Implementation of An Elementary School-Located Influenza Vaccination Program with Billing of Third-Party Payers

Background: In 2008, CDC’s Advisory Committee on Immunization Practices recommended annual influenza vaccination for all persons aged 6 months–18 years beginning no later than the 2009–2010 influenza season.  Delivering annual influenza vaccination services to all children presents new strategic challenges.  Most influenza vaccination has previously occurred in public health or private practice settings; however, due to factors including past capacities of these traditional settings, schools are increasingly recognized as potentially valuable sites to deliver influenza vaccines to school-age children.  Historically, school-located programs have not billed insurance companies for vaccines, limiting programmatic sustainability.

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

Population: Students (N=9,856) attending 20 elementary schools during the 2009–2010 school year.

Project Description: The implementation team, comprised of 8 Denver Health (DH) personnel and 5 DPS nursing/administrative staff, worked for 10 months to develop processes needed to establish, run, and evaluate 40 school-located influenza clinics.  Processes included developing consent forms, health insurance information collection tools, and contracts to bill covered students’ insurance companies, developing standardized protocols, conducting training for vaccination clinics, and planning evaluation.  Processes entail that DH personnel verify insurance/billing information.  Consent packets are sent home with students, completed by parents/guardians, and returned to schools.  Community nurses use protocols to conduct vaccination clinics during school hours without requiring presences of parents/guardians.  Insurers are billed for vaccines and administration fees; eligible students receive vaccines through the Vaccines for Children program.  Parents do not receive bills.  During or immediately after clinics, clerical personnel enter vaccination data into the state immunization registry. 

Results/Lessons Learned: Negotiations with DPS required for program implementation exceeded projections by three months.  National attention on the 2009 pandemic influenza A (H1N1) virus heightened school and public interest in influenza vaccination.  Immunization clinics and billing processes will be conducted November 2009–February 2010.  Programmatic findings will be presented.