Vaccine Management Business Improvement Project Federal, State and Local Partnership Jan Hicks-Thomson, MSW, MPA Washington State Department of Health Immunization Program / CHILD Profile

Coming to Your Project Soon! VMBIP EXPRESS

Vaccine Management Business Improvement Project CDC is consolidating vaccine ordering and distribution nationally Improve national vaccine management efficiency Increase focus on quality assurance activities Key Components: Now: Centralized Distribution and inventory management Interim: Strategies for ordering and accountability Future: Centralized ordering and accountability National implementation complete 2007 Washington is one of 4 pilot sites

CDC is consolidating vaccine ordering and distribution nationally

Improve national vaccine management efficiency

Increase focus on quality assurance activities

Key Components:

Now: Centralized Distribution and inventory management

Interim: Strategies for ordering and accountability

Future: Centralized ordering and accountability

National implementation complete 2007

Washington is one of 4 pilot sites

Current Washington State Vaccine Distribution Model Provider Submits vaccine order to LHJ LHJ Verifies and fills Provider order DOH Fills LHJ Order CDC Receives Order and sends PO to Manufacturer Manufacturers Replenish DOH Inventory LHJ Places bulk order with DOH DOH Places bulk order through CDC LHJ Depot Inventory State Depot Inventory Provider Clinic Inventory Information Exchange: Vaccine Product Flow: Vaccine Inventory: LHJ Clinic Inventory Manufacturers CDC DOH State Depot Local Health Jurisdiction (35 LHJs) Providers (about 1200 statewide) Current Washington State Vaccine Distribution Model

Washington State Third Party Distribution Model (VMBIP) Submit vaccine order Verify and Submit Provider order Receive into NIPVAC, send PO Distributor Fills Provider Order DOH submits provider order through CDC Provider Maintains Clinic Inventory Information Exchange: Vaccine Product Flow: Vaccine Inventory: LHJs Maintain Clinic Inventory Distributor CDC DOH State Depot LHJ (35 LHJs) Providers (1140 statewide) Washington State Third Party Distribution Model

Process and Timing We started early… We began sharing information with stakeholders early in 2005 We shared what we knew … and were up front about learning together as we went We developed a strategy for maximum stakeholder involvement We committed to Frequent timely communication Collaboration and team work Listen to our stakeholders Promote and support local health / provider connection

We started early…

We began sharing information with stakeholders early in 2005

We shared what we knew

… and were up front about learning together as we went

We developed a strategy for maximum stakeholder involvement

We committed to

Frequent timely communication

Collaboration and team work

Listen to our stakeholders

Promote and support local health / provider connection

VMBIP Topic Areas Business Rule Development Ordering – Distribution – Accountability Inventory Management Implementation Strategies Interim and long range processes Provider Relationships Transition Planning Training Systems Development / Connection with CHILD Profile Fiscal Monitoring Evaluation Strategies

Business Rule Development

Ordering – Distribution – Accountability

Inventory Management

Implementation Strategies

Interim and long range processes

Provider Relationships

Transition Planning

Training

Systems Development / Connection with CHILD Profile

Fiscal Monitoring

Evaluation Strategies

Distribution,Ordering and Accountability Ordering Allows current LHJ receipt and approval process Requires orders to be compiled at the state level Establish ordering standards State business rules will describe standards Accountability Allows current LHJ accountability process Identify relationship between distribution and accountability Establish accountability standards State business rules will describe standards Distribution Vaccine shipped directly to provider from distributor Distributor invoices provider and reports shipments to state Inventory Management Consolidates inventories with 3rd party distributors

Ordering

Allows current LHJ receipt and approval process

Requires orders to be compiled at the state level

Establish ordering standards

State business rules will describe standards

Accountability

Allows current LHJ accountability process

Identify relationship between distribution and accountability

Establish accountability standards

State business rules will describe standards

Distribution

Vaccine shipped directly to provider from distributor

Distributor invoices provider and reports shipments to state

Inventory Management

Consolidates inventories with 3rd party distributors

VMBIP Pilot Planning Structure DOH VMBIP Core Group Provides leadership for all VMBIP pilot and implementation of 3 rd Party distribution Statewide stakeholder involvement Decision making for planning, implementation and Immunization Program transition Liaison with CDC DOH VMBIP Workgroup for IP (VMBIP-WIP) Develop and support IP transition plan Support transition for external stakeholders VMBIP Public Health Advisory Committee (VPHAC) Gather and provide local health perspective for VMBIP planning and implementation Make recommendations to DOH about: Vaccine management business rules Piloting and implementation of vaccine choice Provider communication and training Evaluation and customer service measures

DOH VMBIP Core Group

Provides leadership for all VMBIP pilot and implementation of 3 rd Party distribution

Statewide stakeholder involvement

Decision making for planning, implementation and Immunization Program transition

Liaison with CDC

DOH VMBIP Workgroup for IP (VMBIP-WIP)

Develop and support IP transition plan

Support transition for external stakeholders

VMBIP Public Health Advisory Committee (VPHAC)

