Strategy: The Tennessee immunization program developed an Intensive Onboarding Initiative (IOI) that provides personalized, one-on-one support to birthing hospitals during the Vaccines for Children (VFC) enrollment process. The strategy emphasizes relationship building, one-on-one technical assistance, and proactive communication to streamline enrollment and improve participation.
Challenge: Enrollment in the VFC program can be a complex and time-consuming process for hospitals, particularly birthing hospitals. Because nearly all infants are born in a hospital setting, birthing hospitals play a critical role in providing newborns with timely access to immunizations before discharge. Vaccines and immunization products such as the hepatitis B vaccine and respiratory syncytial virus (RSV) monoclonal antibodies (mAbs) are available through the VFC program and are most effectively administered shortly after birth. Enrolling birthing hospitals into the VFC program helps reduce missed opportunities for immunization, promotes equitable access regardless of insurance status, and supports higher vaccination coverage rates.
However, hospitals face barriers to VFC enrollment. Providers are required to complete extensive documentation and enter information into multiple systems, including REDCap, the Tennessee Immunization Information System (TennIIS), and the Routine and Emergency Vaccine Management Plan (REVMP). Many hospitals experienced delays in the VFC enrollment process due to limited staffing, competing priorities, and confusion regarding enrollment requirements. Additionally, many hospital pharmacies utilize sophisticated electronic systems designed to streamline inventory management, ordering, and reporting; however, VFC requirements often rely on manual documentation, paper-based forms, and navigation across multiple platforms that are not integrated with existing pharmacy workflows. This mismatch created additional administrative burden and required staff to spend considerable time gathering and manually transferring information. As a result, incomplete or inaccurate applications frequently required repeated follow-up communications, document revisions, and corrections, further extending enrollment timelines and delaying provider participation in the program. Birthing hospitals also faced challenges related to staff turnover, maintaining vaccine coordinators across shifts, equipment costs, reimbursement concerns, and payment challenges for RSV mAb products. Collectively, these barriers limit VFC participation and reduce newborn access to recommended immunizations.
Solution: To address these challenges, the Tennessee immunization program created the Intensive Onboarding Initiative (IOI), a high-touch enrollment support model designed to guide providers through each step of the VFC enrollment process. Through scheduled one-on-one virtual meetings lasting 30 to 60 minutes, enrollment staff provide real-time assistance with paperwork, explain program requirements, and walk providers through enrollment platforms. The initiative employs a multidisciplinary approach that includes collaboration among the VFC director, enrollment specialists, temperature monitoring experts, vaccine ordering staff, and regional immunization representatives. Birthing hospitals are prioritized throughout the enrollment process and receive regular follow-up through phone calls and emails. Additional support includes on-site visits, assistance with digital data logger setup, vaccine ordering guidance, and opportunities to connect with already enrolled birthing hospitals for peer-to-peer learning.
Outcome: The IOI has improved Tennessee’s ability to engage and enroll birthing hospitals in the VFC program. Of Tennessee’s 56 birthing hospitals, 11 were enrolled in the VFC program as of April 2026, including four hospitals enrolling through the IOI process since Fall 2025. Beyond enrollment gains, the initiative strengthened relationships between providers and the immunization program by validating provider concerns, increasing communication, and offering tailored assistance. Feedback from participating hospitals highlighted the value of personalized support and collaborative problem solving. Tennessee also implemented surveys and site visits to gather provider input and identify opportunities for continuous improvement. Concurrently, RSV immunization administration increased substantially across the state, rising from 11,444 doses in the 2023-2024 season to 32,940 doses in the 2025-2026 season.
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