SETTING THE COURSE

A STRATEGIC VISION FOR IMMUNIZATION FINANCE

PART 1 SUMMARY OF THE CHICAGO WORKSHOP

Committee on the Immunization Finance Dissemination Workshops

Division of Health Care Services

INSTITUTE OF MEDICINE

NATIONAL ACADEMY PRESS
Washington, D.C.



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Setting the Course: A Strategic Vision for Immunization Finance - Part 1 Summary of the Chicago Workshop SETTING THE COURSE A STRATEGIC VISION FOR IMMUNIZATION FINANCE PART 1 SUMMARY OF THE CHICAGO WORKSHOP Committee on the Immunization Finance Dissemination Workshops Division of Health Care Services INSTITUTE OF MEDICINE NATIONAL ACADEMY PRESS Washington, D.C.

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Setting the Course: A Strategic Vision for Immunization Finance - Part 1 Summary of the Chicago Workshop NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W. Washington, D.C. 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. Support for this project was provided by the Centers for Disease Control and Prevention. The views presented in this report are those of the Institute of Medicine Committee on the Immunization Finance Dissemination Workshops and are not necessarily those of the funding agency. International Standard Book Number: 0-309-08307-9 Copies of this report are available for sale from the National Academy Press, 2101 Constitution Avenue, N.W., Box 285, Washington, D.C. 20055. Call (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area), or visit the NAP’s home page at www.nap.edu. The full text of this report is available at www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at www.iom.edu. Copyright 2002 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

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Setting the Course: A Strategic Vision for Immunization Finance - Part 1 Summary of the Chicago Workshop “Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe INSTITUTE OF MEDICINE Shaping the Future for Health

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Setting the Course: A Strategic Vision for Immunization Finance - Part 1 Summary of the Chicago Workshop THE NATIONAL ACADEMIES National Academy of Sciences National Academy of Engineering Institute of Medicine National Research Council The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. Wm. A. Wulf are chairman and vice chairman, respectively, of the National Research Council.

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Setting the Course: A Strategic Vision for Immunization Finance - Part 1 Summary of the Chicago Workshop COMMITTEE ON THE IMMUNIZATION FINANCE DISSEMINATION WORKSHOPS DAVID R. SMITH, M.D. (Chair), President, Texas Tech University Health Sciences Center, Lubbock, TX BRIAN BILES, M.D., Professor and Chair, Department of Health Services Management and Policy, The George Washington University STEVE BLACK, M.D., Co-Director, Vaccine Study Center, Kaiser Permanente, Oakland, CA GORDON H. DeFRIESE, Ph.D., President and Chief Executive Officer, North Carolina Institute of Medicine, Durham DIANNE WHITE DELISI, M.A., State Representative, Texas House of Representatives R. GORDON DOUGLAS, JR., M.D., Former President, Merck Vaccines (retired), Princeton, NJ JONATHAN FIELDING, M.D., M.P.H., Director of Public Health and Health Officer, Los Angeles Department of Health Services MAXINE HAYES, M.D., M.P.H., State Health Officer, Washington State Department of Health, Olympia ROBERT L. JOHNSON, M.D., Professor and Chair, Division of Adolescent and Young Adult Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School SAMUEL J. KATZ, M.D., Wilburt C. Davison Professor Emeritus, Department of Pediatrics, Duke University Medical Center WILLIAM KISSICK, M.D., M.P.H., Dr.P.H., George Seckel Pepper Professor of Public Health, The Leonard Davis Institute, The Wharton School, Philadelphia RONALD J. SALDARINI, Ph.D., President, Wyeth Lederle Vaccines and Pediatrics (retired), New Jersey WILLIAM SCHAFFNER, M.D., Professor and Chairman, Department of Preventive Medicine, Vanderbilt University School of Medicine GARTH SPLINTER, M.D., M.B.A., Associate Professor, Chief Medical Officer, University Hospital Trust, Oklahoma City, OK Committee Staff ROSEMARY CHALK, Senior Program Officer JANE DURCH, Consultant RYAN PALUGOD, Project Assistant

