Bruce Hadloc, AMGA:

It is now my pleasure to introduce and turn the presentation over to Michelle Monnier, Health Systems Marketing Director with GSK, who will introduce today’s presenters.

Michelle:

Thank you so much, Bruce, for the introduction and good afternoon everyone. I am so pleased to have the opportunity to kick off today’s session on a topic of critical importance, overcoming barriers to adult immunization. As mentioned, GSK is sponsoring this event as part of our shared commitment to advancing public health and ensuring that adults have equitable access to essential vaccines. We are a global bio manufacturer company with uniting science, technology and talent to get ahead of disease and positively impact the health of millions of people worldwide. We do this by preventing and treating disease through innovation in vaccines and specialty medicines. Today’s discussion is a key part of that mission, as we explore the challenges and opportunities in increasing adult immunization rates. To lead us in this important conversation, we are honored to have Dr Alex Schnibben from the Northeast Georgia Physicians Group. Dr Schnibben is a board certified ambulatory care pharmacist and brings a wealth of knowledge and experience from her role as Director of Clinical Quality and Ambulatory Pharmacy Services. Dr Schnibben has spent years providing direct patient care to individuals with chronic conditions, including preventative screenings and vaccines. Throughout her career, Dr Schnibben has been a strong advocate for equitable access to vaccines by raising awareness, providing education, and successfully developing vaccination program implementation strategies on both a local and regional level. Dr Schnibben will share GSK-provided content as a compensated spokesperson, as well as her own presentation and based on her experience developing and implementing vaccination programs. Thank you so much. And now we’ll turn it over to Dr Schnibben.

Dr Schnibben:

Yeah, absolutely Michelle. Thank you for that great introduction. Um, I love vaccinations. That’s something I’m very passionate about. Population health is extremely important, so I’m excited to, um, partner with AMGA and GSK today to talk a little bit more about overcoming barriers to adult vaccinations. Um, we will talk about a case study this afternoon from my physicians group over looking at three seasons of data associated with RSV-LRTD, adult prevention for adults.

So I’m excited to share what we’ve done over three years to increase our vaccination rate, talking about some tips and tricks that we’ve done and how we kind of streamline vaccinations here with our, uh, physicians group. But what’s important to know is that GSK is participating through this webinar through a corporate membership with, um, AMGA. Um, NGPG is a corporate member of AMGA. The development of this program has been funded by GSK and GSK has developed this content. Um, as Michelle said, I am being paid for my part of the GSK part today and then will also offer a case study, um, from NGPG. And I’m acting in my role today as a Director of Clinical Quality and Ambulatory Pharmacy Services representing Northeast Georgia Physicians Group.

So let’s talk about what our goals are for today as we delve into the current state of adult vaccinations in the US and the relevancy of, um, talking about its impact to, uh, adult immunization status or AIS measures associated with some of our quality things that will be measured for, um, for in the future. Um, we’ll talk about that timeline as well. Um, we’ll also talk about effective strategies to enhance vaccinations within your health system, but how are we gonna do that today? It’s through a three- pronged approach through, um, advancing health systems through value-based care being one of our barriers to overcome, aligning immunization initiatives with the quadruple aim, you know, optimizing outcomes in adult, um, vaccination strategies, you know, leveraging those immunization quality metrics to meet health system vaccine targets, as well as future directions of adult immunization through those quality metrics. And lastly, talking about enhancing vaccine practices and quality reporting, talking about approaches for health systems to achieve adult vaccination goals, and then talking about the case study as well. So we have three things we’re hoping to, um, cover today.

