing out-of-pocket costs for immunization services is an effective intervention in increasing access to immunization services (Briss et al., 2000) .5 Research also shows that children's health insurance coverage determines whether they are up-to-date on recommended vaccinations, but gaps in private insurance allow some children to fall through the cracks (Blewett et al., 2008; Santoli et al., 2004)
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The NVAC finance work group made final recommendations on vaccine purchase and administration reimbursement in the public and private sectors. Recommendations included expanding funding to the Section 317 and Vaccines for Children programs to cover vaccine administration and reimbursement; broadening access to VFC through public health clinics (access is currently allowed only at federally qualified health centers and rural health centers)
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Committee Recommendation for Financing Immunization The committee believes that Objective 4.2 in the National Vaccine Plan on reducing the financial barriers to immunization is insufficient. The target that is needed is elimination, not reduction of such barriers.
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. To realize the full potential of vaccines to prevent costly disease and disability, the committee recommends: Recommendation 4-2: The National Vaccine Plan should include the development of strategies to eliminate financial barriers such as unreasonable cost-sharing by patients who are unable to afford out-of-pocket costs for vaccines and provider payment mechanisms that discourage full and meaningful participation in the delivery of immunization services.
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From page 109... ...
The Infectious Diseases Society of America has recommended quality standards for complementary sites of immunization, including "ability to appropriately manage vaccine-related adverse events, proper storage and handling of vaccines, appropriate record keeping, regulatory issues, and provision of education regarding both risks and benefits of immunizations" (Pickering et al., 2009)
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. Recommendation 4-3: The National Vaccine Plan should emphasize the application of research and best practices in the organization and delivery of immunization services to improve patient access (such as location and hours)
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or registries that collect individual-level vaccination coverage data are operated by individual providers, health care organizations, public health agencies, and school systems. Immunization information systems are confidential, computerized systems operated at the state and local level that are intended to record every vaccination given to children; some have additional functions, such as vaccine inventory management and adverse events reporting (CDC, 2007a)
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From page 112... ...
Providers need to be able to obtain information on the vaccination status of their patients quickly and easily (to avoid missed opportunities or duplicate vaccination) both in their practice and remotely; it is also crucial that alternative immunization sites such as schools, workplaces, and pharmacies are able to document vaccinations received and share these data with public health agencies.
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From page 113... ...
Such systems could also be searched systematically for a putative adverse event related to immunization which could accelerate the detection and evaluation of a post-licensure safety problem. Interoperable electronic health records can build on these existing systems to increase the power of studies and evaluation of adverse events following immunization and facilitate research studies (e.g., linkage studies, control groups; see Chapter 2 for a detailed discussion)
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of 2009 are an extremely important new development, and their implications for immunization deserve careful consideration in the National Vaccine Plan. Recommendation 4-5: Given the importance placed on the national adoption of certified, interoperable health information technology and electronic health records, the National Vaccine Plan should ensure active involvement of NVPO and relevant partners in the planning and implementation of the national health information initiative.12 12 Currently called the National Health Information Network (NHIN)
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SUB-GOAL 5: PUBLIC HEALTH INFRASTRUCTURE Public health agencies at all levels play a central role in assuring the best use of vaccines to achieve prevention of infectious diseases. Strengthening and clarifying the draft plan's strategies for public health agencies would help to reflect the ideal of integrated measurement, monitoring, assurance, and standard setting of public health functions.
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At the practice level, measures of health care quality would ideally include the provision of immunization services to adults, adolescents, and children. Recommendation 4-7: The National Vaccine Plan should incorpo rate rapid and comprehensive assessment of the outcomes of na tional health reform and their implications for the nation's vaccine and immunization priorities.
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access to immunization services; (c) public health agency analytical, management, and other needed capabilities; and (d)
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2008. Electronic health records in ambulatory care -- a national survey of physicians.
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2008. Defining Key Health Information Technology Terms.
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2009. Immunization programs for infants, children, adolescents, and adults: Clinical practice guidelines by the Infectious Diseases Society of America.
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Key Terms
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