Authors: Ana Isabel Gallego, MPH | Hang Pham-Singer, PharmD | Zachary Withers, JD | Sami Jarrah, MPH | Michelle E. Morse, MD, MPH | Dave Chokshi, MD, MSc
Editor’s Note: Manatt worked closely with the New York City (NYC) Department of Health and Mental Hygiene, as well as payers and providers, on an innovative collaboration to drive vaccine uptake. The proportion of New Yorkers with at least one dose of the COVID-19 vaccine increased from 71% to 82% during the course of the program. Manatt’s role in this critical effort included helping NYC organize and launch a learning collaborative with Medicaid and Medicare Advantage health plans. The learning collaborative provided a catalyst for NYC to foster closer relationships with health plans and collaborate on the pandemic response and related public health activities. Manatt also advised NYC and the collaborative on key strategies regarding the pandemic response, including consumer outreach and engagement strategies around COVID-19 testing and vaccinations. As part of this work, Manatt supported NYC in developing and implementing a vaccine incentive program for health plans to incentivize further engagement with consumers to get vaccinated.
This unique initiative was highlighted in a recent case study published in the July issue of NEJM Catalyst Innovations in Care Delivery. A summary and key takeaways are below.
Summary
The New York City (NYC) Department of Health and Mental Hygiene, as a local health department, partnered with health plans to pay for provider-initiated outreach for COVID-19 vaccine counseling for unvaccinated people through a program called the Vaccine Outreach and Counseling Program (VOCP). The collective effort and use of emergency contracting—with a budget of $35 million in funding from the government of NYC—allowed for an idea-to-execution period of six weeks. Seven insurance companies covering more than 90% of the NYC Medicaid market and a significant portion of the NYC Medicare Advantage market (insurance products that have a disproportionately large representation of people of color in NYC) administered the program as an in-kind contribution to the effort.
Providers implementing the VOCP reported that they felt counseling efforts were valuable in increasing vaccination uptake, but also described operational challenges. Shortly after launching the VOCP, the federal government reached out to the health department to learn more about the program. Two months later, the U.S. Centers for Medicare & Medicaid Services authorized state Medicaid programs to cover such counseling. New York State’s Medicaid program subsequently adopted a reimbursement policy with similar guidance for counseling while addressing some of the operational challenges of the VOCP model.
Key Takeaways
- The VOCP demonstrates how a local health department (LHD) can act quickly and in a synergistic way with state and federal government agencies.
- The VOCP also shows that LHDs and payers can rapidly solve problems together, even when the LHD does not regulate the payer.
- Each individual in managed care is assigned to a health care provider, theoretically making it possible to rapidly contact more than 3 million NYC residents to counsel them with critical public health information. However, this does not happen in practice. The VOCP is a first attempt to enable paid proactive outreach to assigned patients for public health purposes.
- A supplementary success of the VOCP is in how innovation can catalyze longer-term changes in population health management infrastructure and provider behavior. Notably, the VOCP helped accelerate implementation of payment for COVID-19 vaccine counseling at local, state and federal levels.
- In an emergency, speed matters for sound public health. The VOCP was a program for individuals who remained unvaccinated despite multiple efforts to increase access to the vaccine. Every single additional vaccination in this group represented a marginal benefit. A retrospective evaluation using health plans’ claims data and matching to the immunization registry is planned to assess program impact in the future.