A summary of presentations from the weekly Summit partner webinars
September 12, 2024 – The latest Summit Summary
VaxCare: A Brief Overview – Alessandra Fix
Alessandra Fix, Director of Strategic Programs at VaxCare, gave an overview of the platform, which was built to allow practices to just vaccinate.
Who is VaxCare
VaxCare is a vaccine management service and technology company that aims to streamline vaccination for providers. The goal is to make it easier for providers to stock and administer vaccines, increasing patient access. VaxCare does this by taking on the financial burden of vaccination (purchasing inventory and replenishing stock, as needed), so providers don’t have to upfront the cost of products.
How does VaxCare work?…
- Providers get a dose from their refrigerator and scan it into a system.
- VaxCare then takes on all the operational, administrative tasks:
- tracking of inventory.
- ensuring proper dosing.
- charting the administration,
- filing the claim to insurance, then
- VaxCare gets paid for product and administration and passes the administration payment back to the provider.
VaxCare Data
- As a result of the end-to-end handling and visibility into the administration of the vaccine, there is comprehensive data on the whole lifecycle of the vaccine, e.g., shipment, administration, claims. This allows for insight into, for example, nationwide vaccine administration coverage, year-to-year comparisons on different issues, and claims processing.
VaxCare Impact
- VaxCare areas assist medical practices with vaccination in the following ways.
- Reduction of waste and bad debt.
- Reduction in staff time spent on vaccine order management, claims processing, and billing.
- Safety checks that ensure the doses being administered are correct. The system catches and prevents errors roughly 2% of the time.
- Adherence programs result in increases in vaccination rates.
- Vax to School: a text messaging campaign to parents during back-to-school season was followed by a 20% increase in vaccinations and 23% increase in appointments in the test group versus control group last year.
- Flu Outreach: a flu text messaging campaign was followed by a 28% increase in vaccinations and 8% increase in appointments.
- Series Completion: a pilot is scheduled to focus on series completion for multi-dose vaccines.
VaxCare Ecosystem
- VaxCare collaborates with all the key stakeholders in the vaccine system: payers, suppliers/manufacturers, and EHRs via integration.
Data from VaxCare Billing
- The size of VaxCare’s reach allows for visibility into challenges with payment, which can then be dealt with rapidly.
- VaxCare owns the vaccine inventory; the provider stores and administers the vaccine; and then VaxCare submits the claim, gets paid, and sends payment back to the provider.
- Challenges identified by VaxCare include…
- identification of Medicaid-enrolled patients
- the choice of the wrong stock
- changes to CPT code that may not be updated in some systems
- cross-benefit billing (e.g., vaccines covered under pharmacy benefits but administered in offices)
- new products may have a very long lag time for payment
- complex, varied, or nuanced claims processing requirements
- additional requirements based on risk-based recommendations
- Regarding the shift from shared clinical decision making to risk-based recommendations for the new RSV recommendation, VaxCare was relieved to see that patient attestation was deemed sufficient evidence by the ACIP to establish eligibility under the risk-based recommendation. However,
- The VaxCare billing team is tracking this issue via analysis of collections rate and denied claims and comparison to other product data.
- VaxCare is also tracking changes in filing instructions/information requested on claims, in addition to tracking data on eligibility responses and provider demand.
QUESTIONS & ANSWERS:
Q: Is there any early preliminary data that might shed some light as to whether payers are working and improving the attestation risk requirement?
Alessandra Fix (VaxCare): I have connected with our analytics team. A few weeks ago, I know that we hadn’t seen much of a shift in our collections rate compared to other products, but I know our collections rate from RSV vaccines generally was a little bit lower. But the inkling was that was because the MMWR was still quite recent. It has only been out there for a few weeks, or a month, at this point. I don’t have any kind of concrete information on our collections rate. Part of that is because we generally have a lag time, so it takes a few weeks until we’re able to tell whether a claim has been paid. I can circle back on some anecdotal points: I was on a call earlier today where we were looking at how RSV administrations look this year compared to last year. I think it’s been a little bit slow at the start of the season, but it’s something we’re continuing to keep an eye on.