So next, let’s, let’s talk about that impact and how value- based, um, care is starting to align the Quintuple Aim as, um, imperative for the health system approach and thinking about how we can align system strategies around adult immunization status. Value-based care represents a shift from volume to value services provided, focusing on improving patient outcomes and satisfaction, um, through, um, reducing healthcare costs. We all know that medical loss ratio is something we’re measured on, but we also have a strong focus in safety quality in our patients’ experience, which all leads to part of that access to care, including access to adult vaccination. Key goals under the Quintuple Aim guide health system through quality improvement efforts that are designed to improve health, um, equity. So let’s talk a little bit more about how we can align that Quintuple Aim through the adult, um, immunization strategy. Strategic immunization efforts align and advance these key population health goals. It is widely recognized that vaccine-preventable diseases pose considerable financial strain on healthcare systems. A 2021 study estimated that the cumulative undiscounted direct medical cost for pertussis, herpes zoster, flu and pneumococcal disease were totaled nearly 653 billion over 30 years. Wow. That’s a big number. And how it can have a downstream effect through that medical loss ratio through our health systems. Also thinking about readmissions and unavoidable hospital admissions as well, which we’re also measured on. Reducing the incidence of vaccine-preventable diseases enhances community health in turn, reduces the overall burden to the healthcare system, freeing up resources to focus on those critical health needs and improving critical care at our hospitals, you know, and letting them focus on what they need to focus on. And aligning more to that preventative care and chronic disease state management at the ambulatory level or in the clinics in the communities, trying to prevent those from crossing over to that critical care aspect. Investing in immunization also creates opportunities for cost savings by preventing costly outbreaks in hospitalizations, alleviating some strain on health systems and helping prevent clinician burnout. We all know vaccine is a very hot topic across the country right now. We are seeing outbreaks and the education and community outreach is more prevalent than it’s ever been when we think about adult vaccinations and getting them to understand why it’s important for a system to invest in this, but also for our community and our population to receive adult vaccinations. Ensuring marginalized community, um, communities receive immunization promotes comprehensive prevention and accessibility. Going back to that health equity, um, component.

So moving on more into Adult Immunization Status. Really getting into the meat of the conversation today. It’s important to notate in 2023 CMS added AIS or the Adult Immunization Status measure to the Universal Foundation Measure Set. Um, it created a streamlined measure across CMS programs serving as a building block for CMS value-based care and quality programs. AIS replaced standalone immunization measures and offers a comprehensive view of all recommended adult vaccine status going beyond the old measures of flu and pneumococcal components alone.

So, you know, what, what does that mean? What are we measuring? What is in AIS? And that’s important to understand because there’s a lot of adult vaccinations that are out there and more and more are being approved every day. But what exactly is AIS measuring? AIS was developed by the National Committee for Quality Assurance or NCQA—we all know who that is—and includes five routine recommended adult vaccine: flu, Td or Tdap, hepatitis B, herpes zoster, and pneumococcal. For flu, the measure assessed the number of members 19 plus who received the flu vaccine during the last year. The Td or Tdap component measures members of 19 years of age and older who received either Td or Tdap within the last nine years. Hepatitis B newly added to the measure and measures members from 19 to 59 who are up to date on the vaccine. Herpes zoster or shingles, the measure assesses the number of members 50 plus who receive both doses of the vaccine. Lastly, the pneumococcal component measures the number of members 66 years and older who have received at least one dose of pneumococcal vaccine. Importantly, while each vaccine is reported separately, the measure requires submissions of all vaccines. So this is where, you know, when you’re thinking about a strategy from your health system is you have to be good record keepers, good record hunters, really focusing with your HIM department to find those records, ‘cause we all know adults move, they don’t stay in one place, so you have to report things that may have occurred in a different state. So it’s really important when you bring a patient in the established care within your health system that you bring the records with them and you get them inputted into your EHR so that you can report these measures in the future.

