Union County Health Department School Initiative 2010-2011

1. Union County Health Department School Initiative 2010-2011

2. Preparation for Initiative • Met with Bruce Piercy GSK representative about BCBS vaccine program Spring of 2009 to discuss administering vaccines to school employees and learned that BCBS a proponent of vaccines . Inform UCHD that State Employees would cover all vaccines • Summer of 2010 Met with Chris Bryce Area Immunization manager with GSK to discuss BCBS billing and plan for school meetings • Health Director met with Superintendent Ed Davis in May 2010 to explore immunization initiative. Given permission to attend principals meeting in July for final approval • Met with nursing supervisors in summer to discuss initiative and illicit their support , ideas, and assistance with effort • Health Director met with School Principles July 2010 and gave brief presentation of program and its benefits for employees and employee’s families. Unanimous approval received at meeting. • Hired former retired school nurse thorough Public Health Alliance (PHA) to organize initiative.

3. Report on Progress • October 2010 first clinics completed • Decision made to provide flu and Tdap at the same time • 1,291 flu shots and 561 Tdaps given at 10 clusters sites. Total employment for UCPS is 2,834 licensed employees and 2,310 unlicensed personnel. • When clinics completed the percentage of employees receiving the various vaccines as follows: • 25% of UCPS employees covered for flu ,13% for Tdap, 1.6% for Twinrix, • Hepatitis A .3% and .18% Hepatitis B

4. Report on Progress Cont. • Clinics held in January, March, and May 2011 • 7 clinical sites utilized over 7 days from 2-5pm • 3 Nurses at site for January and decreased to 1 or 2 depending on numbers • Totals were: Tdap 149, ( Total Tdap 710) PPV 23 15, HepB 9,Twinrix 136,Hep A 87

5. Revenues Ending June 2011

6. Materials Created • Union County Health Department • School Immunization initiative • The Union County Health Dept. will be offering the vaccines listed below. The shots will be given at the Elementary Schools listed on the schedule sheet. Days: Mon. Tues. and Thurs. Time:2-4:30PM • Tdap - Tetanus, Diptheria and Acelluar Pertussis a combination vaccine that protects against Tetanus (Lockjaw), Diphtheria and Acellular Pertussis (Whooping Cough). Pertussis was added to the vaccine 2 years ago. It is recommended you get a Tetanus shot if at least 2 years has elapsed since the last Td. It is not given to pregnant women. Cost $40 covered by most BCBS. • Pneumonia recommended for people who are 65 and older or anyone with asthma or who is a heavy smoker. Cost is $35 covered by most BCBS. • Hepatitis A protects against Hepatitis contracted from eating contaminated food, a series of 2 vaccines that are 6 months apart is necessary. Cost $60 per shot covered by most BCBS. • Hepatitis B protects against Hepatitis contracted from exposure to blood and body fluids of an infected person, a series of 3 vaccines are necessary for coverage. You cannot get the vaccine if you are allergic to yeast. Cost $70 per shot covered by most BCBS. • Combination Hep A and B protects against Hep A and B in one vaccine. A series of 3 vaccines are necessary for coverage. Cost $115 per shot covered by most BCBS. • For more information or questions contact: Joan at • Joan.Marcantonio@co.union.nc.us or Llyon@co.union.nc.us.

7. Materials Created Flu Site Locations Immunization Cards

8. Materials Created • UCHD/UCPS • Immunization Initiative • May clinics • Time: 2pm – 4:30pm • First time Hepatitis A • First time Hep B • First time combination A & B vaccine • Tdap & Pneumonia must indicate on the sign up sheet which school they will be attending. • If you had Hepatitis A shot or 2 Combination A & B vaccines, you are not due until the next clinic in September. If you have any questions please call or email Lydia Lyon at 704-296-4813,Llyon@co.union.nc.us or joan.marcantonio@co.union.nc.us. • May • 16th – New Town Elementary • 17th – Western Union • 19th – Wesley Chapel • 23rd - Shiloh • 24th - Wolfe • 26th - Wingate • 31st - Rea View

