MODULE 5 – Expanding the Reach of VFC and AFIX through Marketing and Collaboration

http://www.cdc.gov/vaccines/programs/vfc/default.htm  
 http://www.cdc.gov/vaccines/programs/afix/default.htm

Marketing and Collaboration

The purpose of this module is to provide immunization programs at both the state and local level with basic information and ideas on how to market VFC and AFIX and establish collaborations with other organizations to expand participation in VFC and AFIX activities. Effective marketing and collaborations for both VFC and AFIX programs can improve the quality of immunization services at the provider level. Marketing, when applied to provider education on proper storage and handling practices and VFC program requirements, will ensure that all VFC vaccines that reach eligible children are viable and wastage is eliminated. Collaboration with other organizations with similar immunization-related goals and objectives can assist immunization programs in reaching more eligible providers and improving the quality of both organizations' programs.

AFIX Standards
The Program Operations component of the Level I AFIX Standards (which grantees are required to achieve by 2008) requires all AFIX programs to develop measurable long- and short-term objectives for their programs. Standard #9 requires development of clearly defined methods for contacting outside agencies and exploring the possibility of collaborating on quality improvement activities and/or marketing AFIX. (http://www.cdc.gov/vaccines/programs/afix/stds-guide.htm)

A project might develop an AFIX program objective that focuses on a marketing plan to reach VFC providers who are not participating in AFIX. One method for accomplishing this objective is through collaboration with insurers, which would also aid in achieving several of the nine AFIX Level I Program Operation Standards. 

The VFC program might focus its marketing and collaboration activities on a specific effort, such increasing the number of VFC-enrolled providers that meet all VFC storage and handling requirements.

What is Marketing?
"Marketing" means all the activities associated with identifying the particular wants or needs of a target customer and then satisfying those wants or needs of the customer better than the competitors. While the VFC and AFIX programs do not have competition for the services offered, their customers (the providers) have many competitors for their time. For the VFC and AFIX programs to secure office time, the programs must be able to market themselves successfully. This involves doing research on your customers, and then making strategic decisions about product, price, promotion and distribution.
In the case of the VFC and AFIX programs, the product marketed is improved immunization coverage levels and reduction in vaccine-preventable diseases (VPD) through participation in both programs. Optimal provider participation in the VFC program ensures that viable vaccines are administered correctly to VFC-eligible children. Optimal provider participation in the AFIX program ensures that systems are in place in the practice so eligible children receive all necessary vaccines on schedule. Ultimately, the product being marketed is the health of children within a community through prevention of morbidity and mortality related to VPDs.
The price of participation in the VFC and AFIX programs is the cost to a provider to change some behavior. This might be stopping an existing practice, such as inappropriate storage or handling of a vaccine, or adopting a new practice, such as agreeing to the requirements of the VFC program. A key selling point of both the VFC and AFIX programs is that participation is free. The VFC program has an added bonus of providing vaccine at no cost to the enrolled provider. This key component now makes it easier for VFC-eligible children to remain in their medical homes for all medical services and not receive fragmented care based on ability to pay or insurance coverage. A key selling point of AFIX participation is the availability of the knowledge and experience of the AFIX staff to assist the provider in making behavioral changes to improve immunization coverage levels.
Promotion is the most recognizable component of the marketing process. This is the advertising of the product. Promotion does not require an elaborate or costly media campaign. Effective word of mouth and one-on-one conversation can be more effective than a flashy and expensive media campaign. The development and effective use of an "immunization champion" in the eXchange of Information component of the AFIX process provides an excellent forum for promoting Continuous Quality Improvement (CQI). First-person testimonials from a recognizable professional from the community whose practice has gone or is going through the AFIX process to improve immunization coverage levels will have far greater impact than a mass mailing or media spot. Promotion of the VFC program should focus on the benefits of participation in the program. The approach should be multifaceted to include the financial benefits to the provider, benefits to the provider's patients, creating a medical home, and staff development benefits related to receiving education on all aspects of immunizations.
Distribution is the process of actually delivering the goods and services to your customer. The distribution of the VFC and AFIX programs should be twofold, with special focus on the needs of enrolled providers and their staff and on recruiting new providers to participate in the programs. Distribution requires that immunization programs are able to give providers what was promoted during the marketing of VFC and AFIX. This aspect of marketing focuses on providing good customer service and following up on the needs of the enrolled providers.
What is Collaboration?

