1. Strengthening the Delivery of New Vaccines for Adolescents A National Stakeholders' Meeting Washington DC June 2-3, 2005

2. History Oct 2004 –Meeting “conceived” at NVAC meeting Oct 2004 – Feb 2005 –Organizing committee formed –Background topics developed and working groups formed and asked to write draft papers Mar 2005 – June 2005 –New members in organizing committee –Overarching questions added –Facilitators added

3. Goals of the Meeting Identify approaches to effectively and efficiently increase the proportion of adolescents who receive newly recommended vaccines Identify ways to integrate approaches with other adolescent health, education, and development programs

4. Organizations represented Academy for Educational Development Agency for Healthcare Research and Quality Ambulatory Pediatric Association American Academy of Family Physicians American Academy of Pediatrics American Academy of Physician Assistants American College of Obstetricians and Gynecologists American Medical Association American Nurses Association American Pharmacists' Association American Public Health Association American School Health Association Association of Immunization Managers Association of State and Territorial Health Officers

5. Structure of the Meeting Background topics –Selected by NVAC before meeting The medical home alternative settings (schools, high risk youth, others) Legislation prevention priorities economic issues (cost-effectiveness and financing) communication strategies –Reviewed current and historical information on major policies options –Summarized in presentations during plenary –Discussed during breakouts

6. Structure of the Meeting Overarching questions –Drawing on background material, suggest possible directions for NVAC on: Goals and evaluation Delivery Financing Increasing demand

7. Goals and evaluation Questions –What should be the goals of a program to deliver adolescent immunizations? –How will we evaluate the program?

8. Goals and evaluation (cont) Goal 1: Disease reduction –Reduce/eliminate the morbidity and mortality due to vaccine preventable diseases among all adolescents –Evaluation: National and sentinel surveillance systems Goal 2: Vaccine coverage –Goal: Maximize vaccination coverage with universal access (no disparities in subpopulations) –Evaluation: School requirements, insurance benefits, and coverage levels Goal 3: Comprehensive, integrated adolescent health care –Goal: Use adolescent immunization to enhance the delivery of comprehensive/integrated health care and health promotion –Evaluation: Adolescents who receive vaccination in conjunction with comprehensive adolescent health care

9. Delivery Question: –Which approaches will most effectively and efficiently increase the proportion of adolescents who receive newly recommended vaccines?

10. Delivery (cont) Oversight and needs assessment by local public health authorities What will be the dominant venue for adolescent immunization? –Approaches in primary care (medical home) Optimize delivery in this setting (~50% of kids) Systematic approaches Vaccination can be a hook to other preventive services –Approaches in supplemental settings Based on community needs assessment & resource mapping, bring vaccines to the kids Schools –Build on and strengthen existing school health programs and curricula –Hold clinics during school day –Use of registries is essential

11. Delivery (cont) Approaches in supplemental settings (cont) –Pharmacies –Hard-to-reach populations Conduct special planning Integrate into existing programs/services

12. Financing How will the public and private sectors pay for vaccination? Key assumptions: –Will need to be applied across a variety of delivery settings –Private & public sources will likely need to be blended –Needs may differ by vaccine because delivery, coverage, public demand, and key stakeholders will differ by vaccine

13. Financing Stakeholders Insurers/Employers Government Industry Partnerships Patients/Parents Providers/Provider Associations Non-governmental organizations

14. Insurers/Employers Vaccines –Respond to employee demand –Change business practices regarding vaccines (eg, replacement system) Delivery –Finance delivery in supplemental settings in collaboration with providers

15. Government Vaccines –Create incentives for public, providers, employers/insurers –Consider enhancement of existing incentives (eg, VFC reimbursement as pay-for-performance) –New rules for excise taxes, –Matching state:federal funds for vaccine purchase –Override ERISA –Increase funding in 317/VFC Delivery –Enhance operational funding for 317/VFC –Support research re: cost- effectiveness of delivery in supplemental settings

16. Industry Vaccines –Fund educational campaigns to stimulate demand –Consider price breaks for non-federal purchasers (eg, large employers, schools, counties) Delivery –Fund educational campaigns to stimulate demand

17. Partnerships Led by Government Vaccines –Initiate education to prompt demand and additional funding for purchase –Promote adoption of model legislation regarding mandated vaccine benefits Delivery –Work with employers/insurers to “set aside” part of capitation for adolescent vax in supplemental settings –Work with state legislators to increase delivery financing

18. Increasing Demand for Adolescent Immunization

19. Demand Question: How Can We Enhance The Demand/Acceptance For Vaccines Among Adolescents, Parents, And Providers?

20. Demand Focus on 4 groups of vaccines –Catch up –High risk –Newly licensed; newly recommended –STI

21. Demand (cont) –Some strategies are good for all vaccines while others are targeted to individual vaccines –More research is needed about effective messages –Need to coordinate messages with manufacturers

22. Selected questions to be considered by NVAC Medical home –Can we define specifics steps to further optimize delivery? Alternative (supplemental) settings –Are there any “best bets” for new vaccination partnerships among the alternative health care settings regularly used by adolescents? –Should vaccination begin in selected schools (e.g. school based health centers)? –Should schools be appraised as stand-alone immunization opportunities? –Should we begin special efforts to reach youth who fall through the safety nets? Legislation –Should we take a position on laws and consent?

23. Important questions to be considered in “next steps” Economics –Should obvious differences in cost-effectiveness enter into policy? Prevention priorities –Can/Should we demonstrate that vaccination visits are an important opportunity to provide other preventive services? Communication –Can we define an optimal strategies, especially when manufacturers are likely to take the lead?

24. Important questions to be considered in “next steps” Goals –Can we define a common goal? Delivery –Should we begin to vaccinate in one or more types alternative settings? Finance –What are novel financing mechanisms in public/private sectors –Can we define a direction to focus our attention amidst the sea of barriers? Demand –Should we develop a communications blueprint?

25. Information Needed Explore current models of adolescent care delivery (US and abroad) Model different financing options (public and private) Acceptability of delivery options to different populations/stakeholders

26. Next Steps How to acquire needed information How to move the debate forward How to develop an action plan Convene cross-subcommittee working group?