So moving forward, let’s talk a little bit more about, you know, adult vaccination rates are not ideal for many, being less than 60% across age groups. Furthermore, we see inequity in some cases among certain age groups. We have to think about the expansiveness to access adult vaccinations really changed in 2023 when we had, um, plans now required for, you know, adult Medicaid/ Medicare making zero cost, um, cost share to the patient around adult vaccinations that are ACIP approved. So we should see, um, these get approved, um, better year over year as we have a support for that ACIP approval being, um, zero cost for our patients, whether it be commercial, um, Medicare or Medicaid. Now looking at the composite measure all the way down on the, on the right on the chart in that dotted box, we can see that adults are not fully up to date on all recommended vaccinations. You can see really good performance when we think about flu for our elderly adults as well as pneumococcal. But when we put together that composite score, it’s 26.2%. So again, thinking about record keeping being a strategy. So let’s now move into the next component. Thinking about growing integration across AIS, as a key healthcare quality program. For some health systems this measure is currently available for selection via MIPS and MVP and will soon be added to Medicare Shared Savings Programs (MSSP). Furthermore, it is evident that health plans are increasingly held responsible for specific measures as demonstrated by the addition to the Medicare Stars display page. Health plans may begin, if not already doing so passing accountability for AIS to their provider networks and could incorporate the AIS measure into their contractual agreements or collaborations with healthcare systems.

So again, thinking about planning impact for your health system to be proactive instead of reactive when it comes around the AIS measure. Over the past five years, we’ve seen an increase in utilization of AIS measures. The AIS measure has been incorporated into value-based care programs for both providers and health plans with various incentives in place for, to enhance those vaccination rates. We all know we need an incentive to move forward with a lot of things that here, you know, there is financial incentive here, whether it be gain or um, downstream effect if you don’t perform well on it, depending on what those contractual agreements look like. Importantly, over time we have seen AIS replace the standalone flu and pneumococcal measure. Let’s take a deeper dive into this timeline.

Let’s call out 2023. What should your health system be looking at in terms of future AIS implementation? First, because of the addition of AIS measures to this CMS Universal Foundation Measure Set, CMS will consider adding AIS measures to other CMS value-based programs. Um, CMS has signaled the addition of AIS to the Medicare Shared Savings Plan, which will be mandatory for ACOs as early as 2028. And that is right around the corner when we think about it. Lastly, AIS is currently on Medicare Stars display page with a strong indication that this account will extend to the Star ratings program in the forthcoming years. Let’s dig a little deeper into this. Now, CMS has signaled the addition of AIS and Medicare Shared Savings Plan, MSSP, which will be mandatory for ACOs as early as 2028. Talk about getting our ducks in a row for really good reports, as well as medical record keeping to make sure we have all the information we need to report.

Lastly, AIS is currently on the Medicare Star display page with a strong indication that accountability will extend to Star Ratings programs in the forthcoming years. So looking to the future... So how can your health systems be ready for these changes? Make sure that you select AIS as one of your reporting measures in MIPS or MVP. Um, communicate with providers that all vaccine components of AIS must be reported, not just flu or pneumococcal components. So empower workflows at the end user, the provider, clinical support staff, medical office practice operations, having that ability to understand the impact their role and how to get the records. And also figure out do they want to implement adult vaccinations at the clinic level? Ensure your vaccine rates are optimized to maximize AIS performance and support the goals for the Quintuple Aim. So let’s dig a little deeper into that impact associated with, um, governmental reporting. So now you’ll get, we’ll get a little deeper into those two key programs impacting health systems that currently include AIS. First is the MIPS Merit-based Incentive Payment System or MIPS now includes AIS measures as an option for selection. Next, we’ll have MIPS value-based pathways or MVP. Currently AIS um, measures are incorporated into five distinct MVP listed on the slide. So the rheumatology one, women’s health, um, kidney care, um, value in primary care and in prevention of treatment of, um, infectious disorders including hepatitis C and HIV. Opting to report on any of these MVPs allows you the flexibility to include AIS as that, um, fulfillment part in those reporting obligations. So potential benefits for reporting. There’s a lot of positive things here to think about. Selecting AIS measure as one of your measures for both MIPS and MVP offers your health systems four potential benefits. One of those be, um, population health. By incorporating the AIS measures, you focus may shift towards vaccine efforts, um, potentially boosting vaccination rates and reducing prevalence of vaccine-preventable illnesses. Understanding the performance. So providing reporting on AIS measures enables your health system to closely monitor vaccination rates and performance, helping identify and address any gaps or disparity to enhance overall rates.

