also cited several examples of other immunization-related activities in health plans across the country. These activities include analyzing missed immunization opportunities in providers’ practices, sending immunization reminders to parents, and providing recall and reminder information to providers.

Dr. DuPlessis acknowledged that the HEDIS data show the need for further improvement in immunization rates for children enrolled in Medicaid. But achieving those improvements will require better collaboration between the public and private sectors to overcome the challenges that each faces. Most health departments have a limited capacity to deliver immunization services and so must rely on health plans and private providers. Similarly, when immunization registries are not available or are not comprehensive, health departments lack real-time data on immunization coverage. Health plan records can help fill that gap.

Providers could also benefit from assistance from other sources to overcome some of the challenges they face in trying to meet their obligation to provide immunization services. As noted by others at the workshop, the administrative burden in managing vaccine inventories and documenting immunization services is substantial. This includes the complications related to assessing the eligibility of children for VFC vaccine and to tracking multiple funding streams for purchasing vaccine. Staying informed about frequent changes in the immunization schedule is further complicated in California by inconsistencies between the state’s Child Health and Disability Program and Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment guideline in the specifications for the timing of immunizations. Furthermore, the information management systems used by many private providers are not capable of identifying patients who need immunizations or of supporting easy use of immunization registries.

Effective collaborations between the public and private sectors would help in identifying the resources that various parties can contribute to meeting immunization needs and in defining their responsibilities in that process. Dr. DuPlessis cited the effort to establish a consolidated immunization registry in northern California as a promising example of the broadly based collaborations necessary to strengthen the immunization system and improve coverage rates. Plans to expand the activities of the immunization coalition in the Los Angeles area promise to help make more efficient use of the region’s resources for immunization.

Estimating Vaccine Needs

Kaiser Permanente is a large staff-model health maintenance organization that purchases vaccines as well as many other pharmaceutical prod-



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