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2. Connecting the Connectors: Bringing Together Business Coalitions, Employers, Health Plans, Pediatricians and Public Health Pam Beal Southern Nevada Immunization Coalition (SNIC)

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4. Southern Nevada Immunization Coalition (SNIC) Diverse partnership of: individuals, businesses organizations SNIC, NIC 2009

5. U.S. Average and Nevada Vaccination Coverage Levels Among Children 19-35 Months of Age: NIS – 2006/07 Vaccine or Series U.S. AverageNevada 4 DTaP8572 (-13) 3 IPV9384 (-9) 1 MMR9286 (-6) 3 Hib9385 (-8) 3 Hepatitis B9083 (-7) 1 Varicella8982 (-7) 3 PCV78978 (-11) 4 PCV77462 (-12) 4:3:1:3:3:17861 (-17)

6. Background & History Since 1994 the Nevada State Immunization Program has provided vaccines for children regardless of insurance status. The following vaccines were provided universally to all children: ► DTap ► HIB ► Td ►e-IPV ►Tdap ►HepB ► MMR SNIC, NIC 2009

7. Challenges Increasing cost of vaccines Growing population Increasing uninsured and underinsured Low reimbursement rates Adjusting to changes in NV’s policy Insurance companies Pediatricians SNIC, NIC 2009

8. The Change: Effective January 1, 2009 The Nevada State Immunization program would no longer provide all of the recommended vaccines for all children in the state. The Nevada State Immunization Program would continue to provide vaccines for all of the children who are eligible for the “Vaccines for Children (VFC)” program and the “Nevada Check Up” children. SNIC, NIC 2009

9. Health Insurance Coverage in the U.S., 2007 NOTE: Includes those over age 65. Medicaid/Other Public includes Medicaid, SCHIP, other state programs, and military-related coverage. Those enrolled in both Medicare and Medicaid (1.7% of total population) are shown as Medicare beneficiaries. SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March 2008 CPS Total = 298.2 million

10. Health Insurance Coverage in the NV., 2007 NOTE: SCHIP and individuals eligible for both Medicare and Medicaid (dual eligible's) are included in Medicaid. Other Public (Federal) includes individuals covered through the military or Veterans Administration in federally- funded programs such as TRICARE (formerly CHAMPUS) as well as some non-elderly Medicare enrollees SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March 2008 CPS Total = 2.5 million

11. SNIC: Catalyst and Convener SNIC, NIC 2009 Insurers Local Health Departments Nevada Immunizatio n Program Employers Providers AAP NV Chapter Business Health Coalition s Vaccine Manufacturer s SNIC

12. Steps to Success Identify all the relevant stakeholders Increase communications Facilitate collaborations Educate stakeholders Collect and share data

13. Identify all the relevant stakeholders Public Private Pediatricians Employers Businesses Health Plans Business Coalitions

14. SNIC, NIC 2009 National Business Coalition on Health (NBCH) Membership Organizations of employer-Based Health Coalitions Vision - Health system reform, through value based purchasing, community by community Mission - To advance value-based purchasing of health care services. Website: www.nbch.org

15. SNIC, NIC 2009 Nevada’s Business Coalitions on Health Health Services Coalition, Las Vegas  comprised of 23 organizations  provide health benefits for approximately 350,000 lives in Southern Nevada  Members – union trust funds (building trades, firefighters, teamsters, hospitality workers) and large self-insured employers (MGM-Mirage, Harrah’s) Nevada Health Care Coalition, Reno  comprised of 21 organizations  provide health benefits for approximately 43,000 lives in Northern Nevada  Members – union trust funds (building trades, firefighters, hospitality workers fund ) and large self- insured employers

16. Increase communications Used National Infant Immunization Week (NIIW) to bring stakeholders together Coordinated meeting between groups Invited NSHD to attend meeting with employer group Invited pediatricians to meeting with health plans

17. Facilitate Collaborations Active involvement with AAP NV Chapter Member on organizing committee for Immunization Congress Assisted with reviewing presentations Created personal contacts Connected with national groups National AAP ECBT CDC

18. Educate Stakeholders Educational Materials Payer 101 Coding Educational Meetings Immunization Congress 1: 1 meetings

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22. Collect and Share Data Business Coalitions on Health Immunization Surveys Pediatricians and Family Physicians Immunization Survey GIS Mapping of Nevada’s Immunization Providers

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26. Success: Southern Nevada Immunization Coalition Increase membership and involvement Increase access to potential funding Obtain results of Immunization Surveys Provide access to Business Health Coalitions’ members as technical speakers

27. Success: Private Providers Understand health plans in Nevada, particularly Self-Insured Plans Present formally and informally to employers and Business Health Coalitions Understand who is actually paying claims on immunizations Understand contract negotiations and re- negotiations SNIC, NIC 2009

28. Success: Nevada Health Division & Immunization Program Obtain buy-in from key stakeholders Provide technical assistance and formal presentations Increase opportunities for collaboration and partnerships Increase communication with key stakeholders Understand employer issues SNIC, NIC 2009

29. Success: Business Health Coalitions, Health Plans and Employers Invest more in prevention Understand costs associated with purchasing and administering vaccines Examine ACIP recommended immunization coverage for infants, children, adolescents and adults Formed an immunization sub-committee SNIC, NIC 2009

30. Results / Lessons Learned Immunizations programs should reach out to the business community Employers are willing to come to the table for the promotion of immunizations Physicians need to understand health plans within their state Be proactive in reaching all stakeholders: public and private

31. SNIC, NIC 2009 Next Steps Nevada Immunization Forum! April 15, 2009 Purpose – To bring together key immunization stakeholders across Nevada to discuss the impact of recent changes to the funding of Nevada's Immunization Program and how to improve the state’s immunization Key stakeholders must continue to communicate and educate each other

32. SNIC, NIC 2009 American Academy of Pediatricians Nevada Chapter Health Services Coalition, Las Vegas Achal Bhatt, Immunization Services Division, CDC Nevada Health Care Coalition (NHCC) Health Strategies, Inc Nevada Immunization Program Employee Benefit Research Institute Acknowledgments Contact: Pam J Beal pbeal@healthinsight.org (702) 933-7329

33. SNIC, NIC 2008 Today 40,000 babies will be born in Nevada 17 diseases are now vaccine-preventable

34. SNIC, NIC 2009 Questions?