And this is where reports, patient outreach and notifying your clinician of who’s not completing the gap to really help you by providing good visible reports on performance. Reducing reporting burdens. Choosing the AIS uh, measure could simplify your reporting process as this measure is consistently included across various programs and measure sets as we previously discussed. Uh, lastly, thinking about overburdening clinicians, thinking about reducing that burden, limiting hospital admissions and readmissions, improving vaccination rates, and fewer vaccine-preventable diseases, um, could lessen the need for hospital admissions and readmissions, thereby lowering your healthcare resource use and associated expenses and the strain on your system. So now, you know, gravitating on the likelihood. So let’s talk about what that is for you. If you’ve chosen to report AIS measures or are seeking ways to elevate immunization rates within your health system, there are strategies that have been, um, associated with those improvements. Incorporating vaccine administration during in-office visits has been linked to increases in immunization rates. For instance, uh, one study demonstrated a 19% rise in flu vaccination coverage when healthcare providers both recommended and administered during that office visit as opposed to referring that patient out such to a pharmacy. What’s important to understand is there’s middle of the road. We can understand that adult vaccinations, especially with that Medicare population, can be difficult ‘cause adjudication exists on the pharmacy side and you may not have looked into partnering with a third party to allow the ability for your providers to adjudicate to that pharmacy benefit and provide the administration directly in your clinic. But there is that middle ground in between referring out and giving it, and that’s providing a prescription. There is, um, studies that have shown that if you provide a prescription to the patient, sending it electronically to the pharmacy, you can see increase in vaccination rate and completion rates as well because you have handed it off to another healthcare provider to provide that vaccination to your patient, therefore coordinating the care. So there is that middle ground by using a, uh, prescription and not just verbally telling a patient to go to the pharmacy.

So what are some of those strong guidances when we think about onsite vaccination. If it’s not possible, CDC does have some key strategy around this. According to the CDC, the strong recommendation from a provider is still the single most important factor in determining whether or not someone will get vaccinated, whether it’s in office or a different setting. So again, that strong recommendation that is balanced by science, safety, efficacy, and really informing the patient with an individualized recommendation and making it personalized does increase that vaccination rate. And that is that shared decision-making conversation with the clinician. However, the CDC has offered some strategies for you to communicate to patients to, um, on the importance of receiving their recommended vaccination. And that’s through SHARE. Um, so SHARE is share the reasons why the vaccine is suitable and necessary. Highlight the possible effect of vaccines will have for the patient. Address any of their concerns and questions. So what will they expect? What is the cause? Um, is this gonna work for me? Why are you saying I need it? Remind your patients on the importance of vaccinations as well as the safety of vaccines. This is more important than ever with vaccine hesitancy that you take the time to address and remind. And lastly, explain to the patient the possible implications of not being vaccinated. Think about, you know, events in their life that they may miss because they have shingles or they are in the hospital for pneumonia. So making it personalized to them does help explain to the patient the impact of adult vaccination.

So there are lots of other strategies that you can really implement in your health system to improve those vaccination rate. So tactic one is always going to be offer it in your office, but tactic two is that strong recommendation. But you can implement a number of other best practices we know that can help support adult vaccination rate. One of them is to establish, evaluate and update your staff about benchmarks and initiatives. Getting together with your operational and clinical staff, deciding on what do you want to focus on this year and what is the increase that is smart for your, um, entity to do so. Don’t make a huge goal that would, you know, make people not feel like you can get there, so don’t even try, but a smart goal that they can actually get to that finish line by the end of the year and say that they are green for that goal. Promote standing orders. My organization leans heavily on these and that has been a big system strategy in order to increase adult vaccination. Consider the way the patient will benefit from co-administration of multiple vaccine. CDC says that adult vaccines can be given together at the same time through that shared decision-making conversation with a patient. Obviously we don’t wanna make them into an adult pin cushion, but if we can get two or three in in a visit because we know that patient’s only gonna come to see me for back pain, absolutely have that conversation and use that strategy. Identify vaccine companions within your health system that can be your cheerleaders, your reminders, your drivers who really make vaccines, um, exciting for your providers and staff to talk about.

