IAPs can encourage states to do the comprehensive planning that assesses all available resources and how they can best be used. Planning groups that bring together public- and private-sector representatives can help optimize the effectiveness of the resources available in the private sector, which include not only providers but also organizations and individuals that can contribute funds and volunteers.

  • Immunization data. States can encourage the collection of high-quality data on immunization needs and services. Unless data collected on children's immunizations are accurate and comprehensive, they will provide a misleading picture of how well (or poorly) children are immunized. Immunization registries and CDC's telephone surveys can become valuable sources of such data.

  • Cooperation between public- and private-sector providers. Delivery of immunization services takes place at the local level. Therefore, local health departments need to promote effective cooperation between public- and private-sector providers.

Steps to Take in the Longer Term
  • Immunization incentives. States and communities can use Medicaid and other public payment systems to create incentives and promote provider accountability for immunization. HMOs or major purchasers of health services (such as large employers) also might be able to establish financial incentives for providers to achieve high levels of immunization within a defined population.

The system developed in the United Kingdom, which provides strong financial incentives to providers to meet overall immunization targets, is one model that might be used. Providers in the United Kingdom receive a basic incentive payment only if they have immunized at least 70 percent of eligible children. They receive a substantially larger payment for a 90 percent level of immunization in their practices. Because providers receive these payments only if they achieve specific immunization levels for an entire group of eligible children assigned to their practices, they have a clear incentive to reach each and every child.

  • Health services performance measures. Purchasers of capitated health care services (e.g., employers, state Medicaid programs, or, perhaps with health care reform, health alliances or similar groups) could include immunization services as a performance measure. When selecting plans, purchasers can consider whether those plans are meeting specified levels of immunization coverage for children of participants in the plans.



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