Vaccine database helps manage immunization gaps

(mellow contemporary music)

 

Hello, welcome to Optum Forum 2020.

 

Olivia Banyon, Vice President for Cross Optum.

 

Cross Optum is the business unit

 

that sits within OptumInsight Life Sciences

 

and I'm here today

 

to talk to you about developing an all vaccines database

 

to address COVID-19 management efforts.

 

I'm delighted to be joined by Jennifer Brueckner,

 

my colleague within UnitedHealthcare.

 

Jennifer?

 

Hello, I'm Jennifer Brueckner.

 

I'm Vice President of Clinical Program Delivery

 

and I lead our Enterprise Flu Core team.

 

Glad to be with you Olivia.

 

Thank you Jennifer.

 

All right, so I'm going to get started with a question

 

that I think is a really relevant question today

 

and that is, have you asked yourself

 

what you know about your own vaccine history

 

or your parents' vaccine history?

 

Likely, if you have children,

 

you have a lot more information

 

about what their vaccine history is

 

if they're young kids but today, this type of information

 

is very hard for us to really have access to

 

as consumers, as patients, as members, as providers.

 

So we're going to talk to you about

 

how do we make that more accessible to us today?

 

Let's get started with first really reviewing

 

the immunization data gap; what it is, why we have it,

 

what we need to do about it.

 

So, from the basic around the immunization data gap

 

begins with something that was a very, very important effort

 

and importation part of our history around the development

 

of the Immunization Information Systems or IISs.

 

The IISs were started up in about the 1970s

 

at a local or regional geography level,

 

at a state level or a city level in certain cases,

 

and the platform

 

was supposed to collect vaccination records for children

 

and it was really looking at,

 

the diagram on the right shows you the various sources

 

that we can actually get vaccination data,

 

and the IISs were supposed to be receiving data

 

from providers, hospital systems, employers,

 

educational systems, retail pharmacy,

 

all these various sources

 

were supposed to feed into that state level

 

or local level IIS.

 

And the IIS was really designed to give us access

 

as consumers, our providers access to that vaccination data.

 

The problem is,

 

is that this is set up in a very different manner

 

in every geography, in every state.

 

And so the type of data that's collected

 

or the completeness of data that's collected

 

is highly variable.

 

But this is a really important problem to tackle now,

 

especially in light of recent COVID-19 pandemic

 

but also the measles and meningococcal outbreaks

 

that really happened very recently

 

and reinforced the need for nationwide interoperability

 

of vaccination coverage.

 

Along these same lines,

 

we're at a crossroads today from a technology standpoint

 

where we're really compelled and we're set up

 

to use our technology in the right way

 

to share important medical information and data

 

but the IISs have not yet fully migrated

 

to leveraging these new technologies.

 

We know that there's organizations

 

who are increasingly vocalizing the need

 

for US interoperability of data.

 

Let's talk a little bit more about what registries are

 

and what some of the challenges are.

 

So, as I said,

 

registries are independent public health authorities.

 

The state registries that are supporting this data flow

 

and the IISs, as many of you probably know,

 

maybe don't have huge staffs

 

behind making the data interoperable,

 

leveraging new technologies

 

to optimize the state registries.

 

There are a lot of competing priorities

 

within the state health department.

 

And there's also a lot of effort required

 

to make sure the data is flowing correctly.

 

And earlier

 

when the registries were really set up in the 1970s

 

there was a high variability

 

of what type of data was collected, how it was stored,

 

and how data was actually shared between different entities.

 

We know that there's about 90% of registries

 

will have some form of adult vaccinations.

 

The majority have a lot more completeness

 

with childhood vaccinations

 

but we're really beginning to understand

 

where we need to round out that data.

 

There's also some form of

 

when we think about data being shared with large payers,

 

like UnitedHealthcare in this instance,

 

about 70% of the registries

 

have some form of mandated reporting

 

between the registry and UnitedHealthcare

 

for the claims to go back to that registry,

 

the registry data to go back to UnitedHealthcare

 

so we can get to that more complete picture

 

of vaccination coverage for our populations.