And lastly, prioritize non-seasonal immunization throughout the year. We don’t have to do everything at the physical, we don’t have to do everything during respiratory season. Have the conversations frequently at every visit, and that is a great strategy. Lastly, it’s not here, but it should be in your thought process as additional best practice. How are you going to get the record for an adult who has moved into your health system? Because you’re going to need that in order to report it. So it’s very important that if someone hasn’t lived in your state and is not in that vaccine registry, how are you going to get it in the registry? How are you gonna get it into your record in order to be successful at the AIS measure? Now we all think about other parts. Technology. Wow, we’re in the year of AI. What can we do with technology to really advocate for vaccines, notify our patients and take the burden off of our staff so that the patients are coming in asking us, “You know, I received this message. Can we talk a little bit more about receiving my vaccines today?” So leveraging technology to optimize adult vaccines is really important. Modify your EHR to um, get the access for that patient’s vaccine history, setting up alerts. Sometimes your EHR doesn’t update as quickly as the ACIP votes. And you may need to put a strategy in place of how to update your EHR instead of waiting three to six months for your EHR to say, oh, we’re ready to make that update. Now you’ve already missed three to six months of patients that you could have provided an impact on. Optimize your claims adjudication practice to ensure the vaccines you’re providing are reimbursed, um, appropriately, including partnering with a third party to allow it for adults with Medicare Part D. Lastly, enable e-prescribing to electronically send, um, prescriptions to a pharmacy for that point of care. Again, if you can’t do it, a prescription is more likely to increase that vaccination rate than just verbally telling the patient to go to the pharmacy.

So healthcare systems can take action to increase adult vaccinations. Um, those being, um, thinking to, um, the suboptimal vaccine rates among adults and place significant burdens on that healthcare system. The AIS measure is increasingly being utilized within healthcare systems as a strategy to improve those rates. By adapting and reporting, um, the AIS measure within your health system, you can achieve various benefits to fulfill governmental reporting such as MIPS and MVP. To maximize vaccine rates, prioritize in-office vaccinations can result in a higher immunization rates. When it isn’t feasible, offering, um, a strong recommendation and support to enhance that likelihood for an adult to receive a vaccination.

