1. Utilizing a Public-Private Partnership to Sustain a School Located Vaccination Program

2. Introduction The Knox County Health Department (KCHD) has conducted school-located vaccination clinics since 2005 in Knox County public and private schools. Due to costs, required resources, and the desire to maintain high vaccination rates, various methodologies have been explored to maintain the scope and breadth of the KCHD program. In 2010, KCHD entered into a collaborative partnership with VaxCare, a private vaccine immunization provider. The purpose of this coordinated effort was to determine the feasibility of combining the distinct expertise of a private immunizing entity with the experience and relational capital of a public health provider. A public-private partnership was formed to conduct school-located vaccination clinics in a variety of academic locations. KCHD and VaxCare utilized a blended model of public-private best practices in order to accomplish patient consent acquisition, clinic and vaccination provision, as well as education for parents, teachers and community leaders alike.

3. Objectives Did the partnership save money? Was the partnership more efficient? Were vaccination rates comparable? Is this the future? 3

4. Did the Partnership Save Money? 2005-2009 KCHD: FluMist: $16.50 / vaccine TIV: $12 / vaccine 2010 Partnership Vaccine Cost: FluMist: $15 / vaccine TIV: $8 / vaccine Cost of Vaccine

5. Did the Partnership Save Money? 2005-2009 KCHD: Each administration: $11 2010 Partnership: Each administration: $7 Cost of Administration

6. Was the Partnership More Efficient? Program Comparison: Clinic Operations Total Clinic Hours Average Hours / Clinic 269 2 305 2 2005 - 2009 Knox County 2010 Partnership School

7. Was the Partnership More Efficient? Program Comparison: Vaccination Provision Vaccinations Given Avg. Vaccinations / Clinic 30,415 183 29,397 151 Avg. Vaccination Rate (FluMist) 40 Per nurse/hour 44 Per nurse/hour Avg. Vaccination Rate (FluMist + TIV) N/A 46 Per nurse/hour 2005 - 2009 Knox County 2010 Partnership School

8. Were Vaccination Rates Comparable? Program Comparison: Vaccination Rates by School Type 2005 - 2009 Knox County 2010 Partnership School Public Elementary Schools Public Middle Schools 59.45% 42.81% 52.74% 36.76% Public High Schools Private Schools (All Grades) 24.06% 55.66% N/A 47.11% Head Starts Day Cares 57.95% 37.07% 57.11% 47.37% Average % (w/ Public H.S.) Average % (w/o Public H.S.) 46.09% 53.96% N/A 47.86%

9. Were Vaccination Rates Comparable? Program Comparison: Vaccinations by School Type 2005 - 2009 Knox County 2010 Partnership School Public Elementary Schools Public Middle Schools 15,035 5,207 13,955 4,419 Public High Schools Private Schools (All Grades) 3,945 3,673 N/A 3,440 Head Starts Day Cares 453 385 542 1,127 First Dose Second Dose 28,697 1,718 23,483 5,914 TOTAL VACCINATIONS: 30,41529,397

10. Were Vaccination Rates Comparable? Program Comparison: Vaccination Rates by Socioeconomic Level

11. Is This the Future? Benefits: What did the parents think? Questions YesNo I do not have medical insurance Current funding for the School Influenza Vaccination Program is limited. In order to continue offering the School Influenza Vaccination Program in the schools, it may be necessary to charge for vaccination. Would you be willing to pay $20-$30 for your child to receive the vaccination? 34.4%65.5%N/A Would you be willing to have your medical insurance company billed to have your child(ren) given the influenza vaccine at school? 77.1%19.5%3.7% Respondents were public school parents. Method: email request with link to Survey Monkey. N = 1608

12. Is This the Future? Questions Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree N/A Rating Average Getting children vaccinated to prevent the flu is important every year. 566145219424.69 The School Influenza Vaccination Program clinic at my school had a minimal impact on my work activities. 415217343024204.35 I appreciate efforts to vaccinate the children in the schools. 602116154224.78 Benefits: What did the faculty think? 711 Respondents were public school faculty. Method: email request with link to Survey Monkey. N = 748 632 718

13. Is This the Future? Cost Reduction Vaccine and Administration Staffing Time Reduction Decreased Organizational Burden Benefits

14. Is This the Future? Billing Complete and accurate data State insurance platforms Safety Net Issues and Concerns

15. Is This the Future? Next Steps Legislation Pandemic prevention Creation of a new billing category/location Budget considerations

16. Is This the Future? Additional Vaccine Introduction Required school vaccinations Recommended “teenage” vaccinations Teacher/Employee immunizations Next Steps

17. Is This the Future? Inclusive vs. Exclusive Program Who do you vaccinate? Where do you vaccinate? Safety Net Next Steps

18. Is This the Future? Financing School Systems Federal Funds State Funds Public Health Initiatives Pilot Program Allowances Section 317 Next Steps

19. Summary Outcomes of a public-private partnership: The partnership saved money The partnership was efficient The rates were comparable A foundation was laid towards sustainability 19

20. Jennifer Johnson, RN Roberta Hern, MPH Alicia Mastronardi, MPH Acknowledgements Duane Donahoo Stephanie Ard Justin Johnson Knox County Public and Private Schools, Daycares, and Head Starts

21. John M. Lott, MS, RN Director, Clinical Services Knox County Health Department 140 Dameron Ave Knoxville, TN 37917 john.lott@knoxcounty.org www.knoxcounty.org/health Jeremy J. Corbett, MD National Medical Director VaxCare 989 Governors Lane Suite 160 Lexington, KY 40513 jcorbett@vaxcare.com www.vaxcare.com Presenters