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Vaccine Hesitancy Among Health Plan Member Populations Affects Quality Performance Ratings

by Jacques Boschung, President & General Manager, Payer Business, on August 10, 2021
Jacques Boschung, President & General Manager, Payer Business

Vaccine hesitancy has been center stage since the recent COVID-19 pandemic – this is also among health plan member populations. This hesitancy comes from a variety of factors, including poor public awareness, misinformation, costs, access, and other issues related to the Social Determinants of Health. Healthcare organizations are now seeking ways to increase targeted communication and education on safety and efficacy and expand access in populations that are experiencing vaccine hesitancy.

We all know that skipping or delaying these vaccines can lead to serious health consequences for children and unvaccinated adults. Not to mention, the costs associated with one-third of all-American families failing to adhere to a recommended schedule. Yet, some healthcare providers make lackluster recommendations that serve as another obstacle for vaccine adherence – that isn’t too surprising. A recent study published in the American Journal of Managed Care (AJMC) indicated that many providers lack familiarity with CDC/Advisory Committee on Immunization Practices (ACIP) immunization recommendations. Only 60% of physicians and 56% of physicians’ assistants, nurse practitioners, and registered nurses reported using official guidelines to inform their decisions regarding adult immunizations.1 But another thing to consider is how it impacts the quality scores for many healthcare organizations and entities.

What are quality star ratings? 

It’s exactly what it sounds like – a rating to reflect quality in healthcare.

How is this measured? The National Committee for Quality Assurance (NCQA) developed Healthcare Effectiveness Data and Information Set (HEDIS) measures as a tool for performance improvement. There are several HEDIS® measures designed to indicate quality. The Centers for Medicare and Medicaid Services (CMS) created the Medicare Advantage Five-Star Quality Rating System to measure the quality and reflect the experiences of beneficiaries enrolled in health plans, including national programs like Medicaid  Public Health, Medicare Health, Children’s Health Insurance Program (CHIP), etc. CMS Star measures are comprised of dozens of performance measures from HEDIS®, Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures collected by the U.S. Department of Health & Human Services (HHS) Agency for Healthcare Research and Quality (AHRQ), the Health Outcomes Survey (HOS) (which reports on patient-reported outcomes), Prescription Drug Program and CMS administrative data. Both NCQA and CMS have measures for childhood and adolescent immunizations in their systems.

Low quality scores can impact member enrollment, retention rates, and the public’s trust in how well a health plan will meet the needs of the members they serve. Inovalon’s recent white paper by our Chief Medical Officer, Dr. Paige Kilian, provides a deeper understanding of how vaccine adherence among health plan member populations can impact quality performance ratings.

So, how can health plans increase vaccine adherence and ultimately improve quality scores? Inovalon recommends that health plans utilize a data-driven member outreach program that informs targeted disease and vaccine education efforts to promote awareness and uptake of recommended immunizations in support of improved health outcomes.

The bottom line, vaccines benefit both public health and health plans. We believe that increased awareness will lead to greater adherence, improved health outcomes for members, and consequently better quality scores for the healthcare entities.

1. Jacques Boschung. Inovalon’s Vaccine Adherence Program: Winning Strategies for Overcoming Barriers to Vaccination https://www.inovalon.com/inovalon-insights-blog/vaccine-adherence-winning-strategies-overcoming-barriers-vaccination/

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