ACAP Letter Highlights Vaccine Distribution Challenges
In a Feb. 3 letter to Jeffrey Zients, the White House COVID-19 Response Coordinator, the Association for Community Affiliated Plans (ACAP) highlighted several challenges its members face. For example, the plans do not have access to the CDC’s Vaccine Administration Management System (VAMS), which could help them find members who have not been vaccinated as well as remind members about the necessary second dose.
ACAP is a trade association representing 78 not-for-profit safety net health plans, serving more than 20 million people through Medicaid, Medicare, the Marketplaces, and other publicly supported coverage programs.
The letter states that many plans are not getting sufficient guidance from state or local officials on how they can help facilitate vaccine distribution and administration. Plans report a lack of information and general confusion about the logistics and availability of the vaccine. In the span of a week, for example, one plan reported that the eligibility criteria for getting the vaccine changed three times; this led to higher demand which could not be met and appointments had to be cancelled.
Plans report that in some states there is no centralized mode to register for the vaccine. Healthcare organizations are standing up their own clinics and members must register individually at each website; this decentralization makes it harder for many members to navigate. On the other hand, another state has a centralized vaccine appointment site (although it still requires someone to call each place to make an appointment) but the traffic is so high that providers are removing themselves from the site because they are not able to manage the volume of calls/emails.
In other issues related to data access issues, ACAP said that when plans have access to state immunization registries (which is not in every state), they are often only monthly or quarterly feeds; they do not have daily access and often the data are incomplete or out-of-date.
The use of claims data is not sufficiently timely and often does not include pertinent race or ethnicity information, ACAP added. Several plans are working with state or regional health information exchanges or other sources of clinical data to get vaccine information to providers/plans on a faster basis.
Several plans are reporting that Medicare and Medicaid homebound populations have not been included in a prioritized category for vaccine roll-out. Additionally, it will be challenging to get them the vaccine, because it is difficult for home-bound individuals to travel to outpatient centers to be vaccinated, and the need to keep some of the vaccines at very low temperatures complicates the ability of providers to vaccine these individuals in their homes, ACAP said.
To help achieve greater equitable distribution of the vaccine, ACAP recommended that the CDC and states prioritize and help facilitate vaccinations for home-bound members, people living with HIV, Medicare enrollees under age 65, and other vulnerable populations.
ACAP noted that plans are seeing substantial vaccine hesitancy on the part of members as well as front- line workers/LTSS staff. (One plan reported seeing only 40 percent of nursing home workers getting the vaccine.) This may be an opportunity to use incentives, it said. The organization suggested that the administration needs to provide information about effective strategies for how state/local agencies, health plans, and providers can help overcome vaccine hesitancy.
