The CDC recommends that kids get vaccinations for 14 different diseases before the age of 6, another three by the time they’re in the sixth grade, plus yearly flu shots. Many families take care of these during routine visits with the family physician or at walk-in clinics, but in order to reach as many children as possible—especially those with less access to preventative care—some public health departments, nonprofit organizations and academic institutions have set up school-based vaccination programs.
Health4Chicago is one such program established in 2008 as a joint venture between the University of Chicago Medicine and the University of Illinois at Chicago. Many similar projects are funded by grants, which are often not a reliable source of support over time because they run out or aren’t renewed. The Health4Chicago program was designed to create a financially-sustainable model, by billing both private insurance and Medicaid for the immunizations, and facilitating Medicaid enrollment for uninsured children.
The program has been a success from a medical standpoint: During the 2013-14 school year, they administered more than 2,100 vaccines to more than 1,700 children at nearly 40 Chicago Public Schools. But the goal of becoming financially sustainable has been more elusive.
In a report published recently in Pediatrics, the program’s administrators write that because of the complexities of the insurance billing process, high administrative costs, and relatively low reimbursement rates, school-based vaccination programs run by academic medical centers on this model are not financially sustainable in the current health care system.
“We felt strongly that, particularly in the South Side communities we serve, we didn’t want to develop a successful program providing health services to kids and then have the grant funds run out,” said Heather Limper, MPH, Program Director for Health4Chicago and Epidemiologist for Office of Clinical Effectiveness at the University of Chicago Medicine. “Unfortunately, it’s just not financially feasible under our current billing model.”
Limper said the sheer complexity of operating the program out of an academic medical center created too many hurdles. Doses of vaccines had to be ordered from the hospital pharmacies, adding more overhead charges, and billing was routed through several departments, creating additional red tape.
“It’s really difficult to figure out where you stand financially,” she said.
As a better alternative, Limper and her colleagues proposed programs administered by city health departments or community organizations with lower staffing costs, who could purchase vaccines directly from vendors and simplify the billing process.
This is the second paper the group has published on their experiences with the Health4Chicago program. The first, from February 2013, looked at the challenges in gaining access to schools, communicating with parents and obtaining consent. Limper said both sets of issues were comparable, but still worth the effort in trying to find a sustainable model.
“Even after we address issues around parental consent, school involvement, and health education, there are a lot of hurdles administratively,” she said. “But we need a way to be able to walk into a school, and regardless of insurance status, give these kids the immunizations they need.”