California Vaccines for Adults (VFA) Program Overview
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1 California Vaccines for Adults (VFA) Program Overview NAICP Quarterly Call April 3, 2018 California Department of Public Health 1
2 317-funded vaccines in California Primarily used to support adult immunization efforts (uninsured/under-insured adults) in: local health departments FQHCs/ RHCs enrolled in the CA Vaccines For Adults Program As available, 317 funds also support outbreak prevention efforts Past 2 years dealing with outbreaks Mening in 2016, 2017 Mumps in 2016, 2017 Hep A in 2017 California Department of Public Health 2
3 CA Vaccines for Adults (VFA) - New program implemented in June Currently, 501 clinical sites are enrolled in VFA. VFA Program Goals and Objectives To provide vaccines at no cost to eligible adults Eligibility Expand access to 317-funded vaccines to Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) in California Federally Qualified Health Centers, FQHC Look-Alikes, and Rural Health Centers that can demonstrate: Participation in the California Vaccines for Children Program (VFC); Experience providing a safety net for uninsured and underinsured adults; Participation in an Immunization Information System (e.g., California Immunization Registry - CAIR) or use of an Electronic Health Record (EHR) system. To integrate the standards for adult immunization practice into routine adult clinical care California Department of Public Health 3
4 VFA program data Doses administered during Year 1 Quarterly Administration Data 24,664 20,785 14,925 8,682 68,719 vaccine doses administered during Year Q1 Q2 Q3 Q California Department of Public Health 4
5 California Vaccines for Adults (VFA) Program Evaluation Year 1 Formative: Structured interviews with key informants from VFA sites Qualitative data (progress reports) Survey of VFA enrolled sites Process: Number of 317 VFA vaccine doses administered (progress reports) Program outputs: Number of 317 VFA vaccine doses ordered (progress reports) Program outcomes: Patient awareness Provider awareness Number of adults immunized Impact Reduced prevalence of disease in adults immunized California Department of Public Health 5
6 Adult Immunization Intervention/VFA Program Implementation - Barriers - Systems : - Immunizations are not always encounters - There are no established workflows to support the administration of adult vaccines - Vaccine orders need to be placed by provider only - FQHCs are confronted with a staff turnover rate, lack of continuity in knowledge on topic - Providers and clinical staff feel overwhelmed (too many encounters/provider, short appointment time) - Transition to new state immunization registry, CAIR2 California Department of Public Health 6
7 Adult Immunization Intervention/VFA Program Implementation - Barriers - Access/Policy/Billing - Out of pocket costs for patients (visit fee, administration fee addressed in Year 2) - Inadequate reimbursement for clinics prospective payment system (PPS) visit rate, IZ-only or nurse-only visits are not billable encounters - Some vaccines are pharmacy-only benefits, such as for vaccines covered under Medicare Part D) - Very few quality measures related to adult immunizations, no performance reporting requirements California Department of Public Health 7
8 Adult Immunization Intervention/VFA Program Implementation - Barriers - Demand/Norms: - Patient refusal - Adult immunizations perceived as low importance among clinicians and staff - No provider/clinical staff/leadership adult (vs. childhood) IZ culture - Lack of knowledge of schedule and standards - IZ champion role not well-understood California Department of Public Health 8
9 Interview Data Analysis - Facilitators- Norms/Culture/Demand - Providers and clinic leadership supportive of immunizations - Engagement of providers and clinical staff Systems/Infrastructure - EHR use of clinical decision guidelines/health maintenance forms Access - Incentives - adult IZ incentive provided by Medi-Cal Managed Care Plan California Department of Public Health 9
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