Covid Vaccine and Value-based Care

How the Three Pillars can assist the vaccination process

Population health concepts and techniques are employed in both public health and value-based care circles. Public health focuses more on population health improvement through policy, legislation, and community-wide efforts whereas value-based care generally attends to population health management of a specific patient cohort, usually within a medical practice, health system, or a health insurance payer. The development and rollout of the Covid-19 vaccines is a great example of how the application of Pop Health principles - risk stratification, plan of care, and longitudinal support - in both arenas can aid both, showing their points of confluence and synergy.

The push to develop the Covid-19 vaccine reflects a public health effort to counter a significant cause of morbidity and mortality in the US: SARS-CoV-2 (aka Covid-19). In addition to the efforts to decrease spread through social distancing, handwashing, and mask-wearing, the public health folks helped lead the charge to have federal government and private business collaboration to more definitively address the viral pandemic through large-scale vaccination. Legislative and policy changes occurred that allowed for the development of a safe and effective vaccine in a fraction of the time typically needed to accomplish such a feat.

Once vaccines were developed, in an effort to appropriately administer a limited supply of vaccine, the population health improvement (public health) teams have hopefully enlisted the help of the population health management (value-based care) teams. Given the current limited supply but the urgency to start vaccinating before we have 300 million-plus vaccines for the US population, the public health teams (CDC) defined who is at the highest risk from Covid-19 and, therefore, most in need of the vaccine.  

This risk stratification of the population will facilitate the most strategic utilization of the vaccine in the effort to diminish Covid-19’s effect on our health and our economy. Front-line workers were defined (mostly) and listed as the number one priority. Some confusion has arisen at hospitals and health systems as to who exactly is “high risk,” though, as the cohort wasn’t specifically defined. This is where some rational thought about patient contact and risk could be applied to smooth this initial process. If available, additional health risk factors noted by the CDC in their third wave could be applied for prioritization. After them, people over the age of 65 are to be vaccinated. That’s easy enough, as people typically know their age.

The third group is where the value-based entities can really help. The third level of vaccinations are to go to the under-65 population with health risks for Covid, as defined by the CDC. Population health management / value-based entities have access to health data on their cohorts of patients through Electronic Medical Records and/or medical claims data. This information can be used to identify the patients at risk for Covid as defined by the CDC. Again, if employees of health systems didn’t feel it was too much of an intrusion into health privacy, the same data could be used on the initial sub-cohort of front-line workers.

Once identified, these patients can receive multimodal, targeted communications alerting them to their risks and benefits of the Covid-19 vaccine, encouraging them to get vaccinated. They can then be directed to the nearest vaccination point (plan of care). Followup communication can assess completion rate of the process and re-encourage as needed (longitudinal support).

Working in this manner avoids applying resources to those who would initially benefit less from the scarce resource of the vaccine, while aiming efforts and assets towards those most likely to benefit personally and in a public health manner.

It seems simple, but without a population health management framework of risk stratification, plan of care, and longitudinal support and its disciplined application, an ambitious effort like staged vaccination of an entire population will unravel.