Abstract
Incentivizing Community Pharmacy and Healthcare Partners to Improve Adult Vaccination Rates
Sara Roszak
National Association of Chain Drug Stores (NACDS), Arlington, VA
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Community pharmacies are known as convenient access points for immunization with one in five Americans receiving their flu shot at a pharmacy annually. Yet, additional work is needed to raise national rates for other adult immunizations like pneumococcal, pertussis, and herpes zoster.
Despite modest improvements toward Healthy People 2020 goals, greater uptake for some vaccines is still desperately needed. Innovative care models comprised of health systems/plans or Affordable Care Organizations (ACOs) teaming up with pharmacies to achieve greater immunization collaboration can address this issue.
As part of a Centers for Disease Control and Prevention (CDC) grant (IH23IP000985), the National Association of Chain Drug Stores (NACDS) is collaborating with more than 325 pharmacies across four (4) states to develop and implement value-based payment (VBP) models that incentivize community pharmacies and other stakeholders to improve adult immunization rates, and related reporting to state-based registries, for influenza, pneumococcal, pertussis, and herpes zoster vaccine.
NACDS is overseeing three (3) demonstrations projects that seek to improve patient health by aligning the interests of healthcare partners. The following sub-awardees have collaborated with NACDS on these demonstration projects: (1) The University of Pittsburgh; (2) the University of Nebraska Medical Center; and (3) the University of Washington.
Throughout the 7-12 months that the projects are live, NACDS and the project teams compare incoming immunization data with target results. Furthermore, challenges are assessed throughout the project period and changes made to optimize project performance (such as pharmacy workflow, promotion to patients, registry reporting technology upgrades, etc.).
The goal is of these demonstration projects is to develop sustainable, replicable models with practical application to benefit public health. If these projects can provide viable strategies for how VBP models could increase immunizations, improve quality of care, and decrease costs, there is the possibility for uptake of the models beyond the confines of this grant. NACDS intends to generalize the results from these projects and share them in a way that is accessible to others who may want to replicate similar concepts in the future.
Conduct evaluation related to programs, research, and other areas of practice Implementation of health education strategies, interventions and programs Other professions or practice related to public health
Abstract
Improving vaccination rates through community partnerships and technology
Kim Coley, PharmD1, Lucas Berenbrok, PharmD1, Philip Empey, PharmD, PhD1, Deanne Hall, PharmD1, Hannah Renner, PharmD1, Chiara Gessler, PharmD2, John DeJames, RPh2, Renee Richardson, PharmD2, Christine Jordan, PharmD2 and Melissa McGivney, Pharm.D., FCCP, FAPhA1
(1)University of Pittsburgh School of Pharmacy, Pittsburgh, PA, (2)Giant Eagle Pharmacy, Pittsburgh, PA
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Millions of American adults do not receive recommended vaccinations, leading to preventable illness, death, and billions in unnecessary health care costs. Community pharmacists are readily accessible to the public. Increasing their opportunity to vaccinate within dispensing workflow and providing tools to engage patients are essential steps to increasing vaccination rates. The goals of this project are to: (1) develop a value-based model (VBM) to incentivize community pharmacies for increasing adult vaccinations; (2) implement new processes within pharmacy workflow to engage patients regarding vaccinations; (3) develop a new 2D barcode smartphone vaccination app to empower patients with a personalized vaccination record; and (4) create a strategic plan for community pharmacies to facilitate the provision of vaccines during pandemics. To achieve these aims, we partnered with a regional grocery store chain with 99 pharmacy locations in western Pennsylvania. A modified Delphi approach was utilized to achieve consensus among expert stakeholders on the model's tier structure, vaccination goals, and incentive payments. A single, three-tier VBM for four adult vaccines (influenza, pneumococcal, herpes zoster, and pertussis) was developed. Vaccine implementation strategies focused on development of computer algorithms that use prescription dispensing data to identify adult patients eligible for vaccination either at prescription pick up for face-to face interventions, or by generating a patient list for telephonic interventions. These strategies were implemented into pharmacy dispensing workflow and included motivational interviewing techniques. Qualitative assessments are ongoing and changes in vaccination rates over the previous year will be collected to evaluate the success of these initiatives. The vaccination smartphone app workflow will be assessed and evaluated through app metrics such as number of downloads and QR scans. County, state, and pharmacy stakeholders will develop a pandemic strategic plan on topics including coordination with federal agencies, staffing, training, infection control, supply chain, inventory management and documentation to prepare community pharmacies to vaccinate during pandemics. These innovative, yet practical approaches for development of vaccine VBMs and implementation strategies will result in a highly replicable and scalable approach to improve adult vaccination rates by community pharmacy teams.
