Strategies to Resolve the Immunization Crisis in Puerto Rico, Stakeholders Working Together

Background:
The number of Pediatricians administering vaccines in the Private Practice in Puerto Rico has declined to less than 20%.

Setting:
Immunization clinics subsidized by VFC have limited their services to patients without insurance or underinsured, unable to provide this service to these patients with private insurance covering vaccines. Pediatricians claim they cannot afford to purchase all vaccines up-front for their private patients due to incomplete and inconsistent reimbursements by the health insurance plans. Insurance companies acknowledge that only 30% of their clients receive immunizations using their plan.

Population:
Patients with medical insurance have difficulty identifying a provider or a clinic to complete and updated their immunization schedules.

Project Description:
. Prompted by the Puerto Rico Chapter of the American Academy of Pediatrics(PR-AAP) a taskforce was created with support from the patients ombudsman office with the participation of representatives from the health insurance companies, local health department, local pediatric societies, vaccine manufacturers and distributors, consumer ombudsman, among others. A congress was developed and hosted by the AAP-PR where these representatives presented data and their points of view relating to the crisis.Recommendations to resolve this crisis were made after deliberating in workgroups.

Results/Lessons Learned:
Since then, subsequent meetings between Health Department, insurance companies and pediatricians have taken place and the outcomes include: training session for pediatricians to have access to immunization registries; health plans revision and understanding the importance of covering all ACIP recommended immunizations, costs associated with delivering vaccines and providing adequate reimbursement to providers, better communication between providers and insurance companies, better communication between vaccine manufacturers and distributors and the insurance companies; lobbying to modify laws restricting authorization to vaccinate at the office setting; and finally planning for CME for Pediatricians on quality health care, focusing on preventive care and immunization.