Collaboration has been defined as the process of various individuals, groups, or systems working together but at a significantly higher level than through coordination or cooperation. Collaboration typically involves joint planning, shared resources, and joint resource management.
(Reference source: http://www.nccev.org/resources/terms.html#Collaboration) 
Collaboration on VFC or AFIX issues requires research by immunization programs on what organizations in their geographic location have similar or common goals or objectives. The research can be conducted formally or informally. If VFC or AFIX coordinators have extensive professional experience in the community, their research may involve telephoning or sending an e-mail to a long-standing colleague to schedule a meeting over lunch to discuss immunization objectives for the coming year. For new project staff, or staff without a strong established network, more formalized research on possible collaboration partners might be required. One way to do this is to list all organizations you are aware of that have an interest in improving immunization delivery to pediatric populations in your geographic area. Once you have made a list, conduct research on each organization. A good place to start is the organization's website. Review mission statements, goals and objectives and look at sub-sites such as quality improvement, studies and statistics, and clinical indicators. If the organization has compatible goals, find the name of an individual to contact. Target those organizations for collaboration that have the most focus on improving immunizations.

Who is the Target?

The target for marketing and collaboration may be one population or multiple populations depending on the project's objectives for the VFC and AFIX programs. Examples for marketing might be new providers in the community or institutions such as juvenile detention centers. For collaboration, targets might be chapters of national professional organizations of pediatric physicians or nurses.

How Do We Get Started?

                        Often with marketing and collaboration activities the first step is the most difficult. Without breaking down marketing and collaboration into smaller steps, the tasks may seem too overwhelming to implement. The following steps are the same for marketing and collaboration. The steps will assist you in developing and implementing a marketing and/or collaboration plan for your VFC and/or AFIX programs:

Step 1	Determine your objective and your target audience. For example, your objective for the year may be "Increase the number VFC-enrolled providers who receive an initial AFIX evaluation by 20 providers by December 31 20__." 

Step 2	Select and research which providers you want to target to receive an initial AFIX visit during the year. It is a good idea to select a larger number of providers than stated in the objective so there is a better chance of achieving the stated objective. Determine if the targeted providers have ever been offered AFIX visits in the past, and if they have declined, what was the reason for declining the AFIX visit? Determine if the reasons given for declining the AFIX visit can be adequately addressed and resolved. If so, incorporate the solutions into the marketing plan. If not, work on ways to communicate the advantages of participating in the AFIX program and how they surpass the inconvenience to the practice.

	For collaboration activities, make a list of potential partners. Focus on both well-known partners such as the state Medicaid agency, and lesser known potential partners, such as commercial insurers, professional organizations (state chapters of AAP, AAFP and the state nurses' association) and all types of academic institutions with medically related programs (e.g., schools of nursing and technical schools that train medical assistants). Be prepared to communicate how collaboration activities would mutually benefit both the AFIX programs and the potential partner organizations.

Step 3	Develop a written plan for marketing AFIX or plan to recruit other organizations for potential collaboration activities. When developing a marketing plan, focus on addressing each of the components of marketing: product, price, promotion and distribution. When developing collaboration plans, include identifiable common goals, benefits of collaboration, the cost of collaboration in terms of commitment of time and resources, and highlight the expected outcomes focusing on the return on investment.
	
Step 4	Begin to implement marketing plan and/or collaboration plan to target audience or organization.

Step 5	Review and revise the marketing and/or collaboration plan as necessary based on successful recruitment of providers or partners. It is important to document any changes made to the plans in writing to maintain an accurate record of how the plan evolves and the impact of the changes to the success of the plan.

Step 6	Schedule selected providers for AFIX visits. For collaboration partners, schedule meeting to discuss further steps for implementation of collaboration activities.

Step 7	Repeat Steps 1–6 at least on an annual basis.

Resources to Assist with Marketing and Collaboration

•	The Community Tool Box: University of Kansas- Lawrence, Kansas
	Website:  http://ctb.ku.edu/  
•	Immunization Action Coalition 
      Website: http://www.immunize.org/ 
•	Assessment Feedback Incentives and eXchange of Information (AFIX) Strategy
      Website: http://www.cdc.gov/vaccines/programs/afix/default.htm
•	Vaccines For Children (VFC) Program
       Website: http://www.cdc.gov/vaccines/programs/vfc/default.htm