L.J Tan (Immunize): I think we will want to have you come back and give us some of that data going forward. One of the hopes we had is that, if we saw an inkling of trouble, the Summit partners might be able to figure out a way to work with payers or work with each other to figure out how to connect and address the challenge. So, any kind of feedback anyone on the Summit, if you got feedback consistent with what we’re hearing from Alessandra, we want to be able to try to activate so that we can work with partners to solve the problem.
Q: One of the things that the billing coding breakout group talked about at the in-person summit was, “Do we need to add in or specify some sort of lag time from the day that the ACIP recommendations are made or approved by the CDC director? And, when should we make announcements to the public to say, ‘Oh, it’s ready or it’s not ready or this is coming soon.’ Or, from the provider perspective, does it seem to be that things are in place, they’re having fewer claims being denied? Is that a month from the recommendations? Is it 2 months? Any thought about what is a reasonable time to warn the public and providers – “warn” may not be the right word, but let them know that this may not be implemented at the drop of a hat.
Alessandra Fix (VaxCare): It’s a good question, because if you say too early, “It’s available; it’s covered,” and then providers have issues with being paid, they might lose confidence. And so they might say, “Oh, I’m going to leave it for this season and then return next season or I’ll wait a little bit longer.” So, you don’t want to give the okay too early. With that being said, we know that, particularly for routine recommendations, we do see – and I know this based on prior work I’ve done at Avalere – that many payers are activating coverage and putting products on fee schedules soon after the MMWR is published. I’d say there are the early adopters who do it right away and there are the ones who maybe take 3 months. I think that’s when the majority do and then there’s some that just take a little bit longer because they do have, technically, per the law, up to a year or sometimes more. VaxCare tries to pilot a new product once it launches and make it available to some clinics that want it. We’ll ask providers who is getting questions or getting demand for this; we’ll ship it out to you. Then, we closely track what’s happening on the payment side. Once we are confident that our collections rate is in the 85% to 95% bracket, then we’ll start shipping it out more broadly. In terms of how long that take, I’d have to ask; it’s longer for recommendations that are more complex.
L.J Tan (Immunize): It sounds like 3 months appears to be that median, that for most payers, 3 months after MMWR recommendation release is, is where most payers fall into line. Does that sound about right?
Alessandra Fix (VaxCare): That has always been my understanding, and a lot of that is based on prior work that I’ve done that, at least in the commercial market, we typically see pretty good coverage 3 months post-recommendation. I think it could be longer for Medicaid. There’s obviously a different timeline for Medicare Part B. And then there are some that lag. And I think the problem is also that, even if there are just a few smaller payers that are taking a little bit longer, if a provider has one instance where a claim is denied, they are potentially losing quite a lot of money on that product. And so it hurts their confidence. So, even if it is a small number of instances, the edge cases really matter here.
Carolyn Bridges (Immunize): Yes, even 5%, when your margins are really small, could mean the difference between solvency of this service and not. So I appreciate that particularly for smaller providers. That’s really helpful.
Q: Besides new introductions of vaccines, which I think is a major category, do you have a sense of the major causes or the major reasons that claims are being denied? What is that 15% to 5% of denials, what are the main reasons? And are any of those fixable by providers to reduce that rate?
Alessandra Fix (VaxCare): There are a whole host of reasons. Sometimes, it’s the patient’s insurance coverage ended up not being active or we had incorrect information on what plan the patient was covered under because they didn’t present a new medical card. So, we might be submitting a claim to an insurance company and the patient’s not actually covered anymore. Then we must go back and, if we’re able, get in contact with the patient to update their insurance. There are those kind of edge cases where maybe the product is being administered at an age that is close to the thresholds. I don’t know how often we see that. There might be cases where it’s cross-benefit billing, so maybe the vaccine is only covered under the pharmacy benefit and not the medical benefit, so there is a denial. And sometimes it might be just that we don’t have the right filing instructions. So, the payer wants other information on the claim that we don’t have, and in many cases, we’re able to go back and get it. But with the volume of claims that go through the system each day, some fall through the cracks.