9. Materials created • UCHD/UCPS • Immunization Initiative • May clinics • Time: 2pm – 4:30pm • First time Hepatitis A • First time Hep B • First time combination A & B vaccine • Tdap & Pneumonia must indicate on the sign up sheet which school they will be attending. • If you had Hepatitis A shot or 2 Combination A & B vaccines, you are not due until the next clinic in September. If you have any questions please call or email Lydia Lyon at 704-296-4813, Llyon@co.union.nc.us or joan.marcantonio@co.union.nc.us. • May • 16th – New Town Elementary • 17th – Western Union • 19th – Wesley Chapel • 23rd - Shiloh • 24th - Wolfe • 26th - Wingate • 31st - Rea View

10. Spreadsheet for Follow-up

11. Report on Progress School Fair Stallings Elementary March 2010 Vaccine Offered for rising 6th graders and School Employees Vaccines Administered 35 Tdaps rising 6th graders 3 Tdaps :teachers 3 Twinrix

12. Tdap for Rising 6th Graders April 2011 233 given over 7 days

13. Tdap Initiative April 2011 Flyer

14. Challenges • Additional clerical staff utilized to complete entry into HIS and to manage insurance billing. • Due to budget constraints had to seek County approval to allowed larger line item for immunization • Purchased vaccine cost $32,180 ( Flu,Tdap,Hep B, Hep A, Twinrix, Pneumovax) • Purchase again $8,700 for 2nd administration. • Vaccine purchased for number that signed and had 86 not show • Emails had to be utilized to remind teachers

15. Billing 3rd Parties BCBS State Employees covers all vaccines • Administrative Consultant at State can assist with information on establishing as an insurance provider • Calls made by Business Service Supervisor to obtain protocols needed to become a provider • BCBS makes site visit prior to approval and every 2-3 years • If Agency is BCBS provider then establishing as a preferred provider for other carriers is easier • Need data entry to enter into HIS . Personnel must be proficient with HIS and proper coding • Need astute business service employee to follow-up on EOB’s and denied claims. • All of our claims were filed electronically and 2-3 weeks before claims completed • We did not have any denied claims from BCBS

16. Community Partnerships • School nurses assisted with signup • School nurses provided valuable information to staff on importance of vaccines to community • School principals approval to allow UCHD to be immunization provider for school personnel • County allowed budget allowance to purchase needed vaccines • GSK providing investigation of BCBS to provide assurance of insurances compliance with vaccine claims

17. LESSONS Learned • Partnerships with all parties invaluable • Meet with school nurses to discuss vaccines and seek their support • Communication, communication, communication. Individual reminders day of vaccine administration, use of intercom to page teachers • Location that available for staff entry after school personnel gone and doors locked • Shorten hours as personnel did not come after 4:30 • GSK prefilled syringes are same price as individual vials and have pull off labels with lot and expiration date. Makes for quicker administration, saves syringe and needle ,therefore reduces cost • Can manage with 2-3 nurses after first clinic completed • Request for space that has computer availability to allow entry during clinic time • Creation of spreadsheet to monitor teachers administration dates

18. Other Business Initiatives Foreign Travel : Health Director is requesting a funding balance for this program. Most budgets receive income that is then deposited in a general fund and is not available for future expenditures. Provide titers for Measles, Mumps, Rubella, Hep B, HSV 1 and HSV 2, Hep C and HIV. This is flat fee. Colpo is now a flat fee service. Currently beginning a community campaign :CHOICE (Community Health,Immunization Clinics, and Education) Purpose is to reintroduce Public Health to community .

