A summary of presentations from the weekly Summit partner webinars
September 7, 2023 – The latest Summit Summary
- Announcement from L.J Tan (Immunize.org)
- Rise to Immunize Measures Update – Stephen Shields (AMGA) and Elizabeth Ciemins (AMGA)
- Questions
- Announcements
Announcement from L.J Tan (Immunize.org)
The summit held a workshop on August 2, 2023, in Washington D.C., with over 50 participating organizations. There were three teams that emerged from the workshop who led the work to deliver three resources.
The meeting report (13 pages) is available on the NAIIS landing page: www.izsummitpartners.org/2023-naiis-august-2. The report summarizes the discussion and recommendations that came out of the workshop. There is also a truncated 2-page executive summary.
One deliverable is already available on the landing page: Fall 2023 Respiratory Season Vaccination Decision Making for People 60 and Over. This resource includes a specific algorithm table for how to co-administer RSV, COVID-19, influenza, and pneumococcal vaccination for this upcoming respiratory viral pathogen season.
The second deliverable, comprising talking points to discuss the recommended fall respiratory vaccines, should be approved this week and, following the ACIP decision on COVID-19 vaccination, will be released. The third deliverable, which is a personalized vaccination action plan, is scheduled to be available at the end of the week or the beginning of next. Those will be available on the landing page, as well.
Thanks to the team leads. Susan Farrall (DHHS) and Synovia Moss (Good health Wins) have been leading the action plan. Thank you to Amy Harrington ( Kentucky Department for Public Health) for leading the group that’s putting together the talking points. Thank you to Tirsit Makonnen (National Consumers League) for leading the team that developed the now-launched “Fall 2023 Respiratory Season Vaccination Decision Making for People 60 and Over.”
Rise to Immunize Measures Update – Stephen Shields (AMGA) and Elizabeth Ciemins (AMGA)
Stephen Shields, MPH, Lead Population Health Research Analyst, American Medical Group Association (AMGA), and Elizabeth Ciemins, PhD, MPH, MA, Vice President, Research and Analytics, AMGA, gave an update on Rise to Immunize Measures.
What is American Medical Group Association (AMGA)?
- Association of medical groups in America
- Around 440 health care organizations in every U.S. state
- About 175,000 practicing at member organizations
- Deliver care to approximately one in three Americans
- Subset of members are participating in Rise to Immunize (RIZE) campaign
- Not-for-profit 501(c)(6) trade association
- Members are multi-specialty medical groups, integrated systems of care
- Membership not at individual level, but at organization level
- Mission
- Advance the model of multi-specialty medical groups integrated systems of care
- Advance model as preeminent model to delivering high performance care in America
- Dedicated to improving population health and care for patients at a lower cost
AMGA member organizations participating in RIZE
- There are 82 campaign participants
- Most reporting data in 29 states
- About 50,000 full time equivalent (FTE) physicians
What is an AMGA national campaign?
- There are 82 campaign participants
- Campaign framework
- Assemble national advisory committee
- Team of expert stakeholders
- Members consist of healthcare system leaders and organizational leaders
- Get input for strategies moving forward in the campaign
- How to develop measures
- What resources would be important
- What to focus on
- Quarterly benchmarking
- Before launch of campaign to figure out what to measure and goals
- Assemble resources and tools for best practices
- Webinars and meetings
- Throughout the campaign (campaign duration is usually 3–5 years)
- Organizations submit data quarterly and attend webinars monthly
- Attend meetings 1–2 times a year
- End of campaign – disseminate in a White Paper publication
- Taking into account all the learnings, resources, and lessons learned
- Member groups
- Implementing evidence-based practices (“campaign planks”)
- IT documentation
- Provider/patient education
- Clinical support
- Report data quarterly on measures
- Monitor progress and learn from each other
- Administered by AMGA Foundation in partnership with other AMGA departments and corporate sponsors
- Design campaigns
- Leaders of the implementation
- Goal is to drive improvement in a targeted area important to population health
- Help members have higher quality care
- Implementing evidence-based practices (“campaign planks”)
- Assemble national advisory committee
RIZE is the third National Campaign
- Measure Up Pressure Down – Hypertension campaign
- Together2Goal – Diabetes campaign
- Rise to Immunize
Participation is beneficial and motivational
- Benchmarking
- Analyze gaps that can highlight the high performers
- Look at national measures compared to peer organizations
- Peer-to-peer learning
- See data in comparison to their peer medical groups when measuring same thing
- Highlight high performers
- How others have overcome barriers
- Renewed focus
- Increased awareness
- Sustainable process and improvement
- Utilize RIZE resources
- Access to resources
- Utilize campaign planks
Why measures?
- Essential to any improvement process
- Where the group is and where it needs to go
- Learn from peers via benchmarking
- Review data monthly
- Collect and share data
- Healthy competition and create incentives
- Highlight high performers
- Learn from peers
- Organizations strive to be on top
- Some clinics offer bonuses
- Inspire change
- Learn from each other
- Motivate and inspire change
What are the measures and how do they work?
