Module 1	Introduction	Unit 1 IIS Sustainability Toolkit Introduction
Module 2	Getting Started	Unit 1 How to Use this Toolkit
Module 3	Defining IIS Sustainability	Unit 1 What is IIS Sustainability and Why Does it Matter?
Module 4	Strategy 1: Diversifying Funding	Unit 1 Diversifying Funding Introduction	Unit 2 Approach A. Leveraging Medicaid Match	Unit 3 Approach B. Billing for IIS Data
Module 5	Strategy 2: Optimizing IIS Efficiency	Unit 1 Optimizing IIS Efficiency Introduction	Unit 2 Approach A. Increasing the Use of Shared Services	Unit 3 Approach B: Leveraging Shared Infrastructure	Unit 4 Approach C: Using Open Source Software	Unit 5 Approach D. Implementing Process Automation	Unit 6 Approach E: Modernizing IIS
Module 6	Success Stories from the Field	Unit 1 Success Stories Introduction	Unit 2 Using Medicaid Match to Diversify IIS Funding	Unit 3 Diversifying IIS Funding Through Health Plan Billing	Unit 4 Slowing the Curve to Manage Rising IIS Costs
Module 7	Additional Considerations	Unit 1 Additional Considerations
Module 8	Additional Resources Related to Sustainability	Unit 1 Additional Resources
Module 9	References	Unit 1 References
Module 10	Abbreviations and Acronyms	Unit 1 Abbreviations and Acronyms

Stories from the Field

Diversifying IIS funding through health plan billing

Louisiana Department of Health

At a Glance

Challenge: Rising immunization information system (IIS) maintenance and operational costs outpaced available federal immunization funding, creating a need for new, sustainable revenue sources.

Approach: The Louisiana Department of Health (LDH) began billing for IIS data requested by commercial health plans for Healthcare Effectiveness Data and Information Set (HEDIS) reporting, supported by leadership approval, legal review, and stakeholder engagement.

Revenue impact: Since implementation, the program has generated substantial annual revenue (approximately $690,000 midway through Fiscal Year 2026) to support IIS staff and system sustainability.

Key takeaway: A collaborative, data-driven approach, paired with strong leadership support and clear fiscal processes, can successfully convert IIS data services into a sustainable funding stream.

Public health challenge

By 2017, Louisiana became one of many jurisdictions facing increasing IIS maintenance costs while traditional funding sources remained static. The IIS had been providing support for HEDIS reporting to health plans at no cost, despite growing system and staffing expenses.

As maintenance costs increased, program leadership recognized that continuing to provide high-volume data services without reimbursement was not financially sustainable. The challenge was to:

Identify a legally permissible funding mechanism
Avoid the perception of “profit-making”
Maintain strong relationships with providers and partners
Ensure any new revenue would be retained for IIS sustainability rather than absorbed into general state funds.

Approach

Securing legal and leadership approval

Louisiana first confirmed through legal counsel that billing for IIS data was permissible. The team then:

Engaged immunization leadership and advanced approval up to the Deputy Assistant Secretary and ultimately the Secretary of Health
Identified a leadership champion to guide the process and support approval
Used Lean Six Sigma methods to calculate the true per-record cost of generating data for HEDIS
Developed a detailed cost analysis, including staffing time, system maintenance, and module costs, to justify a proposed per-record charge

Establishing a pricing model

After internal negotiations, Louisiana adopted a $0.50 per-record charge for commercial health plan IIS bulk data requests.

Key features of the model:

Billing applies only to commercial health plans, not Medicaid (which was already supporting the IIS through match funding)
Health plans submit covered member files in a required format; IIS staff match, process, and return files with immunization records
Billing is tied to a reference number generated through REDCap to ensure tracking and accountability for files submitted and returned
An invoice is generated for immunization records in files returned, and payments are deposited into a fund with a dedicated reporting category to ensure funds are accessible to the IIS program

Creating a dedicated fiscal category was critical to prevent the absorption of revenue into general funds.

Proactive partnerstakeholder engagement

To maintain trust and transparency, Louisiana took the following steps prior to beginning to bill for IIS data:

Sent advance letters to health plans, the state AAP chapter, medical societies, and other partners
Conducted Q&A discussions to address concerns
Emphasized that the goal was system sustainability, not profit generation

The framing was collaborative: billing would enable the IIS to continue fulfilling bulk data requests, thereby preventing administrative burden on health plans. Without the IIS data returned in the files, plans would spend months manually looking up individual immunization records in the IIS and following up with providers. Notably, the IIS program reported no significant pushback once implemented.

Leadership support at every level was critical to making this model work.

Financial results and sustainability impact

Beyond implementation, Louisiana’s billing approach has produced measurable financial returns that strengthen long-term IIS sustainability. This change is evidenced by the following:

Midway through the current fiscal year, Louisiana has generated approximately $690,000 in revenue
Revenue supports IIS staff and operational sustainability
While record request volume declined after implementation (as plans more carefully scrutinized and adjusted requests in light of being billed for records), the model remains a substantial funding stream

Importantly, Louisiana also noted that this revenue can potentially be used as a state match for Medicaid funding, further amplifying sustainability opportunities.

The revenue now supports staff and helps stabilize IIS operations.

Key takeaways

- Confirm legal authority first. Engage legal counsel early to ensure billing mechanisms are permissible.
- Use data to justify pricing. Conduct a transparent cost analysis to support per-record charges.
- Engage leadership champions. Approval at multiple levels, including executive leadership, was critical.
- Communicate collaboratively. Early outreach to health plans and provider partners minimized resistance.
- Protect the revenue stream. Establish a dedicated fiscal reporting category so funds are accessible to the IIS program.
- Start modestly. Even a $0.50 per-record charge can generate hundreds of thousands of dollars annually.
- Consider match leverage. Revenue generated from billing may support Medicaid match requirements, further strengthening financial sustainability.

Why it matters

Louisiana’s experience demonstrates that billing health plans for IIS data, when implemented collaboratively and strategically, can transform a previously uncompensated service into a durable, diversified funding stream that strengthens long-term IIS sustainability.

Diversifying IIS Funding Through Health Plan Billing