Nonprofit health plan CMOs: Data sharing needed to drive vaccine equity

Editor’s note: Connie Hwang is the chief medical officer and director of clinical innovation at the Alliance of Community Health Plans and Edward McEachern is the executive vice president and chief medical officer at PacificSource Health Plans.

With multiple COVID-19 vaccines available and more than 2 million shots being administered daily, one in three Americans are now fully vaccinated against the virus. Yet, progress has been uneven. Vaccination rates among the White population is nearly 1.4 to 1.5 times higher than rates among Hispanic and Black individuals. While rural residents outpaced suburban and urban residents in early self-reported uptake of COVID-19 vaccines, fewer rural residents now say they are planning or considering vaccination.

To achieve vaccine equity and approach herd immunity, healthcare organizations need access to timely, comprehensive vaccine data. Unfortunately, data regarding who received a vaccine, which brand and when resides in a patchwork of databases across public health departments, healthcare systems and health plans. The inability to synchronize and share this data raises the risk for critical populations who need COVID-19 support, testing and vaccinations.

Many health plans have limited or no access to state immunization information systems, which are experiencing their own struggles in capturing the latest data. Nonprofit health plans, which have been on the front lines of the pandemic, coordinating care and committing workforce and financial resources to combat this crisis in our communities, must piece together who has received vaccinations by tapping into various regional health information exchanges and cobbling together data from multiple external sources.

Greater access to COVID-19 vaccine data will strengthen our ability to vaccinate those in our communities most at-risk for COVID-19 infection and poor outcomes. State governments should grant health plans access to state immunization registries for the express purpose of obtaining COVID-19 vaccine data for specific plan enrollees. We saw this work in Massachusetts when the state issued an executive order allowing data sharing between its Massachusetts Immunization Information System and commercial health insurers. More states should follow suit.

For greater impact, the federal government should provide health plans access to the Centers for Disease Control and Prevention’s Vaccine Administration Management System (VAMS), which was originally intended for management of vaccine clinics, including those run by health systems and pharmacies. While VAMS has limitations on sharing patient-level information, healthcare entities could use the data to target and close vaccination gaps.

In the absence of comprehensive data sharing, health plans are constrained in vaccine efforts, relying upon lagging claims data. Most are not receiving any substantial direct billing claims for COVID-19 vaccinations.

For example, through June 2, 2021, despite multiple kluged data feeds,  PacificSource had received data for members that represented that 35.6% of our members in Oregon had had any vaccine, when the state database shows 61.7% of our members have had any vaccine.  Said differently, despite best efforts with many data feeds, health plans are seeing only about 58 percent of the data on vaccines necessary to be effective community partners. 

Health plans are working to close the vaccine equity gap. PacificSource teams utilize race, ethnicity, language and disability data to target outreach to those most likely to have vaccine hesitancy and/or access issues. In collaboration with providers and community partners, PacificSource shares prioritized risk lists and coordinates real-time calls to help individuals find vaccine appointments and transportation. When HealthPartners identified racial discrepancies between White and non-White vaccination rates, it established vaccine locations easily accessible by public transportation, offered multi-lingual resources, communicated through social and news media in collaboration with trusted community partners, and contacted patients with translation services for Hmong, Somali, Spanish or Vietnamese interpreters.

Public health data infrastructure is long overdue for enhancements in interoperability and vaccine data exchange across providers, health systems and other public agencies. After a long year and deep losses due to the COVID-19 pandemic, optimism in the U.S. is finally on the rise. Yet we suspect that this effort is just the start of a much longer vaccination process that might look like traditional annual flu vaccinations. For the longer term, the focus should be on two tasks: First, develop a comprehensive strategy and sustainable investments in vaccination data tracking to strategically prepare for future variants and pandemics; and second, enable health plan access to more timely vaccination data so that plans can partner with providers and communities to advance vaccine equity and speed our collective emergence from the pandemic.