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Immunization congress proposes solutions to vaccine financing
Representatives from all sides convened to discuss possible solutions to current childhood vaccination issues.
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Health care leaders presented three chief solutions to the United States’ growing vaccine financing and delivery system problems at the American Academy of Pediatrics/American Medical Association Immunization Congress in Chicago.
The congress included representatives from private providers; medical and public health societies; federal, state and local government; medical insurance companies; employers and drug manufacturers. Despite their differences, participants all shared a similar interest, according to Walter Orenstein, MD.
“The congress brought together people from varied backgrounds, but with a key interest in assuring protection for children against vaccine-preventable diseases,” Orenstein, associate director of the Emory Vaccine Center in Atlanta and Infectious Diseases in Children Editorial Board member, said in an interview.
The AAP/AMA Immunization Congress came on the heels of the round table convened by Infectious Diseases in Children at the 2006 AAP National Conference and Exhibition held in Atlanta, during which Orenstein and other panel members discussed the importance of setting standards for reimbursement and the difficulties presented by an ever-changing vaccine schedule.
A time of crisis
Reform to the current state of vaccine financing and delivery is necessary, despite the fact that the crisis is not readily visible, according to Orenstein. Morbidity that could eventually be prevented by new vaccines has not yet become an intolerable problem, and although there has not been a resurgence of vaccine-preventable diseases due to a failure to vaccinate, a threat still remains.
“We have many new vaccines added to the schedule, and we don’t have a financing system to cover those vaccines,” Orenstein said. “The crisis threatens to greatly reduce, or even eliminate, the private provider role in delivery and fragment medical homes.”
The growing number of new vaccine recommendations also increases the stress placed on the public sector, according to Orenstein.
Participant consensus
Congress participants agreed upon a number of points they felt needed to be addressed.
The consensus included the belief that support is needed for universal access to all Advisory Committee on Immunization Practices-recommended vaccines without any financial barriers. However, although solving these financial barriers is necessary, it is not sufficient to ensure high immunization coverage.
It was also agreed that a vaccine delivery collaboration between the private and public sectors should be maintained.
“We have an army of private providers that has enlisted in a public health goal: the fight against vaccine-preventable disease,” Orenstein said. “This has been a major strength to the program, and we are in danger of it eroding, so the big goal is to try to solve that.”
To do this, the private sector should be offered financial incentives, according to Orenstein. He said that the best way to ensure continued participation from the private sector is by covering their costs with reasonable returns on investments.
Other points within the basic consensus included the fact that the overall list of problems is long and that solutions need to solve problems in every state, not just a few of them; otherwise, the states with low vaccination coverage rates may spread these preventable infectious diseases throughout the rest of the country.
Emphasis was also placed on finding non-legislative solutions instead of those that would require legislation. According to Orenstein, although legislation may eventually be necessary, solutions that do not require legislation may lead to relief more rapidly.
In addition to the joint congress with the AMA, the AAP’s Task Force on Immunization also published a discussion paper entitled, “Immunization Financing: Where is the Breaking Point?” to further emphasize the need for vaccine reform.
According to the task force, vaccines save the United States about $10 billion in direct costs and $43 billion in societal costs each year. In fact, for every birth cohort of immunized children, 14 million cases of vaccine-preventable diseases are prevented, and 33,000 vaccine-preventable, disease-related deaths are avoided.
The number of vaccines recommended for children has doubled during the past 15 years, which in turn has increased the pressure put on primary care practices to provide these additional vaccines and vaccine doses, according to the task force.
“A number of factors make it increasingly difficult for providers to continue participating in the current immunization program,” the task force wrote. These factors include:
- Inadequate reimbursement to cover vaccine-related costs (acquisition, overhead and administration).
- An increasing number of new and expensive vaccines.
- A significant lag time from when a new vaccine is recommended and when health insurance plans will pay for the vaccine.
Combination vaccines are also adding to the strain on the system.
“Immunization combinations that previously required several injections are now available in a single vial,” the task force wrote. However, they said, CPT codes currently lack the variation needed to accommodate these multiple-antigen combination vaccines; as a result, immunization providers may avoid giving these vaccines.
The task force wrote that although the process of administering a vaccine may seem simple, there are many other factors involved. Overhead costs are a heavy burden placed on the health care providers, as well.
Solutions to the problem
Congress participants came to the conclusion that three major steps need to be taken:
- Fix vaccine administration fees; this includes collecting data on the costs of delivering vaccines in private practices, getting support on methodology from the Centers for Medicare and Medicaid Services and using the data to educate insurers and Medicaid on appropriate reimbursement.
- Work with vaccine manufacturers to obtain more favorable terms for the initial inventories of new vaccines.
- Work with federally qualified health centers to delegate authority to serve underinsured children through the Vaccines for Children Fund at public health department clinics.
The participants also came up with nine specific recommendations meant to support and further explain the initial solutions. One recommendation was that the data obtained regarding vaccine costs also be used by the AAP and AAFP to advocate for contracts that allow for increases in vaccine reimbursements if prices increase during the course of the contract.
Other recommendations include: a collaboration between the AAP, AAFP and the AMA’s Relative Value Scale Update Committee to better define all components that CPT codes comprise, including overhead costs and insurance; having the National Vaccine Advisory Committee working group on financing examine the potential role of tax credits for insurers/employers in eliminating underinsurance and convening a group of key stakeholders to determine whether a form of universal federal vaccine purchase/funding should be pursued.
Overall success
Although the congress was helpful in getting representatives from all sides to coalesce around certain themes, the success of their efforts will only be known in retrospect, according to Orenstein.
“These are the key stakeholders, and I think we’ve heard each other’s messages,” Orenstein said. “The real goal is to work together. A number of [previous] solutions have pitted one stakeholder against another, and I think the solutions we need to find are solutions that all of the stakeholders can support.” – by Cara Dickinson
For more information:
- Orenstein WA. Pediatric immunization financing: summary of session 1. Presented at: American Academy of Pediatrics/American Medical Association Immunization Congress; Feb. 28-March 1, 2007; Chicago.
- Task Force on Immunization. Discussion paper – immunization financing: where is the breaking point? Drafted post-immunization congress; Feb. 28, 2007.