Enhancing Immunization Services

Yavapai County Community Health Services

December 2007

Yavapai CountyCommunity

Health Services(YCCHS)

Community Health Center

Public Health Department

Immunization DataJan-Nov 2007 Total vaccines given = 13,666 Given to under 18 year olds = 9,809 Given to adults = 3,857 Number of vaccines available = 29

Add Influenza – OVER 20,000/shots/year

The Problem

Travel Immunization Clinic Currently administered by the Community

Health Center A non-traditional (CHC) service – a logical

experiment gone wrong Only provider in Yavapai County A money loser – due to health insurance

contracts with fixed ceilings for reimbursement County indirectly subsidizes travelers

The Solution

Public Health Department Cash up front for travel immunizations Patients deal directly with insurance

companies so no billing woes for department Patients are supplied with detailed insurance-

ready receipts The Health Department is paid in full up front Patients don’t need to travel to Phoenix The program is self-sufficient

The Variables

The (mostly) unknowns Patients’ reactions to having to deal directly

with insurance companies Market variables

Supply and demand Outbreaks/Panics Price swings New vaccines Pharmaceutical industry/Patents

Associated effects on revenue projections

Zostarvax (Shingles)

-100

-50

0

50

100

150

200

$

Cost Billed Paid RealLoss

Opp.Loss

TotalLoss

Recommendations

Transfer all non-CHC immunization functions from the Community Health Center to Public Health

Create a stand-alone, cash-only, travel clinic Round up all vaccine costs to the nearest dollar Adopt the following fee schedule:

Vaccine cost = purchase price plus $10.00 Administration fee = $20.00/shot Consultation Fee = $40.00/planning visit

Effective February 1, 2008

Pros Prices are set at a reasonable market rate Price changes – up or down – are automatic

without constant approvals by the Board of Supervisors

Travel immunizations will be self-sufficient Fewer transactions with insurance companies Clinic patients will still be covered for

immunizations Full indirect costs collected Continued service and convenience to the

community Very comparably priced

Cons

Numerous variables Projection assumptions may be flawed Paying up front for services may not be

agreeable to all

Endorsements

Health Resources And Services Administration

Prescott Free Clinic Board of Directors YCCHS Administration Yavapai Board of Health

Recommendations

Transfer all non-CHC immunization functions from the Community Health Center to Public Health

Create a stand-alone, cash-only, travel clinic Round up all vaccine costs to the nearest dollar Adopt the following fee schedule:

Vaccine cost = purchase price plus $10.00 Administration fee = $20.00 Consultation Fee = $40.00

Effective February 1, 2008