 

Talked a little bit about the registry challenges

 

around the variability and completeness of data

 

and one of the reasons for that

 

is that all the data is not really mandatory

 

for reporting purposes.

 

That there's often high variability

 

in which provider groups are reporting into the registries

 

and sometimes it's quite difficult and cumbersome

 

for providers to report and also to extract data.

 

There's a very important challenge around having a common ID

 

between the registry and the user.

 

So that if we think about establishing

 

whether it's a master patient index

 

so that we can follow a patient across state lines

 

from one registry to another, often that doesn't exist

 

which makes it very hard to look at

 

a complete vaccination picture.

 

There's also a lot of different ways

 

that the data is stored

 

and how the data could be transferred.

 

Sometimes we're looking at data

 

being stored within flat files.

 

Sometimes some registries have evolved to HL7

 

but there are challenges in terms of the size of the file

 

for transmission of the data

 

and there's also different requirements

 

that are setup within the IMS

 

that make handling large file sizes very difficult.

 

So, with all that said, Optum has put forth a vision

 

for enhanced vaccines data interoperability.

 

Our goal is to really serve as a catalyst

 

to drive interoperability,

 

to drive public-private stakeholder partnerships

 

that support the health and human services mission,

 

that support IIS interoperability.

 

We talked a lot about what the problem statement is

 

around fractured data and completeness of data

 

but we also have identified

 

that we share common stakeholder needs

 

across different entities,

 

whether we're looking at large payers like UnitedHealthcare

 

or public health authorities

 

like the state health departments or vaccines manufacturers

 

who have a need to understand where potential outbreaks

 

and gaps in vaccinations are.

 

So we've really stood up a vision

 

for how we can drive data standardization

 

and data liquidity among all of these stakeholders.

 

What can we bring to bear, to accelerate this mission

 

of IIS interoperability?

 

So we've developed a mission and it's a complex,

 

it's a big problem to solve for

 

but we are compelled to do this now given the pandemic

 

and given the other disease outbreaks I mentioned earlier.

 

So our mission is accelerating HHSs interoperability mission

 

for the IISs so that we can get a better sense

 

of vaccination coverage at both an individual level

 

and a population level, allow us to identify gaps,

 

understand where disparities exist in different populations,

 

and prioritize areas of unmet need across the US.

 

We're also looking to help states

 

move toward HL7 standardization.

 

It's a rich language and the market is ready to do this now.

 

We're looking to provide service solutions.

 

So if you can imagine, what can we do with better data?

 

How can we demonstrate potentially even evidence of immunity

 

in terms of personal portable vaccination records

 

for ourselves, for our families

 

and how can we assist vaccines manufacturers

 

in understanding vaccination trends

 

or maybe even better help with supply and demand

 

for forecasting?

 

This doesn't happen overnight.

 

We've put together a five-year roadmap

 

to ensure that we are working towards solving

 

for this interoperability mission.

 

So there are three primary ways we're going to achieve this.

 

We're going to build a data infrastructure

 

that supports processes that are large enough

 

to manage vaccination records nationally,

 

we're going to help aggregate data from disparate IISs

 

where we're working with various health departments

 

and IIS vendors to aggregate the vaccination records

 

into one data infrastructure, and then we have to work

 

toward making the data interoperable.

 

How do we actually make the data bidirectional

 

so that we can better have this ability to share data

 

between all of those different entities,

 

between large payers, between providers,

 

and make it easier to access the data?

 

And so in doing so, we will really be standing up

 

what is the first public-private partnership

 

to use and build interoperable national registry platform

 

across state line.

 

We have a couple of priorities to make this happen

 

to focus on enhancing vaccine data interoperability.