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Setting the Course: A Strategic Vision for Immunization Finance - Part 1 Summary of the Chicago Workshop REVIEWERS This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: BERNARD GUYER, M.D., M.P.H., Department of Population and Family Health Science, Johns Hopkins Bloomberg School of Public Health SARA ROSENBAUM, J.D., Director, Center for Health Policy Research, School of Public Health and Health Services, The George Washington University ARNOLD L. WIDEN, M.D., Executive Director, The Institute of Medicine of Chicago Although the reviewers listed above have provided many construc-tive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Neil Vanselow, M.D., Rio Verde, Arizona. Appointed by the National Research Council, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

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Setting the Course: A Strategic Vision for Immunization Finance - Part 1 Summary of the Chicago Workshop ACKNOWLEDGMENTS The Institute of Medicine workshop on immunization finance was organized with the generous assistance of many individuals and organizations in Chicago and Detroit. We acknowledge in particular the logistical support and hospitality provided by the staff of the School of Public Health at the University of Illinois at Chicago, under the leadership of Dean Susan Scrimshaw. Lynn Denton from the Texas Department of Health and Richard Butler from the Texas Tech University Health Sciences Center also provided valuable assistance and support in preparing for the workshop. Additional guidance was provided by Whitney Addington, Metropolis 2020; Arnold Widen from the Institute of Medicine of Chicago; Steve Potsic and Faith Covisi from Region V, U.S. Department of Health and Human Services; Cheryl Byers, Ed Mihalek, and Julie Morita from the Chicago Department of Public Health; Iris Shannon of the University of Illinois at Chicago; and Rebecca Wurtz from the Chicago Board of Health. Staff from the National Immunization Program of the Centers for Disease Control and Prevention in Atlanta helped to identify immunization program directors and public health advisers in the states of Illinois and Michigan and also prepared data analyses to inform the workshop discussions. The Center for the Advancement of Distance Education at the University of Illinois provided on-site technical support in audiocasting the June 15 workshop to a national audience. An archival copy of the speakers’ remarks and slides can be found at the IOM website: www.iom.edu/iom/iomhome.nsf/Pages/HCS+Immunization+Finance+Dissemination.

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Setting the Course: A Strategic Vision for Immunization Finance - Part 1 Summary of the Chicago Workshop Contents     EXECUTIVE SUMMARY   1     INTRODUCTION   3     BACKGROUND   5     The IOM Study,   6     IOM Findings and Recommendations,   7     CHALLENGES FACING THE IMMUNIZATION SYSTEM   10     Controlling and Preventing Infectious Disease,   10     Assuring Vaccine Purchase,   14     Assuring Service Delivery,   18     Sustaining and Improving Coverage Levels,   21     Conducting Surveillance of Immunization Coverage and Vaccine Safety,   23     Immunization Finance Policies and Practices,   24     STRATEGIES FOR ACHIEVING IMMUNIZATION GOALS   25     Quality Improvement Measures in Health Plans,   25     Performance-Based Contracting,   26     Public Policy Actions,   27     Public-Private Partnerships,   27

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Setting the Course: A Strategic Vision for Immunization Finance - Part 1 Summary of the Chicago Workshop     FINAL OBSERVATIONS   30     REFERENCES   32     APPENDIXES         A Workshop Agenda,   37     B List of Workshop Participants,   41     C Website Referrals,   47

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Setting the Course: A Strategic Vision for Immunization Finance - Part 1 Summary of the Chicago Workshop Tables and Figures TABLES 1   Comparison of 20th-century maximum (year) and current morbidity of vaccine-preventable diseases,   11 2   Estimated vaccination rates for selected vaccines and vaccine combi-nations, 2000,   13 3   Estimated vaccination coverage for the 4:3:1:3 series among children ages 19-35 months, 1996-2000,   14 4   Percentage of 2 year olds in Medicaid and managed care plans who were continuously enrolled in the same plan at 6 and 12 months prior to their second birthdays,   20 FIGURES 1   Six roles of the national immunization system,   8 2   Impact of immunization on disease in Michigan,   12 3   Vaccine costs in Michigan, 1995-2001,   16

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