Thomas Moss Georgia Immunization Registry Manager K2-Increasing Adolescent Immunization through Partnerships and Coalitions Thomas Moss Georgia Immunization Registry Manager

The Issue How to Improve Adolescent Immunization Rates in the State of Georgia?

Key Team Players America’s Health Insurance Plans Kaiser Permanente Georgia Immunization Program

The Target Group Adolescents 13 years of age who have not received their 2nd dose of MMR, 3rd dose of HepB, and/or one dose of VZV by their 13th birthday.

Key Barriers in the Past Most adolescents visit practitioners for specific, acute medical symptoms rather than wellness or chronic conditions. State of Georgia (GA) requires CDC recommended immunizations for entry into elementary and middle school, however health plans have not had ready access to needed Adolescent Immunization information. Children get required shots over several years at different venues, making it difficult to be able to obtain proper documentation.

Key Advancements Georgia completed implementation of its real-time, point-of-care, web-based immunization information system, GRITS, in January 2005; GRITS available to all health care providers statewide. Kaiser Permanente of Georgia completes successful implementation of Adolescent Immunization Best Practices directed at the key barriers allowing break-through performance improvement.

The Team Objectives Raise Georgia’s private and public health care providers’ Adolescent Immunization average to meet the national Healthy People goal of 90% by 2010. Georgia will adapt KPMG's Adolescent Immunization best practices from the private setting to the public health and community setting. KPGA will assist Georgia in engaging a whole community approach in this improvement effort.

KPMG's Proven Strategy KPGA has used a variety of interventions since 1998 to raise its performance to the 75th percentile level Examples include use of a “blitz team” (pediatric nurse practitioner and group of registered pediatric nurses and other staff) who along with KPGA direct care providers (health care teams-HCTs3) do medical record reviews Proactive HCT outreach to parents, capitalizing on giving shots when adolescents come in for acute visits, Identifying the venues where adolescent patients access the healthcare system and proactively provide information to practitioners there so shots can be given at these sites.

KPMG's Proven Strategy

Public Adopts Private Strategy Interventions KP Proven Practices GRITS Strategies Improve data capture KPGA pediatric immunization data involves approximately 100,000 members ages 0-18 “Blitz Team” and HCT3 proactive medical record review, providing “real-time” shot history for HCT outreach calls or shots during acute visits or Dermatology visits Provide Release of Information to parents to get documentation of previous shots KPGA regular sharing with GRITS documented member shot information GRITS data involves 3 million GA children: Annual DHR public school audits with 10% sampling statewide & CASA/AFIX public health reporting for historical data To be adapted from KPGA: -Proactively providing AI information for six other venues where adolescents are seen: Dermatology, Dentists, ERs, Public Health Clinics (including STD), Schools, Georgia Department of Juvenile Justice (DJJ) Increase practitioner/ HCT3 performance feedback Quarterly core practitioner-specific feedback Academic detailing for performance outliers Periodic practitioner CME, newsletters Regular attention by clinical leadership Medical record “flags” re needed shots GRITS / public health reporting provide regular feedback to schools & practitioners; annual audits for school entry, and preparation for GA university entry requirements Population-based analysis of under-served

Public Adopts Private Strategy Interventions KP Proven Practices GRITS Strategies Member outreach / education Blitz Team- and HCT-to-parent outreach calls KPGA Member Newsletter articles Immunization schedules posted in medical offices Extensive education program for schools, practitioners (reminders), and the public Currently partnering with Children’s Healthcare of Atlanta (pediatric hospitals and practitioners) and Georgia American Academy of Pediatrics for these activities Enhance affiliated (network) practitioner compliance Quarterly practitioner-specific feedback on HEDIS performance for KPMG's 300+ affiliated pediatricians & family practitioners Use new 2005 KPGA Provider Website for periodic reminders to the KPMG's 3,000 affiliated primary and specialty care practitioners in 20-country metro Atlanta network GRITS wants KPGA assistance in appropriately educating and involving approximately 3,000 GA pediatricians and family practitioners statewide in regular use of GRITS, and in outreach with and through them to the six other venues cited above in the Data Capture section.