- Measures are designed to be as simple as possible, yet robust enough for meaningful benchmarking
- There are measures for the different vaccines: influenza, pneumococcal, Td/Tdap, zoster, and for a bundle
- For patients age 19–66+, based on CDC recommendations
- Bundle is age 66+ who are up to date on all four vaccines
- Four measurement periods follow a cumulative quarter structure
- Comparing flu to all other vaccines
- Measurement year starts in Q3 and ends in Q2, reflective of flu season
- Patients get flu vaccine in Q3 or Q4
- Compliant for that measure
- Take same measure for flu and apply it to all other non-seasonal vaccines
- Looking at aggregate numerators and denominators
- Submitted to AGMA to analyze number of patients up to date over the number who are eligible and receiving primary care at the health organization with at least one visit in 15 months prior to the start of the campaign
- If they got the vaccine prior to the campaign, they are still compliant
- Patients included
- Age 19–99 first day of measurement (July 1)
- Have PCP
- Complete visit with PCP in last 15 months
- Example: Td/Tdap
- Active patient population (age 19+) is denominator
- Measure numerator and denominator
- Patients who received the vaccine in the measurement period at organization or elsewhere is numerator (compliant)
- If did not get it in past nine years prior to measurement or if history of adverse events due to this vaccine, use that as numerator (not compliant)
- Measure specifications
- Created to guide programming of the measures
- Details
- Definitions
- Suggested codes and data sources
- Measurement periods
- Submission deadlines
- Measure specifications document – helps program the measures
- Report nominator and denominator every quarter
- AMGA creates blinded comparative report and graphs
- Look at who is doing well and who is trying to improve
- Looking at aggregate numerators and denominators
- Patients get flu vaccine in Q3 or Q4
Challenges
- Need to achieve balance between simplicity and robustness
- Adjust measures for changes
- Each group has different capabilities
- Impossible to get everyone to report in the exact same way
- Different amounts of bandwidth with their IT team
- Sudden fluctuations in rates
- When groups submit data they may wonder about fluctuations
- Work with groups individually to identify causes
- Change in guidelines
- Pneumococcal recommendation changed in the last year
Success Stories
- Participants have taken steps to improve immunization care after reviewing benchmarked measures and sharing learning across organizations
- Implementing Medicare Part D vaccines within their organization as best practice
- Groups using third party vendor to be able to bill for Shingrix
- Annual training for their care team for respiratory season to reduce errors
- Successful to reduce errors
- Engaged HCPs to make strong vaccine recommendations by watching AMGA’s video
- How to speak to patients who are hesitant from a provider standpoint
- Steps to go through when a patient is hesitant
- Implementation of standing orders for campaign
- Rates go up for those implementing standing orders after joining campaign
- Flagging patient characteristics in the EHR to identify high-risk patients for pneumococcal
- Age based 66+ flag characteristics in EHR to identify those high-risk patients for pneumococcal (as a second collaborative)
- Engaging entire care team working with staff outside primary care (urgent care, dentists, specialists, etc.)
- Patients engaged by specialists when visiting
- Allowing self-scheduling for patients of vaccinations in the EHR
- Offering vaccination clinics all year
Measuring Success
- One group shared how they use campaign data to drive improvement
- Dig down to the clinician level so providers can see what their own levels are
- AMGA sends out an email to congratulate the top 25 performers and similar email with blinded comparison data
- Talk about ways to improve based on data
- Stories available on website
Questions
Q: Is there any feedback from the AMGA organizations who chose not to participate in this? Did they give reasons? How do you get the success stories out to the rest of the AMGA and others not participating so they can continue to benchmark against each other?
Stephen Shields (AMGA): When we recruit, we let them know that we have a great campaign and ask if they would like to participate. People often say they don’t have time or that their resources are strapped (especially IT resources). We offer opportunities for groups to join the campaign and not report data. Most will join, and most report data; some choose not to report. The second reason people say they can’t participate is that it isn’t a priority for them then.
Lisa Cornbrooks (AMGA): We promote the Rise to Immunize campaign to other AMGA members not involved directly by constant recruitment. Recruitment is rolling to there’s no application window. We are always bringing applicants on. A challenge is staff turnover and leadership changes. We leverage many channels that the AMGA offers and have a range of publications in our group practice journal that goes out monthly. At the annual conference in the spring, we promote the great work of the existing participants and we are try to bring new organizations on board. AMGA’s Rise to Immunize campaign is unique because it’s well-recognized among our members.
Q: I work with local health departments to learn how to better engage with healthcare providers. Seeing the results from your campaign with organizations engaging with HCPs to make strong recommendations, would you be open to connecting offline to share more about their methods and best practices with this strategy? Can you share your contact information for others who might want to continue to work with AMGA?
Email with any questions:
Stephen Shields: sshields@amga.org
Lisa Cornbrooks: lcornbrooks@amga.org
Q: People don’t have a good sense of their coverage rates. IQIP goes into pediatric practices to help them with quality improvement, but adult providers have not had that opportunity. Have you ever compared any pediatric practices to adult practices regarding where they are with the event monitoring and how they’re getting their data? Are there other tips we can learn from the pediatric practices about how better to make adult providers aware of how they’re doing on immunizations?