 

First, we really need to understand

 

how we can enhance the data capture process

 

in an efficient manner.

 

So how can we get data

 

so that we can close gaps more quickly?

 

How do we actually and where do we focus first

 

in terms of supporting HHS's immunization gateway efforts?

 

How do we do a better job in understanding

 

how we can trace data and different files

 

and provide resources back to the states?

 

How do we move away

 

from some of these very inefficient manual processes

 

around data exchange

 

and start to automate a lot of these data exchanges?

 

We have to stand up technical protocols for data sharing

 

that allow us to support the quality reporting requirements

 

around vaccinations and we need to be able to understand

 

how we round out the data

 

so we have a more complete picture of both childhood

 

and adult vaccination.

 

So, really because it's such an ambitious effort

 

that we're talking about today, why lead this?

 

And we'll talk more about this with Jennifer

 

in a few minutes, but if we look at the partnership

 

between UnitedHealthcare and Optum,

 

we share a lot of reasons why we would lead this effort.

 

Number one, we do want to improve vaccinations

 

across all populations.

 

For UnitedHealthcare, that includes supporting

 

over 50 million covered lives across 40 states, plus states,

 

where United has members.

 

We really are aimed

 

to look at how we are tracking vaccinations

 

not just year to year but over a lifetime

 

in effort to increase overall population health

 

and reduce health care spending.

 

From Optum's perspective, why would we do this?

 

We really, it's an opportunity

 

for us to demonstrate our technology competencies

 

and drive toward HL7 interoperability goals.

 

We're really looking at demonstrating

 

how we can bring to bear our advanced analytical engines

 

so that we can not just collect static data

 

but actually make use of the data

 

and make the data valuable to our partners.

 

We're looking to support consumers and patients

 

and providers by making vaccination history more accessible

 

and more useful to them.

 

And finally, we really are looking at serving as a bridge

 

where we will be looking at evolving our efforts

 

to be more nationally representative over time

 

to make sure that we have coverage across payers.

 

Let's talk a little bit about,

 

and this is where we have some urgency here

 

in light of the COVID-19 pandemic

 

and with the vaccines on the horizon,

 

there are real-world applications

 

of why a single-source immunization database is important

 

and what we can do about it.

 

How do we make the data actionable?

 

Some of the things that are on this slide

 

are really just a few of the things that we're working on

 

and things like an immunity passport.

 

How do we demonstrate that we have either a vaccination,

 

the appropriate vaccinations at the right time

 

that could enable us or be required eventually

 

for travel purposes?

 

How do we have a mobile vaccination record

 

that not only gives you your history

 

around your vaccination status

 

but it reminds you what you may be due for,

 

if there is an additional vaccination in a series,

 

if it's a multi-series vaccination

 

or if there is a vaccination that's an annual vaccination

 

or there's a need for a booster

 

or you're a high-risk individual

 

that has a different vaccination requirement?

 

So, how can we enable

 

not only retrospective review of your vaccination

 

but prospective planning around vaccinations?

 

And then where do you get your vaccinations?

 

Today is a very different world for people

 

in terms of accessing care.

 

We've talked a lot about in the industry

 

a return to routine care and preventative care,

 

but we really are thinking hard

 

about what is going to enable consumers to feel comfortable

 

to go out and get vaccinated,

 

to understand that they don't have to feel at risk

 

going to get vaccinated?

 

So where can they find vaccination centers?

 

Are we looking at additional drive-through

 

vaccination locators, as we head into flu season,

 

as an example?

 

There are a lot of efforts that are ongoing in the market

 

that provide vaccination services

 

that don't require you to go into a health care system.

 

So how can we do a good job of connecting the data

 

around a vaccination need

 

with where you can actually take action

 

to get your vaccination?

 

And then on the bottom,

 

just thinking about a vaccination ordering portal.

