# Presentation: 139337

## Every Child By TwoThe Carter/Bumpers Campaign for Early Immunization

- Amy Pisani, Executive Director
- amyp@ecbt.org
- _[www.ecbt.org](http://www.ecbt.org/)_
- NVAC Vaccine Financing Forum
- June 28 – 29, 2004

## ECBT’s Evolving Focus

- Early 1990’s – increased public awareness of need for immunizations.  Encouraged development of coalitions in every state
- Mid 1990’s – focused on improving/increasing provider education and delivery mechanisms
- Late 1990’s – advocated for changes in policy to assure sustained high rates & traveled to states to increase media coverage
- Current – advocate for state and federal pro-immunization laws and policies, better collaboration among orgs/advocates, encouraging media to focus on  safety/importance of vaccines

## 	Rec. 1: New Insurance Mandate

- Insurance Mandate
- ECBT supports bills requiring all private insurance plans to offer first-dollar coverage of immunizations
- Non-ERISA huge hurdle (unlikely to be universal state changes to law)
- Bingaman & Smith’s Children’s Vaccine Access Act (S.2272)  to make the proposed VFC legislative change allowing underinsured children to receive VFC vaccine at any public health clinic (not just FQHCs)
- Still unresolved – SCHIP stand-alones ability to use VFC vaccine (Feinstein bill)

## Rec. 1: Voucher Plan

- Voucher plan/universal federal purchase
- Could result in burdensome bureaucracy – further complicating delivery system
- Is a need to increase stability of manufacturers
- ECBT supports Frist’s bill to improve Vaccine Injury Compensation Program to alleviate manufacturer liability concerns and lift price caps on vaccines

## Rec. 2 – Changes in ACIP membership to include consideration of vaccine costs/funding

- ACIP Charter  - ACIP shall provide advice and guidance to the Secretary, the Assistant Secretary for Health, HHS; and the Director, CDC, regarding the most appropriate application of antigens and related agents for effective communicable disease control in the civilian population...
- Charter does not include that the ACIP shall take into consideration economic implications  & such change in charter could be detrimental to public health overall.

## Calling the Shots 

- Immunization financing was explicitly structured to be a federal-state partnership
- Federal policy makers never expected federal funds to be sufficient to cover the full cost of vaccine purchase and delivery for disadvantaged groups.
- Federal funds are provided to supplement, not supplant, state investments in immunization programs

## Calling the Shots – Issues to Consider

- Issues to Consider
- Federalizing the immunization financing system may result in less value of vaccines – people find little value in things that are free
- -State support critical to immunization delivery (difficult to drum up support that is not in some way attached to budgets)
- -Are there areas within the delivery system that can better function – saving money/resources for other purposes?

## Considerations

- What makes childhood vaccination programs so successful? How can we replicate in adolescent and adult program?
- Financing is not the only answer?
- Even with VFC, barriers still exist – rates are not at 100% (language, culture, mobile populations, schedule confusion, fears).
- Was it the school laws? If so, how can we enforce adolescent?  Are nursing home requirements enough?
- State support equally critical (political champions)

## Alternative Cost-Saving OptionsHow can we make more efficient use of funds?

- Immunization Information Systems (Registries)
- 21% of 19-35 month old children are over-immunized –cost of $15 million (without administration costs) NIS survey 1998
- 22% of American children see two imm. providers in first two years of life, 3% see three or more providers.  Each change in providers requires manual record pull and review – cost $16 million
- Annual savings estimated –
- 250 million for health care
- 137 million for schools
- Registries do the marketing for vaccines, can result in better accountability of vaccine funds, pinpoint outreach dollars, conduct reports facilitating provider education