L.J Tan (Immunize): It sounds like, if we could get a top three list, we could compare that to our Frequently Asked Questions that we regularly update. And we can see whether there is a way we can continue to highlight these major challenges that are being met by providers and help providers address them. So, one solution could be just making sure that the providers update their patients’ medical insurance. That’s done all the time: when I go in, I’m always asked for my insurance card. But clearly, that’s one of the challenges, that patients’ medical insurance records are not up to date. So, if we could highlight some of these top five or top three reasons, we could work at the Summit to address them.
Alessandra Fix (VaxCare): Yes, that’s true. Another element to consider is that we get the information from the patient and then we use a clearinghouse to verify insurance coverage. So, occasionally, we do still see some coverage restrictions on vaccines, even though, theoretically, there are very few plans that are grandfathered in and not required to cover all vaccines. But it does come up. But sometimes we also just get more information back from the clearinghouse. I cannot speak to why that might be. I think there’s a little bit of a lag time, but I think that’s another one of those operational challenges that can make it tough to assess whether the patient is truly covered for the vaccine that they are here to receive today. And if that’s an issue that we face, I’m sure that other providers face it, as well.
L.J Tan (Immunize): I like this idea of trying to use you all at VaxCare, with your breadth of providers, to get a sense of these major problems and whether our smaller providers are seeing those, as well. I don’t know if that’s something the payment working group might be able to work through a little bit, Caroline.
Carolyn Bridges (Immunize): Yes. And something that you brought up at the Summit, Alessandra, was this challenge of risk conditions. And I would be curious to know what proportion of those denials are because there wasn’t a risk condition coded that the payer thought was related to an ACIP recommendation. So that would also be really helpful to understand.
Alessandra Fix (VaxCare): Yes, what I can share is that I know, with the RSV maternal recommendation, in the early weeks of that recommendation, it was still unclear what information would be required on the claim to get payment. What we ended up seeing was that payers were requiring the week’s gestation, which we sometimes had access to, based on our integration with the EHR, and sometimes did not. So, we had to go back and build a feature into the product to create a drop down list so providers could add it if we weren’t able to depend on getting it via our integrations. So that was an example of how VaxCare was able to address the issue when we saw that there was a challenge. So that’s what we’re keeping an eye on for the older adult recommendation, as well, in case we need to create workarounds like that.
Announcements
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- There is a hold date for the May 2025 Summit Meeting: May 12-14 at the Crowne Plaza Ravinia in Atlanta, GA.
- For all who have given permission, slide decks for the 2024 meeting archives are up on the Summit website: www.izsummitpartners.org.
- The archive for the Messenger RNA webinar – in co-sponsorship with the American College of Physicians –is also up on the Summit website, in addition to a clinical update with clinical considerations based on the recent approvals for COVID-19 vaccines. A Frequently Asked Questions (FAQ) that addresses some of the questions that came up in the webinar and aligns those answers according to information from the CDC as a result of the release of the new vaccine can also be found there.
- If you have interest in participating in any of the Summit’s three working groups– Operationalizing Adult Immunizations, the Payment Working Group, or the Equity Sustaining Community Organizations Working Group – please send an email of interest to info@izsummitpartners.org to be connected to the leaders of the working groups. These groups are continuing their work for the fall respiratory virus season and will address some of the action items coming out of the summit.
- The Association Immunization Managers (AIM) annual influenza webinar was Wednesday, September 18. The Summit presented and featured Carolyn Bridges.
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- The National Foundation of Infectious Diseases (NFID) annual national news conference that kicks off the respiratory season, preventing respiratory disease this fall and winter, is September 25, at 9:00 a.m. ET and will be live at the Press Club in Washington, DC and available for virtual attendance.