19. Samples of CHOICE Correspondence : Church Letter The mission of the Union County Health Department is to promote health, prevent disease and protect the health of the community. While we are very proud of the care that our patients receive when they visit the Health Department, as a Public Health agency we also serve the community as a whole. The faith community is a vital component of our community. We would like to partner with you to work toward a healthier community, a reduction in chronic disease and move toward healthier lifestyles for your congregation. As the local Public Health entity we are extending the reach of the Department through the establishment of “CHOICE” Community Health, Outreach, Immunization, Clinics and Education. The Health Promotions Director will make an annual visit to your location with a clinical representative to discuss the specific needs of your organization and match them with the Public Health programs and services that can be provided on site to your church members and employees. With the challenging economic climate and the rising cost of quality health care and dental services, Public Health can offer solutions that are often much less expensive than what can be provided through the private sector. With the ability to provide on-site services and programs, congregation members will have access to a broad range of affordable healthcare options in a familiar atmosphere. It is especially beneficial to seniors that can be apprehensive. While we cannot meet all needs, please allow us the opportunity to come to your office and reintroduce Public Health to your agency. We can provide NC required Tdap immunizations to rising 6th graders at Vacation Bible School. International Travel Vaccines are also available for upcoming mission trips. Together we can discuss the many Public Health programs and services available and the potential cost saving measures that may meet your needs and help the Health Department advance the agency mission of promoting health, preventing disease and protecting the health of the community. I will be in touch to set up a time to meet with church officials, or you may contact me now if you have an immediate need. Sincerely, Jackie Morgan Health Promotions Director

20. Samples of CHOICE Correspondence : Industry Letter June 1, 2011 South Piedmont Community College 4209 Old Charlotte Highway Monroe, NC 28110 Dear Dr. McKay: The mission of the Union County Health Department is to promote health, prevent disease and protect the health of the community. While we are very proud of the care that our patients receive when they visit the Health Department, as a Public Health agency we also serve the community as a whole. Business and Industry are a core component in the fiscal health of a community. Companies are only as healthy as the employees that work there. We would like to partner with you to work toward a healthier workforce, fewer lost time accidents, fewer absences from work, a reduction in chronic disease and move toward healthier lifestyles for your employees. As the local Public Health entity we are extending the reach of the Department through the establishment of “CHOICE” Community Health, Outreach, Immunization, Clinics and Education. The program Coordinator will make an annual visit to your location with a clinical representative to discuss the specific needs of your organization and match them with the Public Health programs and services that can be provided on site to your employees. With the challenging economic climate and the rising cost of quality health care and dental services, Public Health can offer solutions that are often much less expensive than what can be provided through the private sector. With the ability to provide on-site services and programs, employees do not lose valuable work time, and the company does not lose productivity. While we cannot meet all needs, please allow us the opportunity to come to your office and reintroduce Public Health to your agency. Together we can discuss the many Public Health programs and services available and the potential cost saving measures that may meet your needs and help the Health Department advance the agency mission of promoting health, preventing disease and protecting the health of the community. Sincerely, Jackie Morgan Health Promotions Director

21. Samples of CHOICE Correspondence : School Letter June 1, 2011 South Piedmont Community College 4209 Old Charlotte Highway Monroe, NC 28110 Dear Dr. McKay: The mission of the Union County Health Department is to promote health, prevent disease and protect the health of the community. While we are very proud of the care that our patients receive when they visit the Health Department, as a Public Health agency we also serve the community as a whole. School students, their parents and families and the faculty and staff are all part of the community we serve. Communities are only as healthy as the citizens that live there. We would like to partner with you to work toward a healthier community, fewer student absences, less staff absences from work, a reduction in chronic disease and a move toward healthier lifestyles. As the local Public Health entity we are extending the reach of the Department through the establishment of “CHOICE” Community Health, Outreach, Immunization, Clinics and Education. The program Coordinator will make an annual visit to your location with a clinical representative to discuss the specific needs of your organization and match them with the Public Health programs and services that can be provided on site to your employees. With the challenging economic climate and the rising cost of quality health care and dental services, Public Health can offer solutions that are often much less expensive than what can be provided through the private sector. With the ability to provide on-site services and programs, your organization does not lose valuable work time, and students do not lose class time. While we cannot meet all needs, please allow us the opportunity to come to your school and reintroduce Public Health to your agency. Together we can discuss the many Public Health programs and services available and the potential cost saving measures that may meet your needs and help the Health Department advance the agency mission of promoting health, preventing disease and protecting the health of the community. Sincerely, Jackie Morgan Health Promotions Director