## Children < 6 years with 2+ Immunizations in a Registry, 2002

**Children < 6 years with 2+ Immunizations ****in a Registry, 2002**

***National coverage = 43%***

- 0-33%
- 34-66%
- 67-94%
-  95-100%

- VT    0
- NH   3
- MA   6
- RI   79
- CT  61
- NJ  15
- DE   81
- MD  10
- DC   88

- 98

- 0

- 19

- 50

- 45

- 55

- 99

- 45

- 13

- 47

- 100

- 95

- 65

- 94

- 59

- 43

- 54

- 15

- 6

- 27

- 5

- 80

- 36

- 45

- 65

- 91

- 78

- 51

- 94

- 43

- 78

- 18

- 77

- 28

- 79

- 61

- 27

- 63

- 16

- 53

- 41

- 0

- Source:  Immunization Registry Annual Report, CY2002

**Notes:**
The next few maps that I’m going to show were created by the CDC. 

we are slowly moving forward in meeting this Healthy People 2010 objective. In 2002, 43% of children under 6 years of age have two or more of their immunizations contained in a registry. 

## Public Provider Participation in Registries, 2002

**Public Provider Participation ****in Registries, 2002**

***National average = 75%***

- 0-33%
- 34-66%
- 67-100%

- VT    0
- NH   2
- MA   4
- RI   100
- CT  100
- NJ   58
- DE   58
- MD   2
- DC   68

- 55

- 0

- 51

- 20

- 100

- 100

- 100

- 100

- 100

- 100

- 100

- 100

- 72

- 90

- 70

- 29

- 98

- 0

- 100

- 100

- 0

- 97

- 75

- 100

-  98

- 100

- 100

- 100

- 100

- 59

-  100

-  48

-  47

- 100

- 100

- 27

- 100

-  100

- 41

- 87

- 32

- 0

- Source:  Immunization Registry Annual Report, CY2002
- *: % of provider sites reporting to the registry within the last six months of
- 2002

**Notes:**
This next CDC map illustrates that in 2002 we were doing quite well with the number of public providers involved with registries. The national average was 75%.

## Private Provider Participation in Registries, 2002

**Private Provider Participation ****in Registries, 2002**

***National average = 31%***

- 0-33%
- 34-66%
- 67-100%

- VT    0
- NH   3
- MA   <1
- RI   38
- CT  100
- NJ   2
- DE   43
- MD   9
- DC   77

- 53

- 0

- 11

- 12

- 68

- 0

- 100

- 10

- 33

- 17

- 100

- 93

- 14

- 83

- 50

- 0

- 33

- 0

- 0

- 0

- 0

- 27

- 34

- 10

-  9

- 100

- 49

- 4

- 59

- <1

-  1

-  5

-  0

- <1

- 50

- 0

- 0

-  2

- 17

- 40

- 16

- 0

- Source:  Immunization Registry Annual Report, CY2002
- *: % of provider sites reporting to the registry within the last six months of 2002

**Notes:**
However, it is a different story when it comes to private sector. In 2002, there were only an average of 31% of PRIVATE providers participating in registries. Consequently, on a national level, the CDC, Every Child By Two and other national organizations have been looking for ways to inform providers and health plans about these very valuable tools. 

## What Have You Done To Support Registries Lately?

**Notes:**

We are currently working with the state and local chapters of the Academy of Pediatrics (AAP) in order to promote registries and the CD-ROM to their members.

Professional Association of Health Care Office Managers included a one-page article in an newsletter alerting members about an impending mailing of the CD-ROM and they will provide us with a list of over 3,000 of their members for this mailing. We are also hoping to collaborate with the American Academy of Family Physicians (AAFP) in the near future.

ECBT is working to promote the CD-ROM through health plans as well. 

## Other Cost-Saving Options

- CDC/NIP Vaccine Business Improvement Plan (VFC)
- Despite areas of needed improvement the VFC program very successful
- Several areas of improvement identified
- Distribution
- Inventory Management
- Provider Ordering/Approval
- Funds Management/Administration
- Stockpile Management
- Consolidation and centralization could save from $11 – 20 MM in distribution & ordering costs – overall savings could be $25 – 47 MM to be redeployed to other priorities

## Thank You