1. Enhancing Immunization Services Yavapai County Community Health Services December 2007

3. Yavapai County Community Health Services (YCCHS) Community Health Center Public Health Department

4. Immunization Data Jan-Nov 2007 Total vaccines given = 13,666 Given to under 18 year olds = 9,809 Given to adults = 3,857 Number of vaccines available = 29 Add Influenza – OVER 20,000/shots/year

5. The Problem Travel Immunization Clinic Currently administered by the Community Health Center A non-traditional (CHC) service – a logical experiment gone wrong Only provider in Yavapai County A money loser – due to health insurance contracts with fixed ceilings for reimbursement County indirectly subsidizes travelers

6. The Solution Public Health Department Cash up front for travel immunizations Patients deal directly with insurance companies so no billing woes for department Patients are supplied with detailed insurance- ready receipts The Health Department is paid in full up front Patients don’t need to travel to Phoenix The program is self-sufficient

7. The Variables The (mostly) unknowns Patients’ reactions to having to deal directly with insurance companies Market variables Supply and demand Outbreaks/Panics Price swings New vaccines Pharmaceutical industry/Patents Associated effects on revenue projections

8. Zostarvax (Shingles)

9. Recommendations Transfer all non-CHC immunization functions from the Community Health Center to Public Health Create a stand-alone, cash-only, travel clinic Round up all vaccine costs to the nearest dollar Adopt the following fee schedule: Vaccine cost = purchase price plus $10.00 Administration fee = $20.00/shot Consultation Fee = $40.00/planning visit Effective February 1, 2008

10. Pros Prices are set at a reasonable market rate Price changes – up or down – are automatic without constant approvals by the Board of Supervisors Travel immunizations will be self-sufficient Fewer transactions with insurance companies Clinic patients will still be covered for immunizations Full indirect costs collected Continued service and convenience to the community Very comparably priced

11. Cons Numerous variables Projection assumptions may be flawed Paying up front for services may not be agreeable to all

12. Endorsements Health Resources And Services Administration Prescott Free Clinic Board of Directors YCCHS Administration Yavapai Board of Health

13. Recommendations Transfer all non-CHC immunization functions from the Community Health Center to Public Health Create a stand-alone, cash-only, travel clinic Round up all vaccine costs to the nearest dollar Adopt the following fee schedule: Vaccine cost = purchase price plus $10.00 Administration fee = $20.00 Consultation Fee = $40.00 Effective February 1, 2008