22. UNION COUNTY HEALTH DEPARTMENT 1224 W. ROOSEVELT BLVD. MONROE, NC 28110 704-296-4800 WWW.CO.UNION.NC.US International Travel Vaccines now available The Union County Health Department now offers vaccines for residents traveling internationally. The below services are available by appointment only: R egistered nurse will review travel itinerary Registered nurse will provide immunization education and vaccination(s) Vaccination record will be provided To schedule an appointment call Lisa Amos at 704-296-4878 or e-mail lisa.amos@co.union.nc.us

23. Union County Health Department 1224 West Roosevelt Boulevard Monroe, NC 28110 704-296-4800 / Mon – Fri (8AM – 5PM) FREQUENTLY ASKED QUESTIONS Mission: To promote health, to prevent disease and protect the health of the community. What services do we offer? Breast and Cervical Cancer Control : women’s health program to provide screening services which include pap smears and mammograms for uninsured and underinsured women 55 and older. Child Health: children’s primary care provider, to include well child visits, immunizations, sick child visits. Additional children’s services; kindergarten physicals and sports physicals. Children can be seen from birth to 18 years of age. Care Coordination for Children: home visitation program for at-risk children identified and referred through the Health Department Child Health clinic and other county pediatric practices. A Social Worker will provide developmental screening and coordinate therapy and resources as needed. Communicable Disease Control: Services include sexually transmitted disease exams and treatments, Tuberculosis screening and treatment. Patient education is a major component of the prevention of communicable disease. Immunizations: services include a full range of pediatric, adolescent and adult immunizations. The immunization clinic can provide on-site targeted immunization clinics, (influenza, Tdap, international travel immunizations). Family Planning Services:women’s health for women of child bearing age, with a primary focus of birth control methods (pills, patches, Depo injection, IUDs, Implanon). An exam is required prior to receiving a birth control plan. Maternal Health: primary care for maternity patients, including pregnancy testing, prenatal lab work, exams, ultra sounds and a post-partum home visit with a nurse. None Stress Tests are available when the physician deems necessary. Maternity patients can be reassigned to High Risk Maternity based upon physician referral. High Risk Maternity: primary care for high-risk maternity patients with Diabetes, High blood Pressure, advanced maternal age, or a family history of pre-natal issues. Dental Health: full service dental clinic for adults and children 3 years old and up (cleanings, fluoride treatments sealants, x-rays, extractions, root canals, crowns, denture repairs / cleanings, pulpotomies, Night Guards) Women, Infants and Children (WIC): income basednutrition education program providing healthy supplemental foods for pregnant women, infants and children up to age 5. As part of the WIC program, breast feeding counselors provide support and education on breast feeding to new moms. Registered Dieticians are available for clients with special dietary needs. Diabetes Self-Management Program: educational program for diabetics and border-line diabetics, offering 8 hours of classroom instruction, one-on-one assessment and a follow up visit to monitor progress. The educational component is designed to provide knowledge and tools to gain control of your diabetes and establish a healthy lifestyle conducive to disease management. The program manager is a Registered Dietician. This program can be brought on-site with 5 or more participants. Health Education: educational presentations and materials on various health and wellness topics: workplace flu prevention, Re-think Your Drink, Healthy Homes, Parenting classes, Workplace Wellness Initiatives, workplace health screenings Is it free? The Union County Health Department is not free, but does offer services on a sliding fee scale, based upon income. What insurance or payment do we accept? Medicaid / NC Health Choice Accepted Private Insurances: Blue Cross and Cigna Other private insurances can be filed, and if payment is rendered, the patient will be reimbursed. Uninsured patients can pay in cash, debit card or credit card at the time of service.

24. Questions ? Contact : Lydia Lyon llyon@co.union.nc.us Amy Parker Parker@co.union.nc.us Phone Number 704-296-4800