Gather and provide local health perspective for VMBIP planning and implementation

Make recommendations to DOH about:

Vaccine management business rules

Piloting and implementation of vaccine choice

Provider communication and training

Evaluation and customer service measures

Stakeholder Involvement LHJ Stakeholders Participated in 4 topic specific conference calls Participated in meetings for review of recommendations Will attend regional training Pharmaceutical Companies Received periodic updates at quarterly meetings with DOH Providers Received information from LHJs regarding planning Received information from DOH via associations and other venues

LHJ Stakeholders

Participated in 4 topic specific conference calls

Participated in meetings for review of recommendations

Will attend regional training

Pharmaceutical Companies

Received periodic updates at quarterly meetings with DOH

Providers

Received information from LHJs regarding planning

Received information from DOH via associations and other venues

Agenda Planning

Commitment to Communication… VMBIP Q&A after conference calls and meetings Summaries after conference calls and meetings Opportunities for discussion as part of VFC site visits Updates at regular Immunization Coalition, Partnership and Advisory Committee, and other stakeholder meetings Newsletter articles

VMBIP Q&A after conference calls and meetings

Summaries after conference calls and meetings

Opportunities for discussion as part of VFC site visits

Updates at regular Immunization Coalition, Partnership and Advisory Committee, and other stakeholder meetings

Newsletter articles

VMBIP Q&A

VMBIP Call & Meeting Summaries

Commitment to Listen… We started by asking questions What are stakeholder questions and concerns? What do stakeholders think will work best? How is business being conducted? How can we accommodate varying needs? What support is needed? What do stakeholders recommend? How can we incorporate key elements of interest to stakeholders? What messages should go back to CDC/NIP?

We started by asking questions

What are stakeholder questions and concerns?

What do stakeholders think will work best?

How is business being conducted?

How can we accommodate varying needs?

What support is needed?

What do stakeholders recommend?

How can we incorporate key elements of interest to stakeholders?

What messages should go back to CDC/NIP?

Tools for Gathering Input

Transition Planning DOH and LHJ staff will no longer physically handle vaccine storage and handling as depots DOH and LHJ staff will continue to: Monitor provider orders & inventory Support provider vaccine storage and handling best practices Conduct quality assurance and educational activities DOH will provide transition tools and support for: Depot transition, including inventory scale-down and closure Staff transition planning Training

DOH and LHJ staff will no longer physically handle vaccine storage and handling as depots

DOH and LHJ staff will continue to:

Monitor provider orders & inventory

Support provider vaccine storage and handling best practices

Conduct quality assurance and educational activities

DOH will provide transition tools and support for:

Depot transition, including inventory scale-down and closure

Staff transition planning

Training

Transition Tools: Timeline

Transition Tools: Staff and Depot Plans

Training and Communication Tools

Is the VMBIP Express on track?

Process Outcomes: How did we do? Stakeholders Valued: Being involved from the beginning Opportunities to interact with their counterparts Participating in problem solving and planning DOH responsiveness Information sharing, consistency of meetings/calls, and time spent documenting processes Collaboration

Stakeholders Valued:

Being involved from the beginning

Opportunities to interact with their counterparts

Participating in problem solving and planning

DOH responsiveness

Information sharing, consistency of meetings/calls, and time spent documenting processes

Collaboration

Reviewing the Business Rules Helps to Understand VMBIP 4.6 The Materials Clarify the Role of the LHJ 4.6 Overview of Interim Strategies is Helpful 4.3 Materials and Information will be helpful for Local Planning 4.3 DOH Listens and Addresses Concerns 4.4 DOH Listens and Incorporates LHJ Feedback into Guidelines 4.7 N = 16 LHJ participants Process Outcomes: How did we do?

Interim Vaccine Ordering Strategies Following changes for LHJs: LHJs submit individual provider vaccine orders to DOH for processing Options for LHJ to submit orders: Via the web through VACTRACS or possibly a new CHILD Profile module if available DOH staff will electronically up-load the data into VACMAN Via e-mail using an excel spreadsheet generated from an existing LHJ data base DOH staff will electronically up-load the data into VACMAN Via fax in a hard-copy format DOH staff will hand enter the data into VACMAN Providers: Submit order to LHJ (phone, fax, e-mail, in person) submit vaccine accountability reports to LHJ LHJ: Reviews order, inventory and doses administered information Approves order as submitted and forwards to DOH OR LHJ contacts provider to negotiate and adjust order as LHJ deems appropriate, then forwards adjusted order to DOH Providers cannot pick-up vaccine same day Interim Vaccine Ordering Strategies Providers Ordering Strategy Outcomes

Following changes for LHJs:

LHJs submit individual provider vaccine orders to DOH for processing

Options for LHJ to submit orders:

Via the web through VACTRACS or possibly a new CHILD Profile module if available

DOH staff will electronically up-load the data into VACMAN

Via e-mail using an excel spreadsheet generated from an existing LHJ data base

DOH staff will electronically up-load the data into VACMAN

Via fax in a hard-copy format

DOH staff will hand enter the data into VACMAN

Providers:

