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

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

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

4. 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.

5. 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.

6. 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.

7. 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.

8. 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.

9. KPMG's Proven Strategy

10. 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

11. 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.

12. 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 (see Support Attachments 2 and 3, GRITS practitioner brochure and State Form 3231 used for school entry)

13. 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

14. 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.

15. 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.

16. 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.

17. 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

18. 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

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