Public Adopts Private Strategy Interventions KP Proven Practices GRITS Strategies Immunization tracking System Continue to optimize our use of GRITS as our HCT real-time point-of-care tracking to ensure we use this information to proactively give immunizations at all opportunities, and to share information we gather with GRITS Continue activities to share information between GRITS and the electronic medical record system KPGA implements in 2005 GRITS, having just completed full implementation in January 2005, will be doing major efforts to engage all statewide stakeholders for its use to improve immunization performance throughout 2005-2010 (see Support Attachments 2 and 3, GRITS practitioner brochure and State Form 3231 used for school entry)

Evaluation Methodology Measure increase in Adolescent Immunization rate from 2004 baseline - approximately 50% - toward the Healthy People 90% goal by 2010: HEDIS methodology for managed care segment of Georgia reported through NCQA 8.6 million 2003 state population (source US Census Bureau - Internet) 2 million children (ages 0-18), approximately 100,000 of which are turning 13 each year 5 million commercially insured population (source Nov/Dec ‘04 Health Affairs, Vol. 23, No. 6) 1 million Medicare population (source Kaiser Family Foundation - Internet) 1.3 million Medicaid population (source Kaiser Family Foundation - Internet) Assume “managed care” segment is 20% of population or 1.6 million; pediatric members represent approximately 30% or 500,000 of which 25,000 are turning 13 each year State of Georgia CASA and AFIX methodology for other adolescents measured through GA DHR Includes care provided by both private care and public health practitioners; measured annually by Georgia county and by public health districts; public health adjusts measurement of Georgia population that “moves or goes elsewhere” annually

Innovation-Adaptability-Expected Impact Innovations: Using health care delivery system practices from the private system to inform practices in other parts of the private system and public delivery systems in the State of Georgia about opportunities for improving Adolescent Immunizations. KPGA assisting the State of Georgia in accelerating the use of the real-time point-of-care State immunizations tracking system by all State adolescent care practitioners Proactively ensuring that practitioners and providers at all points of access for adolescents are prepared to advise parent on immunizations, e.g., Dermatology, Dentist, ER, Public Health Clinics, public schools, and the high-risk population of State Department of Juvenile Justice Using KPGA relationships with community family practitioners to assist the State in best communicating use of the GRITS tool and program.

Innovation-Adaptability-Expected Impact The combination of health plan and state interventions to improve Adolescent Immunization rates could be readily adapted in other settings and in other states. Expected Impact: Assisting the State of Georgia and KPGA in achieving 2010 immunization goal. Demonstrating significant health care public – private partnership.

Use of AHIP Funds KPGA: $25,000 – GRITS: $25,000 – Will be used to support KPMG's current annual cost of $5,000 for the AI Blitz Team activities for 5 years. GRITS: $25,000 – Will be used to support planned educational meetings with the public, practitioner educational opportunities, Immunization Outreach Events, School Engagement Opportunities, and GRITS User Group meetings over 5 years.

Current Status Teams are established Funds are located with appropriate agencies First Group Project Panel Presentation at Immunize Georgia’s Little Guys in January 2006 Second Group Project Partner with Dekalb Public Schools Board of Education Third Group Project Release Public Awareness Information Flyer/Post Card

Current Status First Group Project – IGLG Panel Increase in public and private school participation Increase in Metro Atlanta Provider participation Second Group Project – Dekalb Public Schools Concept – Use Seniors interested in Health Field enter immunization information into GRITS Reward – Seniors would volunteer for 1 semester and Kaiser Permanente will ensure employment for 1 semester at a KPGA Medical Clinic. Barrier - FERPA

“Coming Together is a Beginning. Keeping Together is Progress. Working Together is Success.” - John C Maxwell