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A summary of presentations from the weekly Summit partner webinars

 

May 13, 2021

HRSA COVID-19 Coverage Assistance Fund – Kip Castner (HRSA) and Lauren Williams (HRSA)

Kip Castner, branch chief, and Lauren Williams, legislative analysist, both of the Office of Provider Support at Health Resources and Services Administration (HRSA) provided a presentation on the HRSA COVID-19 Coverage Assistance Fund (CAF).

Lauren Williams

Introduction to HRSA COVID-19 Coverage Assistance Fund (CAF)

The Health Resources and Services Administration’s (HRSA) new program, HRSA COVID-19 Coverage Assistance Fund (CAF), addresses the outstanding compensation needs of providers on the front lines vaccinating underinsured patients. CAF reimburses the cost of vaccine administration fees for the uninsured, underinsured, and for patients with fees from cost-sharing plans.

Two programs, the Provider Relief Fund and the HRSA COVID-19 Underinsured Program were created to help providers endure the challenges of the pandemic, providing financial support to help healthcare providers who have lost revenues and increased expenses. These programs joined with CAF so healthcare providers can administer the COVID-19 vaccines to patients where they live and patients can seek out providers they trust.

Kip Castner

Provider Relief Programs

There are general and targeted distribution programs with phase relief distribution to Medicare providers, Medicaid/CHIP providers, commercial dentists, assisted living facilities, and expanded eligibility to certain providers who don’t typically participate in Medicare/Medicaid. There is also a second program, the HRSA COVID-19 Uninsured Program, which reimburses providers for vaccine administration fees associated with vaccinating uninsured individuals, as well as COVID-19 related testing and treatment for the uninsured, regardless of their immigration status.

HRSA COVID-19 Coverage Assistance Fund (CAF)

Through CAF, enrolled providers are reimbursed at the national Medicare rate for vaccine administration fees for vaccinating the uninsured, underinsured, and for patients with fees from cost-sharing plans.

Providers who have administered FDA-authorized COVID-19 vaccines on or after December 14, 2020, are eligible for claims reimbursement through the program as long as the services provided meet the coverage and billing requirements. Providers must verify that there is a remaining balance from the patient’s health insurance plan that doesn’t include COVID-19 vaccination and that no other payer will provide reimbursement for the administration of a COVID-19 vaccine.

Enrolled providers must submit claims to the patient’s primary health insurance plan and if there is a remaining balance that does not include COVID-19 vaccination, and no other third party will pay, then the provider will be reimbursed. The provider must have checked for healthcare coverage, accept the reimbursement, agree not to balance bill the patient, and accept the terms of CAF. The SSI Group is the program administrator for funding, coverage, and reimbursement for the program.

Shoo the Flu – A School-located Influenza Vaccination Model Program – Jade Benjamin-Chung (Stanford University Dept. of Epidemiology and Population Health) and Casey Wright (Flu Lab)

Jade Benjamin-Chung, PhD, MPH, of Stanford University Department of Epidemiology and Population Health and Casey Wright, ScM, of the Flu Lab provided a presentation  on the school-located influenza vaccination program called “Shoo the Flu.”

Casey Wright

The Shoo the Flu program has administered tens of thousands of free flu vaccines to children in grades k–8 in more than 90 schools (public, charter, and private) in the Oakland, California area since the program began in the 2014–2015 flu season. The program is intended to provide vaccinations to meet students where they are and reduce logistical challenges for families. This effort was made possible by state and county health departments, the school districts, philanthropic financing, insurers/healthcare organizations, and nursing and staffing services.

Shoo the Flu is a multi-year project, vaccinating children in dense, urban, multicultural locations in the Oakland, California area. During this project they looked at whether vaccinated school children of ages 5–12 resulted in limiting community transmission and severity of influenza for the 2014–2015 flu season. To do this, they flooded a geographic area with the flu vaccine, vaccinating as many children as possible, and then performed an evaluation of vaccination coverage, Tamiflu® utilization, school absences, and flu-related medical visits (see below).

Parent written consent was, and still is, required for children to be vaccinated, which sometimes posed a challenge even with bright colored forms (in six languages) sent home and promotional and educational resources given to the schools. The Shoo the Flu toolkit is freely available to everyone, and adaptable and ready to distribute.

Children with completed forms were vaccinated between early October to mid-November, depending on the size of the school site. Nurses provided by the county, registry nurses, and other qualified volunteers vaccinated the children, and were assisted by teachers, school staff, and parent volunteers at the school. Following vaccination, each participant’s immunization was documented in the California immunization information system.

Jade Benjamin-Chung

Evaluation Objectives

Stanford and UC Berkley evaluated the impacts of the program on elementary children age 5–12 in the 2014–2015 school season, as well as the effects on the community due to the vaccinated children in the program. They were looking to measure whether offering school-located vaccinations in a large, diverse school district would increase coverage, reduce Tamiflu prescriptions, reduce illness-related school absences, reduce visits to the doctor for flu-like illness, and reduce flu-related hospitalizations.