 

If we think about the importance of this

 

for a large provider organization or health care system,

 

if we can understand where the biggest gaps are,

 

where the disparities are, where the outbreaks are,

 

where the highest need is, could we actually envision

 

developing a vaccine ordering portal

 

directly connected to this registry

 

that has allow more access to real-time data

 

so the manufactures can really think about how they manage

 

or potentially alter supply and demand,

 

fulfillment, and distribution?

 

And then other things like house calls targeting.

 

So house calls or other types of home programs

 

that are available today

 

and actually are showing a resurgence

 

where medical teams are going into the houses of elderly,

 

of other high-risk individuals

 

for the purposes of care provision.

 

How can we actually look at

 

where some of the gaps in vaccinations might be

 

to drive maybe a more formed targeting approach

 

around these house call types of programs.

 

Similarly, if we think about educational efforts,

 

market awareness, vaccine awareness, outbreak awareness

 

we can start to link the registry data

 

to where this education is provided.

 

There are also a few other use cases that we can think about

 

with this single source immunization database.

 

So, thinking about this as more than just data.

 

We talked about education

 

but there's also other types of marketing campaigns

 

that vaccine manufacturers could maybe target

 

more specifically to certain geographies, zip codes,

 

provider groups, and so on.

 

How do we actually look at

 

different types of performance metrics?

 

So, which providers might have higher vaccination status?

 

Which providers actually might be vaccinating lower

 

than average for a specific vaccine?

 

Can we use this data for research

 

around population cohort analyses?

 

Thinking about how do we actually visualize this data

 

in a way that is meaningful,

 

that can easily be utilized

 

by public health state department,

 

by provider organizations, by payers,

 

by vaccines manufacturers?

 

There's got to be a way that we can deliver this data

 

so that we can understand where these gaps are

 

and adjust them in a more efficient manner.

 

And then finally, I've talked a lot about HL7

 

and really looking at accelerating the move

 

to a more standard data dictionary.

 

So with that said, I am going to bring back up my colleague

 

Dr. Jennifer Brueckner

 

and we're going to have a little bit of a discussion

 

around UnitedHealthcare's perspective

 

on why this is important.

 

So welcome back Jennifer.

 

Thank you.

 

All right, so Jennifer, I think one of the things

 

that I wanted to start off with is really talking about

 

what do you think are currently the biggest challenges

 

with immunization data, from a payer perspective?

 

One of our biggest opportunities

 

is to be able to have complete and accurate data

 

from the time you're born up through adulthood

 

until the end of life so that we're able to maximize

 

every opportunity for you to get the vaccines you need

 

to live your healthiest life,

 

to be able to really understand

 

when you received all your vaccines,

 

when you can get those catch-up vaccines,

 

and when you're due for vaccines.

 

Many of us, including myself, may be challenged

 

to know every vaccine we received throughout our life.

 

So something a registry could be critical as a resource

 

to verify what vaccines we have received

 

and most importantly which vaccines we need to receive.

 

Thank you, but I know UnitedHealthcare

 

has been working with the state registries

 

for quite some time.

 

Could you describe a little bit

 

about how UnitedHealthcare currently engages

 

with the state registries for immunization reporting?

 

Yes, we reach out to registries and request information

 

on our members.

 

That member information can be so valuable

 

helping not only myself in programming

 

so that we're able to target individuals

 

that need that additional encouragement or education

 

to get vaccinated but also supplying that information

 

to providers and members

 

so that they can make educated decisions

 

about the next step in their clinical care.

 

That makes a lot of sense and you have three large teams

 

who are working toward this on a daily basis probably.

 

How would you summarize what the goal

 

of these engagements with the state registries are

 

for UnitedHealthcare?

 

It would be to increase the timeliness

 

of obtaining this data and to partner with the registries

 

so that we can share the information we have

 

as well as the information they have bidirectionally

 

so that we have accurate, up-to-date information.

 

So, for example, our providers can make clinical decisions

 

on next steps and care.

