Special Section: The COVID-19 Crisis

In this recurring section, Healthcare Innovation editors take an in-depth look into the numerous ways the COVID-19 pandemic is impacting the healthcare ecosystem. In this issue, we take a close look at the challenges and opportunities around vaccination education and outreach.

Washington’s Community Health Plan Goes Digital for ‘Greatest Patient Engagement Challenge’ Ever

Now that the COVID-19 vaccine is being rolled out across the country—still mostly to at-risk populations—healthcare organizations have arduous logistical challenges in front of them from the standpoint of controlling supply and distribution. But another issue—perhaps an unforeseen one—has presented itself as well. More and more market research has come out validating an unfortunate reality: many Americans are still skeptical of getting the vaccine this first go-around.

One poll’s findings that were released late last year, conducted by the de Beaumont Foundation and pollster Frank Luntz, in partnership with the American Public Health Association, the National Collaborative for Health Equity, and Resolve to Save Lives, found that just 60 percent of Americans said they were either “absolutely certain” or would “probably” get the vaccine if they could now. What’s more, the data showed that the groups least likely to say they were “absolutely certain” were Americans in rural/farm communities (26 percent), Republicans aged 18-49 (27 percent), Black Americans 18-49 (28 percent), and women 18-49 (29 percent).

For healthcare stakeholders, the importance of getting the right messaging and education out to patients, while combatting misinformation, has never been greater. Increasingly, to ramp-up their outreach efforts, organizations are turning to digital health companies for help. One such vendor, Arcadia, which provides a population health management and healthcare intelligence platform, is aiming to help its customers reach out to millions of patients to improve engagement for vaccinations and other important preventative care. More specifically, Arcadia Analytics is providing a platform for COVID-19 vaccination education and engagement, as well as for patient stratification and targeted outreach to high-risk patients and underserved groups, including support for multiple languages. The platform includes ongoing patient tracking and communications to ensure series completion, and reporting and analytics to track vaccinations and ensure equity in vaccine administration, according to company officials.

Arcadia’s Chief Medical Officer, Rich Parker, M.D., called the vaccination education and outreach effort “the single greatest patient engagement challenge of our lives.” What’s particularly discouraging, Parker explains in a recent interview, is that despite having an incredible opportunity to use one of the most successful vaccines ever created—noting that both the Moderna and the Pfizer vaccines have a 95 percent efficacy rate, as well as a great safety record—there is still too much resistance to the concept of getting the vaccine. “So [organizations] have to be creative with their outreach, and that’s due in part to the political climate that has intersected with the public health crisis, and the public health exigency of getting everyone vaccinated,” he says.

The service is provided to Arcadia’s healthcare organization customers, which are primarily health plans in this instance. One such entity is Community Health Plan of Washington (CHPW), which is rolling out the program to its members. CHPW is Washington State’s first not-for-profit health plan, and was formed to coordinate care and advocate for people who were not being served by traditional insurance companies.

The majority of the plan’s members are in Medicare and Medicaid programs, and over the last few months the company has been getting lots of inquiries from members about when it’s their turn to get the vaccine and where they need to go to get it, says Jennifer Polello, Community Health Plan of Washington’s senior director of quality and population health. While that interest is a good thing, one big priority for CHPW has been reaching out to underserved populations to make sure that they have enough information so that they’re prompted to get the shots when it’s their turn, Polello says.

Research has also revealed that communicating vaccine information and recommendations via patients’ providers should lead to more improved engagement and adherence. According to a December Kaiser Family Foundation (KFF) survey, 85 percent of patients trust vaccine information and recommendations their doctor or healthcare provider, while only 53 percent trust pharmaceutical companies, for comparison’s sake. Polello notes that CHPW was founded by 20 community health centers, so oftentimes the health plan will partner with a specific community health center for a specific community-based message, meaning that for the recipient patients, the information is coming from their trusted provider.

Speaking to the importance of leveraging data and analytics to track vaccinations and ensure equity in their administration, Parker offers that historically, if one were to ask the average internist or family practitioner how many of their patients have not gotten the flu shot, the response from the doctor might be a blank stare since he or she has no way of knowing the answer to that question. But Arcadia’s system can immediately answer it, while also figuring out where those patients who didn’t get their shots are located, and identifying general areas with lower vaccination completion rates. “And then we can do a text outreach program, which is pretty seamless, electronic, fast, and cheap,” Parker contends. “You couldn’t do any of that in the old days. So, in other words, technology has facilitated public health outreach,” he says.

