Health Departments and Health Plans: a Public/Private Partnership for Reimbursing the Costs of Administering H1N1 Vaccine in Public Clinics

Background: The H1N1 pandemic created extraordinary demands on the public and private health sectors, as well as opportunities for collaboration.   Primary care providers do not have the capacity to administer the H1N1 vaccine to all children. A variety of settings, including schools and public health vaccination clinics, would be needed.  To vaccinate the target populations against H1N1, especially school-aged children, would require enormous effort on the part of local health departments and schools.  PHER funding would help, but more resources were needed.    

Setting: Local public health vaccination clinics, including school-based clinics.

Population: Target groups for H1N1 vaccination.

Project Description: In response to the pandemic, the Massachusetts Commissioner of Public Health (MDPH) asked health plans to voluntarily reimburse municipalities for administering H1N1 vaccine in public clinics.  Commonwealth Medicine, a division of the University of Massachusetts Medical School, and the health plans established a system by which municipalities collect billing information on a standard form from all vaccinees and submit all forms to Commonwealth Medicine.  Commonwealth Medicine sorts the forms and submits them electronically to the appropriate health plans.  The health plans each send reimbursement covering the eligible claims to Commonwealth Medicine, who, after deducting a small administrative fee, disperses the funds to the appropriate municipalities.

Results/Lessons Learned: This payment relationship enables local public health to be compensated for conducting public H1N1 vaccine clinics.  Municipalities are not traditional contracted health plan providers and do not have the infrastructure to negotiate with individual health plans.  Eight of the largest private health plans have contracted with Commonwealth Medicine to reimburse municipalities for the cost of administering H1N1 vaccine, and the number of communities contracting with Commonwealth Medicine grows daily.  MDPH is funding a demonstration project for municipalities to bill private health insurers for reimbursement for administering seasonal flu vaccine to plan members in schools.