So we’re gonna round out that GSK component and transition into Northeast Georgia Physicians Group case study. So talking about operations adult vaccinations, that word sometimes is really hard to say. So let’s move into that. And so there’s gonna be three key points we’re gonna talk about here, strategy, education, technology, and those stakeholders. What can you do with those four things to really impact and I’ll, I’m gonna show my RSV data ‘cause we are so excited about our three years of season. Um, and moving into, um, where we’re at right now and some of the things that we put in place. So Northeast Georgia Health System is five hospitals. We have more than 700 providers, 1500 medical staff, more than 1000 beds. We just opened three new towers, 11 urgent cares that’s constantly growing. Seven rehab locations and three long-term care centers. One of our key strategies here is staying ahead of the game. When will the FDA approve it? When will ACIP do it? When will it be signed? Who will provide the coverage? And when can we vaccinate? Now in our institution, we will hang our hat on that ACIP vote, we’ll wait for that signature. And the MMWR. Sometimes, we just go, we have everything ready to go, usually within one to two weeks post that vote that we will take an eat on insurance coverage just to make sure that if our patients are coming in and asking for it, absolutely let’s do it. Let’s be prepared. Let’s not delay just to make sure we’re gonna have coverage of the vaccination. So how do we put it into operations? One is researching, discussing and anticipating those vaccines approvals. And, you know, it, it is very important in our organization that we have some strategies put in place to stay on top of this. So research, we are always meeting with our medical science liaisons across all of our vaccine manufacturers to understand what is in the pipeline. Reading the clinical trials, reviewing what’s available for each indication, going ahead and having a conversation about cost and coverage way before ACIP votes. Um, making sure that we watch the attendance, we publish immediately to our staff what those votes were within 48 hours so that when those phone calls start coming—’cause we all know everything’s already been to social media, news signs, on the TV— our providers and staff from the front office to the back office know what the votes are and can speak to it. Instead of saying, “I don’t know,” and saying, “Let me call you back.” We make sure that we are proactive at it. We gather our stakeholders anytime there’s someone new. We have representations from infectious disease, family medicine, pediatrics, pharmacy, operations, from our PR department, our nurse educators, as well as our purchasing department so we can be ready to go quickly for our patients. Nextly, we focus on review and selection. So what does that look like? We all know that there’s competitors on the market. So we have four key things that we try to address in SBAR format. What is the financial stewardship? What downstream effects will happen on contracts? Is this TransactRx? So we need to make sure that’s ready to go and loaded. What is the coverage gonna look like? Making sure everything gets loaded. And then doing a cost analysis to make sure that we can guarantee coverage within that first six months. Patient safety. Is the vaccine going to have a pediatric component because least thing we want is to have one for peds and adults and increase our rates of missed vaccination. What is the storage like? Do we need education on preparation and administration, you know, to prevent patients from not getting, um, reconstituted vaccines correctly? What is the complexity? Do we need to understand the vaccine technology or the hesitancy around that vaccine? What is the strategy to make sure that is addressed? And lastly, that clinical review. Reviewing safety, efficacy, the impact on hospitalizations, and then reviewing all available options on the market for that vaccine.

Next is that sourcing. So really meeting with our vendors, looking at everything, looking at the contracts and downstream effects. So if I pick vaccine A, what will happen to vaccine B? Because I don’t want another adult vaccine to be so costly that I can’t offer it in our process. Or if I go over here, will you drop the cost on another vaccine so that it makes it more doable to continue to offer vaccinations? Signing that contract at best pricing. Then we create a whole entire order initiative to make sure that it’s ordered and in our offices before our go-live. And that go-live happens after deployment is in our offices. Next is our education plan, but part of that is always standing orders. Which one of these vaccinations can we have a standing order for? What is a universal recommendation versus what is one that requires clinical intervention? And so that’s one of the things that’s part of our education plan. So we do develop strategies around the patient, the clinical support staff and the office staff, not just those in the back office. And then lastly, our provider.

So with that being the case, we have multimodal forms of communication. We all know adult learners all have a way of learning whether it’s auditory, visual or just being put directly in front of them. So we use at least seven ways to educate. We use multiple newsletters, both our ambulatory pharmacy newsletter as well as our, um, system-wide newsletter. So it’s in two ways. So if someone only reads one, they’re gonna get it. We do a full formulary review and publish that to our doctors so they can see the side-by-side and why the decision was made. So if they’re like, well why didn’t you choose the new one on the market? They’re well aware of what led to the decision through that committee and they feel informed to understand why we made that decision for the patient. Also, we use pharmacy team. We publish journal clubs. We launch a like curbside service to answer any questions and then we also publish a webinar from the pharmacy on any new vaccine as part of that rollout and then publish it. So it has, it’s a living document for people to see.