Philly-Area Health Systems Work on Vaccination Outreach

Cooper University Health Care in Camden County, N.J., and Temple Health in Philadelphia serve some of the poorest neighborhoods in the country, and many of their patients come from underserved and minority communities that have been disproportionately affected by the pandemic. In recent interviews, their executives described how they are working to extend the reach of their vaccination efforts.

Tony Reed, M.D., chief medical officer at Temple Health, says that after setting up its vaccination infrastructure, his organization is starting to address the issue of people who are hesitant to get a vaccination. Reed was asked if he saw that as a public health department messaging issue or the responsibility of health systems. “I’m kind of a little on both sides of the street,” Reed says. “I’m a family doctor who has built a career in population health, so I look at it from the perspective of what are my responsibilities? I am the chief medical officer of a major inner city, underserved health system, and this is kind of a public health crisis.”

In Temple’s Center for Urban Bioethics, Reed says, there is a relatively young physician, who has her master’s in urban bioethics and studies hesitancy to get care. She began a project doing qualitative research on vaccine hesitancy, and is having conversations with patients. “We have an effort ongoing here in North Philadelphia, for those who are hesitant, for those who are concerned, for those who have questions. There’s an outreach program with community groups,” Reed says. The Center for Urban Bioethics is putting in a request for proposal with the city to do vaccinations out where patients are. At one of the local churches, “the pastor has put out a call from the pulpit for people to be vaccinated,” he says.

Temple Health installed Epic’s scheduling application, Cadence, in a couple of weeks to get patients scheduled for vaccinations. Reed says they tried to keep the deployment minimalistic, because they wanted it to be functionally simple for their frontline workers who were going to be using the tool. “If the person to be vaccinated was already a patient of Temple and already has a patient portal account, it would pre-populate the form. If they’re not, we set them up with a MyTemple account so that they get the reminders about the second dose,” he says.

Temple Health is connected to PhilaVax, the local public health department immunization registry. “That is integrated right into the patient’s medical record. So we are able to do that kind of push,” Reed says. “And for those who get vaccinated at other places, or for those employees that we vaccinated, who also have an Epic chart, the vaccination data goes from the PhilaVax back into Epic, so it closes the loop. We can add a filter to say, look, that person’s already been vaccinated, so don’t push out an invitation to them.” Epic says that it is supporting 100 sites running community-based mass vaccination locations across the country. These sites have the capacity to administer 300,000 vaccinations a day.

Reed notes one challenge will be once the vaccinations open up to healthy people at younger ages. “We’re going to have to figure out how to open up a call for invites to age 50 and up without overwhelming the phone lines and the scheduling process,” Reed says. “That’s the trick. That’s where we’re going to run into difficulty.”

Anthony Mazzarelli, M.D., co-CEO at Cooper University Health Care, says his organization is working both with the Camden County’s public health agency and Jefferson Health by extending the use of their Epic system to the mass vaccination site. “I think having health systems work together during this time of COVID has become increasingly less unusual,” he says. “We all want to get everyone vaccinated, so when Camden County looked for help in support of their vaccination site, both Jefferson and Cooper stepped up and we were more than happy to partner with Jefferson on that. We’ve helped not only with the logistics and organization, but with our Epic tools, not just for scheduling, but for the entire workflow.”

Cooper had begun vaccinating employees weeks before the larger vaccination site opened. “We were able to do a proof of concept and look at the workflows and understand how to maximize the technologies,” Mazzarelli says. “We knew we wanted to use the front end and scheduling that was in Epic. We set it up so that it’s got automatic submission of the vaccination data from Epic right to the state.”

Once the State of New Jersey opened up, essentially overnight, the number of people that qualified to get the vaccine, there was an extremely high demand. “I think we scheduled like 35,000 people in 24 hours,” Mazzarelli explains. “There was a real sprint in the very beginning.” Cooper is looking at new ways to reach out and register people who may not have computers set up in their home. “We are exploring some AI and automated solutions to assist large numbers of people, especially putting in multilingual voice channels,” Mazzarelli adds. “We want to scale up as quickly as possible to get shot in people’s arms. It’s always about how we can get that workflow better. So we used a check-in and welcome kiosk to shorten the registration time. We got that down to less than three minutes, so our end-to-end vaccination process, on average, is about 20 minutes, including the 15 minutes where they have to sit and wait afterwards.”

Right now there are so many people in New Jersey who qualify to get vaccinated that the Camden County site is already booked out until August or September. “We’re trying to add more slots if we can get more vaccine and we know that the state’s trying to get more. The bottleneck is on the supply side right now,” Mazzarelli says. “That being said, we do want to make sure we get to harder-to-reach groups. So we’re currently planning some pop-up vaccination sites in the City of Camden in communities that are a bit resistant to the vaccine. We’re working with the State of New Jersey to plan those now.”

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