Implementation of a Middle School-Located Adolescent Vaccination Program with Billing of Third-Party Payers

Background: While several vaccines are routinely recommended for adolescents, successful delivery of these vaccines raises challenges.  Adolescents less frequently seek preventive health services in the traditional medical home compared to other age groups.  Therefore, developing sustainable, effective vaccination programs outside the medical home is likely needed to improve delivery of adolescent vaccinations on a population level.  Schools offer promising venues to deliver vaccines, but historically, school vaccination programs have not billed insurance companies for vaccines, limiting programmatic sustainability. 

Setting: Eight schools affiliated with Denver Public Schools (DPS).

Population: 6^th, 7^th, and 8^th grade students (N=3,277) attending eight schools during the 2009–2010 school year.

Project Description: The implementation team, consisting of 8 Denver Health (DH) personnel and 5 DPS nursing and administrative staff, worked for 12 months to develop all processes needed to establish, run, and evaluate 24 school-located adolescent vaccination clinics.  Processes included developing parental consent forms (with requests for health insurance information) and contracts to bill covered students’ insurance companies, conducting training for vaccination clinics, and planning evaluation activities.  Processes entail that DH personnel will verify insurance and billing information.  All routine and “catch-up” vaccines recommended for adolescents, including influenza vaccines, will be offered to all students.  Consent packets will be sent home with students, completed by parents/guardians, and returned.  Community nurses will use protocols to conduct clinics during school hours without parents/guardians needing to be present.  Covered students’ insurers will be billed for vaccines and administration fees; eligible students will receive vaccines through the Vaccines for Children program.  Parents will not receive bills for uncovered services.  During or immediately after clinics, clerical personnel will enter vaccination data into the state immunization registry. 

Results/Lessons Learned: Negotiations with DPS to implement the program took longer than anticipated.  The program will start in January 2010 with billing conducted for insured individuals.  Findings from the program will be presented.