Um, we also do provider presentations. We keep them published on our SharePoint. We do a lot of electronic education. This is one of our biggest success factors around vaccines as we partner with our coding. And on our tip sheets, we have everything there on one page. What are the codes? What is the ICD-10? What is the NDC? What are we gonna charge? What is the dose? Who’s gonna get it? What’s the indication? Does it need to go through TransactRx? We try to make it very visible and newly, we’ve also added self-pay so we don’t have to look for it. We do add anything to this into our town halls in which we talk a lot about a lot of things that impact our patients and our staff. But we also put vaccines in there as another, um, you know, audio and visual touchpoint. Um, we also do letters to our providers. Anytime we’re doing something new, we will write and ink a letter to that provider, we will interoffice it to ‘em and have their practice manager put it on the desk. So if they’re not reading the email, we put it visually in front of them in paper. We do a Know Do Say to all of our staff around any type of vaccine go-live, ACIP vote. Any change, any safety concerns go through a Know Do Say process. And then lastly, we make sure we round at least quarterly on vaccinations and letting each provider know where they’re at in each clinic level. Um, we also, um, have lots of forms of communication through an annual education. So we do an annual vaccine competency that covers everything to make sure everybody has that re-up. We also use, um, fridge card. So in our fridge for safety double check, we have what the vaccine is, where it falls in the safety, any tips or tricks you need to know about it as well as storage. Um, we do, um, pre-visit planning to make sure the communication is clear to the front desk and the back desk to make sure who needs to have that vaccine talk today. So that’s required for all of our, um, hospital follow-ups, annual wellness visits, and anybody coming in for hot three um, chronic disease states. So depression, um, diabetes and uh, blood pressure have that required vaccine component. Um, and then we also publish a dashboard for clear transparency about how you’re doing. Next, with our go-live, we have to make sure our technology is ready to go in that go-live.

So technology is imperative with this. So, Transact, we have to make sure that it’s loaded, available. We update our tip sheets. We make sure that we put an order validation in. So when you’re ordering a vaccine for a patient who has Medicare Part D, you have to um, uh, order validate that yes, you’re aware it needs to go to Transact and you are testing that you’ve already done that before you give the vaccine to make sure that we have everything in place to ensure coverage. Also through our technology, we have to make sure it’s in Epic, loaded to be ordered, as well as be able to be scanned. Um, we use a lot of things with our health maintenance field and our EHR. We do, um, not wait on our, um, upgrades. We do go ahead and put tickets in and build our own and then we’ll accept the upgrade when it happens. Um, medication scanning and vaccine scanning has been implemented for increased safety, especially to ensure our vaccines are reconstituted. Lastly, in any disease state in which we can associate an increased risk for a vaccine-preventable disease, we have it in the SmartSet for treatment. So not only is it in our wellness visits, but every single disease state in which a vaccine needs to be done because the patient’s at risk for that vaccine-preventable disease, it’s in there as well for an easy point-and-click for our providers and to remind them to have that vaccine conversation. We also have those standing orders we were talking about implemented into our, um, nursing SmartSet. So in the nursing actions, they can see all the ones that they can offer very quickly for that patient to help close the loop. Lastly is, you know, we do follow-up that is very important. Six months to, uh, one year I will interview our high utilizer of the vaccine, our low utilizer of the vaccine to figure out best practices, what were the barriers, and then revamp for the next set of education for annual. But also if it’s seasonal vaccine, what can we do better? And we provide that react education.

