NACCHO Annual 2013: Immunizations as a Model for Integrating Public Health and Health Care

Jul 12, 2013, 10:41 AM

While immunizations are a ubiquitous symbol of public health, in the last decade or so many public health departments have shied away from using the icon on their home pages or even adding it to a top ten list of what they do in the hopes of making both citizens and policymakers realize that public health extends far beyond infectious disease. Yet as public health departments integrate their work with the private sector, who will do the vaccinating, how immunization records will be kept and who gets paid for the work are pivotal issues that local health officials are grappling with.

A well-attended session at the NACCHO Annual conference yesterday provided a few more questions than answers, but armed attendees with new information as implementation of the Affordable Care Act (ACA) begins and both public health and private providers see their roles change and merge. Significantly, the ACA is expected to enroll millions of children, and under new rules the Vaccines for Children program will no longer cover the cost for vaccines for children who can receive immunizations under their own insurance. That will reduce funding for some health departments.

Other changes ahead for vaccination coordination include the role of accountable care organizations (ACOs) in coordinating care under the ACA, electronic registries and billing for public health services, said Paul Etkind, MPH, DrPH, head of infectious diseases at NACCHO.

“Much of this has yet to play out, so there are many unknowns,” said Etkind, who added that vaccines are a good example of the need for up front conversations with providers about what public health has to offer and a good way for health departments to become part of ACOs. “Going forward there will be a greater emphasis on coordinating care between the public and private sectors, than in delivering the care in many cases and public health needs to be active players in this process.”

Examples of immunization activities that public health is involved in beyond administration include auditing school records, maintaining vaccine registries and monitoring some doctors’ offices, as well as auditing hospital records especially for employee flu shot information. But whether local health departments will be able to bill for any of those services remains an open question, according to the session presenters. Other potential billing opportunities include public education about the need for vaccines and educating medical providers.

“It would be a great mistake for us to look to the past as the direction of the future,” said Gary Goldbaum, MD, MPH, the health officer of Snohomesh County in Washington State. “This is a terrific opportunity for this to push us and clinical managers to work together outside the box—team medicine, if you will.”

He added that he expects providers to be much more interested in speaking with health departments as the providers take on new roles including caring for the homeless. “We have to go to providers and establish relationships and say, ‘we’re here to work with you.” Examples might include having the health departments take charge of directly observed therapy for conditions such as asthma and TB and lab testing.

  • In Mariposa County the health department has worked with insurers to become in-network providers for some services, but needed the county supervisor to help with some of those conversations.
  • Electronic health data requirements will also spur coordination between public health and providers, says Dean Lampman, regional surveillance coordinator for the Tarrant County Public Health Department in Texas. Lampman said syndrome surveillance with hospitals has helped their department develop relationships, and that under the ACA there is funding to populate and monitor data for health information exchanges which health departments can be a part of.

“We need to need to double our efforts to be sure providers understand what health departments can provide,” said Etkind.

>> Read more NewPublicHealth coverage of NACCHO Annual.

This commentary originally appeared on the RWJF New Public Health blog.