Elizabeth Ciemins (AMGA): We’ve had lots of conversations about this at meetings and we always say that we should turn to pediatrics because we could learn a lot about how the immunizations are organized and covered. There’s been a long history of immunization, so I don’t know if that was looked at that specifically. We did run an HPV vaccination campaign, so we learned that it’s much easier to engage the pediatricians and recruit in general because it is such an important part of pediatrics. The adults have other vaccines and many other competing priorities. I think it’s a great idea, and we should look at organizations’ pediatrics departments and those who are providing adolescent vaccines to see what they learn and take away from what’s already being done within their own organizations.
Lisa Cornbrooks (AMGA): We’ve had a desire for a webinar on leveraging the lessons learned from pediatric practices and applying them to adults. Our speaker fell through, so if there’s anyone you know who can speak on that topic, let us know. We’ve talked about it a lot with our partners who straddle the spaces of adult and pediatric so it’s definitely on our mind. We’ve had pediatricians speak on our webinars. It’s an area of interest and something that we would love a speaker to talk to our groups about.
Elizabeth Ciemins (AMGA): We have taken away the prep that happens in pediatrics. A baby comes in, and all of their vaccines are laid out. We’ve discussed how it might be a good strategy for adults to do when they’re young. This is for all kinds of prevention. There may need to be a layout at what ages you will need to start getting certain vaccinations, even if you’re 50 or 65. So people can be thinking about what’s coming in their future. In pediatrics, a lot more is laid out.
Q: The composite measure in the bundling, that by your measures, is based on the composite measure. How does a bundled adult composite measure going to work in the future where obviously you begin to be measured by your lowest performing vaccine?
Stephen Shields (AMGA): We tend to see that. Zoster is the lowest because we’re only tracking Shingrix, but it’s also rising the quickest. We see that the bundle mostly tracks with the lowest vaccine. I totally agree. I think it’s dependent on what vaccines you have in there. It’s nice to see the improvements in the bundle because you can say with this improvement in rate it’s equated for X number of patients getting more comprehensive care than if the percentage was what it was last quarter. I really think it depends on the vaccines you put in and what rates they’re at over time.
Elizabeth Ciemins (AMGA): We had a composite measure for diabetes, and what we liked about it is it forced providers to take more of a holistic view. Could you look at all the patients who are missing one vaccine? That gives them a strategy. I think it helps in that approach and that, ultimately you could get more people vaccinated. I think with the four you have, they’re well performing vaccines. I’m just thinking what happens if you now add the routinely recommended hepatitis B vaccine and it’s now part of the bundle. How is that going to impact your participation? It might be a more challenging vaccine, with two or three doses. It’s a good conversation point.
Q: Stephen, you mentioned the idea of overheating an IT system. What does that mean?
Stephen Shields (AMGA): You have a number of programmers in your organization. Those people have the ability to pull together reports that you haven’t pulled before. It’s easy to get a button and run it frequently, but if you have to create a whole new measure or a whole new report, that takes the resources of a programming IT professional. On the back end, it’s more of the programming, so you have a limited amount of people with a limited amount of time. A lot of groups have either not a lot of people or a lot of demand, so most of IT time is taken up reporting for other things. It’s a competing priority, and they have to decide how they will use their people’s time. A lot of groups want to know how long it’s going to take them because they love to know the number of hours it’s going to take, which makes a lot of sense. It’s hard to tell because every group is so different and the capabilities they have with different systems and electronic medical records, as well as different types of staff. With some of the smaller staff, it might be more difficult for some of them and might be easier for some of the larger ones. It’s always a balance and it’s different for every group.
LJ: I recall when you first piloted this program, and I was privileged to be on your committee for that. Part of the challenge was the bidirectional data exchange and the state immunization information systems. I think from your earlier response about getting systems to enroll resources; this tends to continue to be an issue. I think we really mean competing priorities because it’s where you decide to put your resources. Maybe there’s still room here for pushing of the benefits adult immunizations is so important.
Q: Are you thinking about moving this into adolescence at some point?
Elizabeth Ciemins (AMGA): We have three HPV vaccination studies going on right now so we’re looking at a qualitative study on initiation. We’ve got two other NIH trials we’re participating in to try new methods. We’re learning from those.
Lisa Cornbrooks (AMGA): We’ve been in the HPV space for Rise to Immunize. To date we’ve focused on routine adult vaccinations, but we are exploring a potential extension and expansion of the campaign. As of now, our groups have expressed interest in other adult immunizations to potentially add four measures, but not in the adolescent space for this campaign. Our work at AMGA at large straddles both, and if anyone’s interested in getting involved in any of those HPV vaccination studies, please reach out to any of us. We have opportunities in the adolescent space.
Email with any questions:
Stephen Shields: sshields@amga.org
Lisa Cornbrooks: lcornbrooks@amga.org
Announcements
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