25387 Universal Childhood Vaccine Purchase In WA State

Tuesday, March 29, 2011
Columbia Hall
Edgar Marcuse, MD, MPH , Professor, Pediatrics, University of Washington, Seattle Children's Hospital
Janna Bardi, MPH , Manager, WA Immunication Program CHILD Profile, Washington State Department of Health
Ginny Heller, MSW , Program Manager, WithinReach

Background: For many years, Washington State has provided childhood vaccines to all providers licensed to administer immunizations. In 2009, state vaccine funds for privately insured children were scheduled to end due to budgetary constraints. The state’s health care community mobilized to preserve universal purchase - widely regarded as an efficient, cost-effective system- fostering both collaboration between state and local public health and primary care clinicians and optimal immunization practices. A multidisciplinary team convened an Immunization Congress, attended by private practitioners, vaccine manufacturers, state legislators and staff, and representatives of other states that have solved similar problems. The Congress laid the foundation for the formation of a public/private partnership that culminated in legislation that created the Washington Vaccine Association (WVA), an independent, non-profit organization to administer the flow of funds collected from private health plans, insurance companies and other payers and remit them to the state for the purchase of childhood vaccines.

Setting: Washington State

Population: Privately insured children under age 19 years

Project Description: The WVA was funded by prepayments from the state’s six largest private health plans totaling $7.8 million. Ongoing funding is generated from providers submitting a dosage based assessment form to payers as well as a claim for vaccine administration for privately insured patients. Payers are responsible for covering the costs of vaccines administered to privately insured children.  Costs are determined by a per dosage assessment based on federal contract rates plus reasonable add-ons to cover operating costs.

Results/Lessons Learned: Since May, 2010, the WVA has collected and remitted funds to cover the costs of all vaccines administered to children with private health insurance. By October 2010, more than two-thirds of the vaccines administered to the state’s privately insured children were processed via the dosage based assessment methodology and all major health plans were making payments to the WVA.