Washington State: How an Immunization Registry Is Funded Can Determine Its Success
- Annual birth cohort: 34,000 in five counties; 70,640 statewide (the RWJF grant funded the registry for the five-county area; the system was then implemented statewide in July 1998)
- Geographic area covered: Five-county health jurisdiction and State of Washington
- Legislation: None
- Percentage of immunizations given in private sector: 80 percent
- Other sources of funding: Federal, state, other grants, fee-for-service
It is difficult to stand in another's shoes. Yet, that ultimately is what developers of registries must do to understand the perceptions of users of registries. In most states, that means that public health department staff must understand the perceptions of private sector doctors, nurses, administrative staff, and health plans. Such was the case in Washington State where an unusual approach to funding the registry had been adopted in 1997. In an effort to convert the CHILD Profile (Children's Health, Immunization, Linkages, and Development) from a public, grant-supported project to a fee-for-service model, a cost-based pricing structure for users of the system was established, based on the number of children in their client load under age 6. A private organization, Health Information Institute (later called Health Radius), licensed the software and assisted with the marketing of the registry's fee-for-service approach.
The goal was to have the registry "primarily supported" by fee-for-service as of January 2000. But it became clear that providers were resisting the fee-for-service arrangement, and that not only had fees contributed just 1 percent of the revenue budget, but they also had resulted in providers holding negative views of the registry. As of June 2000, only 25 percent of provider sites were submitting data to the registry, despite aggressive marketing efforts and enhancements to the registry to make it more useful, such as reminder-recall and vaccine inventory functions.
An in-depth study of providers' perceptions and motivations was funded by CDC and conducted collaboratively by CHILD Profile and Group Health Cooperative of Puget Sound. Among its findings: Providers believe a registry is a public good, the cost of which should be borne by the public sector.
|Registries should clearly define the value proposition. What will the registry do for its users?|
GRANT DETAILS & CONTACT INFORMATION
Washington State CHILD (Children's Health, Immunization, Linkages, and Development) Profile
Snohomish Health District (Everett, WA)
Dates: February 1998 to May 2000
M. Ward Hinds, M.D., M.P.H.
Program Director: David A. Ross, Sc.D.
Former Program Director: William H. Foege, M.D., M.P.H. (December 1991 through July 1997)
Former Program Director: William C. Watson, Jr., M.P.A. (August 1997 through July 2001)