Methods – Matched Cohort Design Study

There were 50 schools in the Oakland Unified School District, which they matched to a control county, West Costa Unified School District, which had similar characteristics and publicly available data. The data sources used were a school-based survey, school absence records, flu hospitalization surveillance dataset, and a large Kaiser Permanente Northern California dataset (Kaiser is a large integrated healthcare system, fairly representative of the underlying population, except for the lowest income population.)

There were differences between the two sites, but researchers were able to use statistical analysis to control for those differences between the districts.

Key Findings

They found that for children 5–12 years of age, the program yielded 7–11% higher vaccine coverage, 4% fewer Tamiflu prescriptions, and 3K–8K fewer illness-related school absences per year. There was no statistical decrease in flu hospitalizations or medically attended acute respiratory infections. However, flu hospitalizations are very rare in school age children, so it’s difficult to statistically identify any effects in that group.

After removing the 5–12-year-olds data, they looked at the effects on reducing flu-related outcomes in other age groups that were not directly targeted by the “Shoo the Flu” program. Results showed a small decrease in Tamiflu prescriptions in adults, lower medically attended acute respiratory infections in adults, and lower hospitalizations in all ages, especially in those age 65+ (300-700 lower cases per season).

Question: How do you deal with forms that were lost or never made it back?

Casey Wright: It’s important to leverage every communication opportunity possible. The forms are never printed on anything but bright colored paper, and they are not only sent home, but readily available in the front offices.  The schools are all given robocall scripts, email scripts, and school announcement scripts. Forms are also available to sign by guardians in the front offices the day the vaccinations are given. We do our best to use every opportunity to reach parents and guardians.

Question: Have you looked at other ways to do this electronically?

Casey Wright: In the interest of communities we were serving, it was not a tool that would have been successful. It would have been different with private schools in areas with families who had more resources.

COVID-19 Communications: Promoting Prevention Measures and Vaccine Confidence – Diana Olson (NFID)

Diana Olson, senior director of strategic communications and the National Foundation for Infectious Diseases (NFID) provided a presentation on NFID’s efforts to promote evidence-based prevention measures to stop the spread of COVID-19.

The mission of NFID is to educate the public and healthcare professionals about the burden, causes, prevention, diagnosis, and treatment of infectious diseases. Promoting COVID-19 vaccine confidence is challenging and complicated even for those who are trained to do so. NFID has developed a communications framework to help address real-world situations that communicators from different sectors have when discussing COVID-19.

Pandemics require adjustments to guidance and recommendations as new scientific discoveries are made, which leaves people feeling like they are receiving conflicting advice. The public may not be aware of guidelines or how to properly follow them and changing guidelines can be confusing. Socioeconomic status can be a significant barrier to following recommendations and messages need to be tailored to be more empathetic, credible, and effective.

In January of 2021, NFID convened a multidisciplinary expert roundtable with more than 50 leading multisector organizations, to share research, insights, and best practices for improving communication based on public health COVID-19 prevention measures. Out of this discussion came the new communications framework, which was published in an NFID report: COVID-19 Communications: Promoting Prevention Measures and Vaccine Confidence.

The report lays out key communication strategies based on four core principles: equity, empathy, transparency, and respect. Challenges can be addressed through proactive communications that address concerns, meet the needs of specific target audiences, and offer practical solutions to help people follow public health guidance.

Research shows that we can have an impact when we focus on the movable middle verses those firmly against vaccination. To persuade those on the fence, we need to address concerns, misinformation, and communicate transparently and empathetically. Misinformation needs to be corrected promptly.

The NFID toolkit, which includes videos, social media graphics, and other complimentary resources available on the NFID website may be useful in efforts to promote vaccine confidence. On the website is a complimentary webinar by NFID, co-sponsored with the American College Health Association, Business Group on Health, and National Medical Association. In the webinar, experts share real-world insights and practical strategies for implementing the communications framework.

Question: How else is this implemented into some of the businesses and communities?

Diana Olson: We are working with many organizations to help push out these tools and resources to their constituencies. We offer a webinar and plan to offer more in the future.

Question: If Moderna, Pfizer and J&J get full licensure of their vaccines, what movement will there be to make stronger mandates of COVID-19 vaccination? If so, how soon?

Diana Olson: The recommendations that come from ACIP are national recommendations and those mandates happen on the state-by-state level and within local communities and employers. As of now, I don’t believe there are any states that have started to mandate covid vaccination, however we know number of universities and colleges have.

Marla Dalton:  The reason that NFID partnered with so many different organizations and sectors is that there probably won’t be one single solution. Everything will be customized based on sector as well as organization. We are already seeing discrepancies between public and private organizations, and we anticipate that will continue.

L.J Tan:  We are beginning to see more approaches to incentivize employees getting vaccinated, as opposed to mandating vaccination.

Announcements – L.J Tan (IAC)

The Summit will conduct a virtual meeting, Maintaining Influenza Prevention During the Ongoing COVID-19 Pandemic, on May 20 from 2–4:30 pm ET. This webinar will be held in place of the usual in-person Summit meeting held each spring. The agenda will include updates on influenza surveillance, influenza vaccine uptake, communications planning for the upcoming season, and presentations from vaccine manufacturers on their estimated vaccine supply for the 2021–22 influenza season. Registration information is available on the Summit website.

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