Implementation of health education strategies, interventions and programs Other professions or practice related to public health Planning of health education strategies, interventions, and programs Protection of the public in relation to communicable diseases including prevention or control Provision of health care to the public
Abstract
Implementing value-based collaborations: Improving adult immunizations in Iowa and Nebraska
Nizar K. Wehbi, MD, MPH, MBA1, Rajvi Wani, PhD (Candidate)1, Donald Klepser, Ph.D., M.B.A1, Nicole Duehlmeyer, PharmD, MBA2, Jaclyn Smith, MA1 and Ali Khan, MD, MPH1
(1)University of Nebraska Medical Center, Omaha, NE, (2)Hy-Vee, Inc, West Des Moines, IA
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Background and Objective: Hy-Vee, Inc. and the University of Nebraska Medical Center’s College of Public Health and College of Pharmacy proposed a collaborative effort to increase adult immunization rates in Iowa and Nebraska in partnership with the Nebraska Health Network (NHN), University of Iowa Health Alliance (UIHA), Scientific Technologies Corporation (STC), and both state immunization registries: Iowa’s Immunization Registry Information Systems (IRIS) and the Nebraska State Immunization Information System (NeSIIS). The objective of the study is to 1) improve immunization (influenza, pneumococcal, pertussis, and herpes zoster) rates for adult patients (age 19 and older) in Iowa and Nebraska; 2) allow personalized immunization recommendations by utilizing a common technology platform (ImmsLink) in these pharmacies; 3) ensure reporting these immunizations to the respective state registries; and 4) facilitate exploration of a state level memorandum of understanding between public health and pharmacy for pandemic response.
Methods: ImmsLink platform was installed into 159 participating Hy-Vee pharmacy locations in Nebraska and Iowa. A single location sign on to ImmsLink addressed a workflow barrier of single user sign on for individual state registries. ImmsLink also provides personalized on screen recommendations for a patient’s full immunization needs to aid the pharmacist and patient discussion of immunization needs at the time of the patient seeks the seasonal influenza vaccination. The primary point of contact to improve the immunization profile of adult patients was the 2016 season influenza vaccination.
Results: By 2/5/2017, we were able to provide 165,123 influenza immunizations, thereby exceeding our goal to increase influenza immunizations provided by our pharmacy partner by 6% from the previous influenza vaccination season. Also, a total of 13,310 Pneumonia, Prevnar, Tdap and Zostavax immunizations were administered. Both the state registries received the counts of these immunizations through the ImmsLink platform.
Conclusions: Reporting of immunizations in Nebraska is currently voluntary for any health care provider and in Iowa, only pharmacists are mandated to report. Using ImmsLink can improve reporting to the states registries thus improving adult vaccination rates by accessing immunization status of the patient.
Implementation of health education strategies, interventions and programs Protection of the public in relation to communicable diseases including prevention or control Provision of health care to the public
Abstract
Value-based collaborations to increase community-based adult vaccinations and emergency preparedness: Project VACCINATE
Jennifer Bacci, PharmD, MPH, BCACP1, Ryan Hansen, PharmD, PhD1, Andreas Stergachis, BPharm, PhD1, Christina Ree, PharmD2, Marci Reynolds, PharmD3, Jenny Arnold, PharmD, BCPS4, Aasthaa Bansal, PhD1 and Peggy Odegard, BSPharm, PharmD, CDE1
(1)University of Washington School of Pharmacy, Seattle, WA, (2)Bartell Drugs, Seattle, WA, (3)QFC Pharmacies, Bellevue, WA, (4)Washington State Pharmacy Association, Renton, WA
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Adult immunization rates are below the goals established in Healthy People 2020. Enhancing community pharmacy-based immunizations is one approach to address this gap in care. Project VACCINATE is a one year demonstration project in Washington State aimed at fostering collaborations to (1) increase adult influenza, herpes zoster, pneumococcal, and pertussis vaccinations administered and documented in the immunization information system (IIS) by community pharmacies; (2) design and pilot a value-based payment model for immunizations administered in community pharmacies; and, (3) improve pandemic preparedness planning among health departments and community pharmacies. A bi-directional immunization interface has been implemented in 70 traditional and supermarket chain community pharmacies to enable proactive immunization forecasting, patient outreach and documentation in the IIS. Implementation strategies included classroom- and pharmacy-based live training and coaching for pharmacists and pharmacy technicians; identification of a pharmacist and technician champion at each demonstration pharmacy; monthly newsletters with project updates, education, and best practices; and a web-based dashboard for bi-weekly monitoring of immunization performance at each pharmacy. Stakeholder input and pharmacy data were used to inform the development of value-based payment model to incent immunization performance in community pharmacies. A tier-based incentive payment model for herpes zoster, pneumococcal, and pertussis vaccinations is being piloted in 12 demonstration pharmacies for 3 months. An outcomes-driven risk sharing of influenza cases in unvaccinated individuals is being modeled for future implementation as part of a balanced incentive to immunize against influenza. The change in immunizations administered and documented by the community pharmacies will be used to evaluate the impact of the bi-directional immunization interface and value-based payment model. Pandemic influenza exercises are planned with demonstration pharmacies to test the activation procedures of a novel memorandum of understanding (MOU) that formalizes relationships between local public health departments and pharmacy organizations for coordinated response to emergencies. Rapid cycle improvement techniques are planned to identify opportunities to enhance the current MOU operation plan. This demonstration project will ultimately identify best practices for immunization delivery, documentation, and payment as well as emergency preparedness, which could be replicated in community pharmacies throughout the country and inform state and national policy.
Implementation of health education strategies, interventions and programs Protection of the public in relation to communicable diseases including prevention or control Provision of health care to the public Public health or related public policy