Submit order to LHJ (phone, fax, e-mail, in person)

submit vaccine accountability reports to LHJ

LHJ:

Reviews order, inventory and doses administered information

Approves order as submitted and forwards to DOH

OR

LHJ contacts provider to negotiate and adjust order as LHJ deems appropriate, then forwards adjusted order to DOH

Providers cannot pick-up vaccine same day

Recommended Vaccine Ordering Business Rules & Guidelines Ordering Strategy Outcomes Order Frequency Business Rule Washington promotes the following guidelines: Providers will order on a periodic and regular cycle – Most providers will order monthly High volume providers may order every 2 weeks Providers with very low volume may order every 2 to 3 months. DOH and LHJs will establish their order time-frames. DOH will accommodate LHJ staffing patterns to ensure provider orders are processed in a timely fashion. LHJs will determine ordering patterns that best fit provider needs. LHJs assess provider storage capacity and provide technical assistance and guidance regarding storage to support provider ordering patterns. Ordering Patterns

Washington promotes the following guidelines:

Providers will order on a periodic and regular cycle –

Most providers will order monthly

High volume providers may order every 2 weeks

Providers with very low volume may order every 2 to 3 months.

DOH and LHJs will establish their order time-frames.

DOH will accommodate LHJ staffing patterns to ensure provider orders are processed in a timely fashion.

LHJs will determine ordering patterns that best fit provider needs.

LHJs assess provider storage capacity and provide technical assistance and guidance regarding storage to support provider ordering patterns.

Recommended Vaccine Distribution Business Rules & Guidelines Vaccine Distribution Planning Outcomes Distribution Roles and Responsibilities Business Rule LHJs will work with providers to complete and sign provider agreements annually, updating contact information. LHJs will check provider contact information prior to the placement of provider orders. Provider shipping information can be updated on line via the appropriate application (e.g., interim strategy VACTRACS, long term strategy CHILD Profile); via fax or e-mail to DOH. LHJs will monitor vaccine transfers between providers, and between providers and the LHJ. LHJs will monitor all vaccine distribution, including emergency distribution, central pharmacy distribution, and/or distribution to satellite clinics. Shipping Information

LHJs will work with providers to complete and sign provider agreements annually, updating contact information.

LHJs will check provider contact information prior to the placement of provider orders.

Provider shipping information can be updated on line via the appropriate application (e.g., interim strategy VACTRACS, long term strategy CHILD Profile); via fax or e-mail to DOH.

LHJs will monitor vaccine transfers between providers, and between providers and the LHJ.

LHJs will monitor all vaccine distribution, including emergency distribution, central pharmacy distribution, and/or distribution to satellite clinics.

Vaccine Accountability Planning Outcomes Recommended Accountability Business Rules & Guidelines Accountability Roles and Responsibilities Business Rule Providers will abide by the VFC Provider Agreement. Providers will submit their monthly accountability reports to LHJs in accordance with the VFC Provider Agreement. Inventory on hand, by vaccine type, will be required when the provider places an order. LHJs can work with individual providers who are not compliant with accountability reporting to determine what the best course of action prior to order processing. LHJs may hold provider orders until accountability issues have been resolved (e.g., missing reports turned in, doses administered updated etc.,) or until other follow-up deemed necessary by the LHJ to ensure that vaccine is being handled and used appropriately is completed. Accountability Required for Order Processing

Providers will abide by the VFC Provider Agreement.

Providers will submit their monthly accountability reports to LHJs in accordance with the VFC Provider Agreement.

Inventory on hand, by vaccine type, will be required when the provider places an order.

LHJs can work with individual providers who are not compliant with accountability reporting to determine what the best course of action prior to order processing.

LHJs may hold provider orders until accountability issues have been resolved (e.g., missing reports turned in, doses administered updated etc.,) or until other follow-up deemed necessary by the LHJ to ensure that vaccine is being handled and used appropriately is completed.

There’s Still More to Do…

What’s Next? Refinement and submission of Business Rule Recommendations to DOH leadership for final approval Conference calls / e-mail updates October – December periodic up-dates Regional training LHJ and DOH planning team Dec./Jan. February - March 2006 regional training meetings Post training preparation for implementation March – June Combination of conference calls, e-mail up-dates and site visits as needed VMBIP implementation June – August 2006

Refinement and submission of Business Rule Recommendations to DOH leadership for final approval

Conference calls / e-mail updates

October – December periodic up-dates

Regional training

LHJ and DOH planning team Dec./Jan.

February - March 2006 regional training meetings

Post training preparation for implementation

March – June

Combination of conference calls, e-mail up-dates and site visits as needed

VMBIP implementation June – August 2006

Uniting the State in VMBIP Implementation VMBIP EXPRESS VMBIP Golden Spike Ceremony: Olympia, WA June 2006 VMBIP EXPRESS