1. Implementing Expanded Seasonal Influenza Meeting Healthcare and Other Settings

2. Overall Goal Getting every patient (<18yo) vaccinated no matter where they get immunized.

3. Targeted Groups – Workgroup Two Provider organizations Community partnersPharmacists Mass vaccinators

4. Overcoming Barriers Current Influenza Vaccination Rates Rates after Expansion of Seasonal Influenza Vaccination Time-frame Missed opportunities Demand Misperceptions Laws / Regulations Walking the Talk Thinking out of the box Lifespan Vaccination Compensation Access Medical Home Administrative Burden Staffing Vaccine safety Liability Legal / regulatory Dealing with adolescents Documentation Supply

5. Challenge / Barrier Solutions / Input Time Frame and small percentage of kids coming in Reminder recall from trusted provider Reminder recall from trusted provider Registry use and target messages Registry use and target messages Rx-label / vial reminders Rx-label / vial reminders Funding for community- based approaches Funding for community- based approaches Missed opportunities Provider education Provider education Expand types of providers Expand types of providers Consistent messages Consistent messages Lack of parental demand Education & consistent messaging from govt & their provider Education & consistent messaging from govt & their provider

6. Challenge / Barrier Solutions / Input Misperceptions (patients) about vaccines / dx and value Adolescent directed messages Adolescent directed messages Risk vs benefit Risk vs benefit Its a yearly vaccine Its a yearly vaccine Increase recognition of dx Walking the Talk by providers Risk vs benefit Risk vs benefit Have physicians talk to other physicians @ pt cases Have physicians talk to other physicians @ pt cases Mandate for HCP and staff Mandate for HCP and staff Make vaccination standard of care Make vaccination standard of care Make it an OSHA issue Make it an OSHA issue HEDIS measure and public report carding of provider IZ HEDIS measure and public report carding of provider IZ Medical education about extending season & vaccine Medical education about extending season & vaccine Look at medical / nursing / phcy school education Look at medical / nursing / phcy school education

7. Challenge / Barrier Solutions / Input Out of box thinking Get vaccinated where comfortable Get vaccinated where comfortable Tools to providers Tools to providers CME requirement vs Volunteer Service for licensure CME requirement vs Volunteer Service for licensure Models besides schools (San Diego Youth Program; CMA Fdn – Girl Scouts project) – utilize community service requirements Models besides schools (San Diego Youth Program; CMA Fdn – Girl Scouts project) – utilize community service requirements Coupons from merchants Coupons from merchants Insurer-issued vouchers Insurer-issued vouchers School-placed; Faith-placed; work-placed programs School-placed; Faith-placed; work-placed programs Incentivize families by insurers Incentivize families by insurers

8. Challenge / Barrier Solutions / Input Compensation and Recognition Cost of reminder systems Cost of reminder systems Types of practitioners Types of practitioners Lifespan coverage Lifespan coverage SCHP vs VFC program eligibility SCHP vs VFC program eligibility Incentivize performance Incentivize performance Expand VFC providers to non- traditional providers Expand VFC providers to non- traditional providers Vaccinations need to be profitable Vaccinations need to be profitable Incentivize performance Incentivize performance Compensation for counseling Compensation for counseling Vaccines on consignment / extend terms Vaccines on consignment / extend terms Who assumes risk? Who assumes risk?

9. Challenge / Barrier Solutions / Input Lack of easy access and/or lack of medical home Is the medical home the patient? – need to articulate it is not a facility or control Is the medical home the patient? – need to articulate it is not a facility or control Communication systems between providers of care Communication systems between providers of care Reporting (self-reporting vs system documentation) Reporting (self-reporting vs system documentation) Administrative burden Compensate for education, counseling, paperwork Compensate for education, counseling, paperwork Publish efficient models / success stories Publish efficient models / success stories Standing orders (STAND on CHART) Standing orders (STAND on CHART) Allow other providers to IZ Allow other providers to IZ IZ clinics are efficient / more frequency and regularity IZ clinics are efficient / more frequency and regularity Tools / templates / algorithms for flow and vaccine ordering Tools / templates / algorithms for flow and vaccine ordering

10. Challenge / Barrier Solutions / Input Staffing capacity Offer clinics / appt / build into flow Offer clinics / appt / build into flow Hard to add into already packed practice Hard to add into already packed practice Collaborative opportunities between community providers & private practice Collaborative opportunities between community providers & private practice Better reimbursement leads to better staffing Better reimbursement leads to better staffing Utilize empty offices @ certain times and have volunteers staff Utilize empty offices @ certain times and have volunteers staff Need models for volunteer programs that work Need models for volunteer programs that work Vaccine safety concerns Consistent and credible messages Consistent and credible messages Liability concerns Ability to give to whole family Ability to give to whole family

11. Challenge / Barrier Solutions / Input Legal / regulatory concerns Messages to policymakers Messages to policymakers Access to school data Access to school data Standing orders / protocols Standing orders / protocols Who can vaccinate and age restrictions Who can vaccinate and age restrictions Who indemnifies volunteers & mass vaccinators Who indemnifies volunteers & mass vaccinators Address risk-management restrictions Address risk-management restrictions How do you deal with adolescents? Messages targeted to adolescents and delivered by peers Messages targeted to adolescents and delivered by peers Documentation To patient, to provider, to registry? To patient, to provider, to registry? Concern about supply (wastage, shortage, sources) Risk assumption? Risk assumption?

12. Theyre coming…will we be ready...