Note: At the time of the provided case studies, the UpToDate engagement and education solutions were called Emmi.
Despite the well-known and often articulated value of annual flu shots, vaccinations rates in the U.S. frequently hover at around 50% of the population, less than the Centers for Disease Control and Prevention’s (CDC) advised maximum protection standard of 70%.
Pharmacists, providers, and payers in the U.S. prepare annually for vaccine season expecting the typical 50% population uptake of the influenza vaccine that the CDC has tracked. This is generally considered good enough to keep the majority of the population protected and ease the burden on the healthcare system.
Because the CDC estimates adults aged 65 and above account for 70-85% of seasonal flu-related deaths and 50-70% of seasonal flu-related hospitalizations, it especially important for providers and health plans to engage this population during flu season.
Closing gaps in care related to influenza vaccines
According to the Wall Street Journal, in the decade prior to the pandemic, there were several years in which the vaccination rate dipped below that 50% threshold, occasionally hitting as low as 42%. From 2022 to 2023, Star Ratings for Medicare Advantage contracts saw performance related to annual flu vaccines drop nearly a point.
The Hill tracked flu vaccinations from 2019 through November 2021, and found that child flu vaccinations stayed steady at 40%, but adult coverage across all 50 states and Washington, D.C., saw a notable decrease during that time, with per-state ranges from 18.9% to 35.6%.
The reason for some of this decline, according to a 2021 study in Research in Social and Administrative Pharmacy, is an increase in vaccine hesitancy in adults ages 18 to 49. Among those surveyed who did not or would not get flu shots, the study reported that about 20% said they believed the shot gave them the flu (despite that being an incorrect assumption) and about 38% said that they did not believe it would help. The researchers posited that those beliefs arose from the participants having been exposed to misinformation and from the individuals’ (possibly faulty) perceptions of their general health and vulnerability.
Evidence-based education and non-judgmental professional outreach could be essential steps to re-engaging these patients and members and helping overcome the misinformation and cognitive bias that is leading to increasing rates of vaccine hesitancy.
Awareness is key to better vaccination rates
National Influenza Vaccination Week is observed December 4-8 this year, and it is an ideal time to focus on outreach, awareness, and education of the risks and benefits of influenza vaccinations. These types of engagement initiatives can:
- Protect patients and members with chronic health conditions
- Lower risk of hospitalizations associated with flu
- Improve overall population wellness
These stories of how targeted influenza vaccination patient engagement and outreach show how three healthcare organizations changed outcomes for their communities.
Enhancing patient adherence and documentation for flu vaccines
Triad HealthCare Network (THN) in Greensboro, NC, was facing challenges scaling their operations to close the gaps in care related to the influenza vaccine due to a two-pronged patient problem:
- Lack of the vaccine being administered
- Or lack of documentation of vaccinations administered outside their facility
The administration was concerned knowing that the CDC reported:
- Influenza vaccination can reduce the risk of flu-associated hospitalization for children and adults but is a crucial prevention tool for those chronic health conditions.
- Influenza vaccine lowers the risk requiring a doctor’s care during flu season by 40% to 60%.
THN implemented UpToDate® Outreach interactive voice response (IVR) engagement solution to reach out to its population who either had not had a flu shot or lacked documentation of a flu vaccine in their medical records. Over the course of the campaign, 6,737 patients received IVR calls powered by conversational AI. The calls informed patients of the importance of vaccinations and asked them to report whether or not they’d been vaccinated yet. All these responses were recorded by the IVR system and provided back to THN.
The automated campaign was cost-effective and scalable for THN, while providing a gentle, nonjudgmental, and easy reminder for patients, underlining the importance of the vaccination. At the end of the campaign, the impact of patient engagement and documentation was evaluated:
- 34% (2,270) of the targeted patients engaged with the program
- 53% (1,119) of the patients who engaged documented they received the vaccine
Improving CMS ACO rankings through patient engagement
Another health system in the Southeastern U.S. was facing a similar conundrum in trying to identify if flu vaccine care gaps were due to members failing to get vaccinated at all or simply members failing to report and document their vaccinations.
This health system was also looking to improve its performance in a key quality metric. The Center for Medicare and Medicaid Services (CMS) quality performance benchmarks for accountable care organizations (ACOs) aim to accomplish policy goals, such as promoting ACO participation, developing incentives to reduce healthcare spending, and achieving program fiscal objectives. One of those objectives includes a measure for increased adherence to influenza vaccines.
The health system used UpToDate IVR campaigns to contact specific patient populations from two practices within the system, targeting 1,270 patients with missing vaccination records. The program’s messaging was designed to:
- Improve documentation by offering a convenient method to do so on the call
- Educate patients on the importance of vaccinations
- Encourage vaccination scheduling
The health system experienced the following results from the targeted populations who had no influenza vaccine documentation:
- Compliance for practice one increased from 51% to 65%
- Compliance for practice two increased from 57% to 67%
- The average compliance for both practices increased from 54% to 66%
- This resulted in a 10% increase in CMS ACO Ranking from the 50th to 60th percentile
Vaccine adherence improves with interactive voice recognition and video education
When Centura Health system was looking to improve influenza vaccine adherence and documentation, they wanted to go beyond an IVR outreach program to improve population health year-over-year.
The health system has locations in Colorado, Utah, and Kansas and set up a campaign targeting 31,862 patients and members with options for both IVR outreach phone calls and multimedia education by email. Both engagement options offered information about the importance of flu vaccinations, with multimedia, interactive programs from UpToDate Engage providing content in plain language with easy-to-understand visual learning cues, helping to drive patient understanding and action. The IVR calls offered a convenient mechanism by which patients who had already had flu shots could simply document their immunization for their health record over the phone.
Centura found the combined program cost-effective and scalable, and the health system observed that patients and members who interacted with the program were more likely to document their flu vaccines:
- 89% of patients (28,258) had an email address on file and were sent a multimedia program to watch.
- 11% of patients (3,504) provided both an email and phone number and received both a multimedia program and an IVR call.
- Increased vaccination documentation – Patients who did not interact with the programs documented their flu vaccine at a rate of 28%, whereas those who did engage documented their flu vaccine at a rate of 35%.
- Improvement in engagement – Overall, patients who received both a multimedia program and an IVR call experienced a 25% year-over-year improvement in flu vaccine documentation compared to unengaged patients.
Combating influenza: Innovative solutions for healthcare providers and patients
Member and patient engagement is an important tool in overcoming vaccine hesitancy, and studies have shown that educational intervention can correlate with influenza vaccine improvement. Payers aiming to protect older, at-risk populations may see increased adherence when using an engagement platform.
As these three health systems learned, engagement campaigns and scalable outreach can make a significant impact in influenza vaccine uptake and combat declining rates to improve overall population health, protect at-risk patients and members, reduce hospitalizations and strain on the healthcare system, and boost key performance metrics.
Learn more about how UpToDate Outreach can help your patient and member community engagement efforts.