So part of that is, is it’s a key imbalance. Transparent communication and technology is imperative to ensure an increased adult vaccination rate. So let’s put this into perspective around adult vaccine. So we are on our third season focus here and what’s important to understand is, in the three seasons, um, looking at uh, 23, 24 and 25, we really um, put some things into perspective. So in that third season we really stopped evaluating because we know when it first rolled out it was like vaccine whiplash. Uh, where it’s like, oh, you can get it, you can get it, you can get it—break. No, you can’t get it. They can get it. So that was really confusing for our providers. So, and our staff. So we completely revamped the education to make it very easy. Number one, standing orders redone. Number two, redid all of our pamphlet education, um, AVS dot phrases around, um, RSV adult vaccination. So our patients would have more. We did a campaign to notify our patients if they were eligible. We also then redid at the help of support staff and provider, including front office education to make sure they knew what the vaccine was, who is eligible for it, and what is a clear way for you to see that that patient has not had it. And then nextly, our EHR-EMR, we didn’t wait. We know that there has been a lot of votes put in place around um, adult RSV vaccinations. So we completely revamped, changed it and turned it on very quickly ‘cause that was a request from our providers. Please make it simpler. I know that it’s here. I know that what it is. You’ve really explained that to us. But we need help identifying these population. Adult vaccination is constantly growing and they felt overwhelmed by it. So we heard, we listened and we implemented. Lastly, that marketing of EHR alerts to our patients. So when they would open up their app on our EHR that they have access to, it’d clearly show them upfront and center the vaccinations. We did pushed outreaches to them so that they would come and ask for it. But then we also put into place, um, marketing in the waiting room and in the, um, office room so that they would know, okay, uh, this is something I’ve really gotta talk about. But we also partnered with PR, to really do a regroup around adult vaccination with a clear strategy around RSV to let them know that we have it. You can get it here with us. If you wanna have the conversation, we’re here for you. Another EHR strategy we put in place around RSV is you can’t suppress it to 2099. You can only suppress it for six months to a year in order to come back and have that conversation. ‘Cause we never know what’s gonna happen. RSV is an ever-changing site that, you know, we didn’t really have testing about it before, but post-COVID, we have those PCR testing where you can test through your respiratory conditions at once. And that’s a huge strategy when we think about it, that we have data. That’s the other thing we did with marketing to the patient is health departments don’t really capture RSV for adults. So we took the ability to publish our true circulation of RSV to our community, um, and letting them know that it’s circulating, it matters and we care and being very visible. Lastly, we had a lot of questions about is this, are you covering cost here? So we did a true deep financial analysis around vaccinations, including the RSV vaccine. And what we found is we’re doing very well with covering costs, but we have strong contractual agreements in place that we were able to renew and then also we’re eligible for a multiplier to get another rebate by maximizing other vaccines within that portfolio. So again, combining these things together. Put a big plan around Transact to really put that order validation we were talking about. We also made sure to put some safety stops in. So if you tried to accidentally give it to a pediatric, you couldn’t do it. But also you couldn’t administer without making sure that the ABN was signed and the, uh, the patient knew it was going through a different insurance, through pharmacy benefits. And lastly, taking that deep amount evaluation into financial stewardship safety, quality and efficacy. Really publishing that globally as an initiative really in that third season. And really publishing our numbers to say you had this many people that walk through your door last fiscal year that were eligible for RSV that were missed opportunities. What is your action plan that we’re going to see that change in behavior? And by golly, it worked. So you can see in 2023 to 2024, we only had a 0.8% increase. That’s where a lot of confusion occurred with ACIP. But regrouping from 24 to where we are at in 25—this data for us is dated through August 28—we had a 36.8% increase in adult RSV vaccination. We are extremely proud of that for being a newer vaccine, having other competitive vaccines on the market that, you know, cloud this space. But we really tuned into that and talked about timing, patients, really partnering with patients to hear their concerns and why they weren’t receiving it, and really making frequently asked tip sheets about that to our providers. Um, and so we’re really proud of where we’re at right now for RSV and we’re not even into the quote quote, um, uh, our respiratory season, um, where they say that you should really in that, you know, early, uh, fall late summer patients who received their dose of RSV to have maximum efficacy. We’re not even there yet and we’ve already had an extreme increase. So I’m excited to see where we close out the calendar year on this.

Um, so I really do appreciate your time today. Um, coming here to talk about adult vaccinations. It’s something that we really can improve on, um, for our patients. There are millions of open care gaps around our adults. And if I can empower you to do one thing, don’t miss your shot. Ask ‘em every time you see them. Empower the patient to ask questions, but empower yourself to follow up, get the record, or follow up to ensure adult vaccinations. Thank you so much for being here today and partnering with AMGA and GSK to increase our adult vaccination rates. I’ll turn it back over to you, Michelle.

Michelle:

Well, thank you so much Dr Schnibben. Um, I enjoyed learning about what you and your team have done and thank you everyone for joining today. Uh, we’re so pleased to, uh, be a part of AMGA. And, um, that’s it for us, so Bruce, over to you.

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