 

So, Jennifer, could you describe how this impacts

 

your population health management goals?

 

I know you have oversight and responsibility

 

for population health management within UHC as well.

 

Yes, it actually helps us reach some of our goals

 

along with we've been working with the CDC since 1980s

 

on our Healthy 2020, 2025, 2030 goals

 

and this additional information helps us identify

 

who is currently vaccinated and up to date

 

and who we need to reach out to,

 

to really encourage and educate

 

to obtain additional vaccinations.

 

Great, thank you.

 

So, Jennifer, I know it's somewhat of a complicated process,

 

but maybe you could share with us

 

how UnitedHealthcare currently engages with state registries

 

for immunization reporting.

 

Yes, we've developed relationships

 

with different information registries

 

and we've been able to send them our member information

 

and be able to receive back the immunization data

 

for those members

 

and that enables us to reach out to those members

 

that are still noncompliant,

 

that have not received the vaccinations they need

 

so that we can encourage and educate them more

 

about those vaccines and get more of those individuals

 

to be vaccinated and protected from those illnesses.

 

Yes, so that kind of describes also

 

what the goal of engaging with those state registries are.

 

Maybe, could you describe a little bit more

 

about the goal for the state registry engagement

 

as it relates to your providers?

 

Absolutely, in addition to getting that information

 

so that we can reach out to the members and educate them,

 

we can also provide this information to our providers

 

so they can use this information to make clinical decisions

 

on what vaccinations those individual patients, members need

 

in order to meet their goals

 

and also to prevent unnecessary illness,

 

preventable illness.

 

We also can use this information to further understand

 

where there's opportunities.

 

There may be areas where inadequate vaccination is occurring

 

and we can use our resources

 

as well as providers in those areas

 

to advocate for vaccination

 

and really help close some of the opportunities that exist.

 

Great, thank you.

 

You're very passionate about this.

 

I think it rubs off on people.

 

Now, thinking really about turning to COVID-19

 

and the pandemic we're in.

 

Do you think this pandemic is going to change

 

the way immunization data is collected and shared

 

and if yes, how?

 

Yes I do.

 

I do think there's going to be a need

 

with the potential vaccines

 

that are going to become available

 

for us to need to be able to easily and efficiently

 

be able to track

 

not only what brand COVID vaccine you received but when

 

so that the appropriate timing of a subsequent vaccine

 

to complete a series can be completed

 

and so that everyone involved could have easy access

 

to the information, whether it's yourself as a member,

 

whether you're a provider

 

looking to provide say a second shot in the series,

 

whether you're UnitedHealthcare looking at okay,

 

how many of our members are getting vaccinated?

 

Where are there areas of opportunity where we can encourage

 

and provide access so that adequate coverage

 

is occurring throughout all of the United States?

 

That's, I think we're probably going to,

 

as we talked about in the presentation,

 

see a lot of these changes become accelerated

 

and prioritized.

 

I would definitely agree.

 

So, if you then, in closing,

 

could you tell us in your own words

 

how UnitedHealthcare views

 

this immunization interoperability project?

 

Yes, this is so important.

 

As we move forward and really want to change

 

and improve people's lives for the better

 

we need to embrace

 

every opportunity to prevent avoidable illness.

 

Just like with the upcoming flu season,

 

this is something we can do, we can prevent,

 

so we want to leverage every opportunity

 

in the coming weeks and months

 

to ensure everybody has the catch-up vaccinations they need

 

and also have the opportunity to get vaccines

 

as they become available, like the flu shot,

 

and soon, the COVID vaccine.

 

Absolutely, so

 

since we don't yet have a COVID vaccine,

 

I think we do have one final parting message

 

that we wanted to share with everybody.

 

Please, go get your flu shot.

 

Thank you Jennifer

 

and thank you all for attending Optum Forum 2020.

 

We value your feedback and appreciate your time

 

to come to this session.

 

(mellow contemporary music)