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A summary of presentations from the weekly Summit partner webinars

February 20, 2025 – The latest Summit Summary

AMGA Maternal RSV Quality and Innovation Collective Program Introduction – Emily Nick, MPH, Sr. Manager, National Health Campaigns, AMGA Foundation

Emily Nick, MPH, gave an introduction to the AMGA Maternal RSV Quality and Innovation Collective Program.

AMGA Maternal RSV Quality and Innovation Collective Program Introduction – Emily Nick, MPH
The American Medical Group Association (AMGA) is a trade association with the mission of driving change in integrated healthcare delivery in order to improve the lives of patients.

  • There are more than 177K physicians practicing in the 400+ member groups that serve more than 142M Americans.
  • Membership is diverse: 80% of AMGA members are large, integrated health systems, and 20% are small and medium sized medical groups.

AMGA’s Quality and Innovation Collectives (QuICs)
QuICs are made up of recruited healthcare organizations that share insights and best practices to improve patient outcomes. They use discussion forums and interactive learning in virtual and in-person settings.

  • Maternal RSV Vaccine Preparedness QuIC Design and Components
    • This QuIC, sponsored by Pfizer, aimed to improve care of infants at risk of RSV by maternal RSV vaccination and raise awareness of the burden of RSV disease.
    • The QuIC engaged 10 AMGA members in a three-phase initiative.
    • Components of the QuIC included an educational webinar, a virtual discussion forum, a virtual meeting, and an in-person meeting.
  • Maternal RSV Vaccine Preparedness QuIC Deliverables
    • Maternal RSV Immunization Implementation Strategy: A Checklist for Providers, which provides a framework for the integration of new vaccines into immunization efforts. The checklist is available online to members and non-members.
    • Webinar: AMGA Maternal RSV Vaccine Preparedness QuIC Lessons Learned (February 26, 2025). The webinar was only for AMGA members.

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AMGA Maternal RSV Quality and Innovation Collective Program – Sherry Lindsey, LVN OB Nurse Navigator/Birth Planner, Shannon Health

Sherry Lindsey, LVN, gave an overview of the AMGA Maternal RSV QuIC activity at Shannon Medical Center.

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AMGA Maternal RSV Quality and Innovation Collective Program – Sherry Lindsey, LVN
Shannon Medical Center has a specialty care level 2 maternal NICU designation. It serves about 24 counties in west Texas with 12 OB providers and 4 midwives and has about 2,000 deliveries per year.

AMGA Maternal RSV QuIC: Season 1
A pre-season evaluation before participation in the AMGA QuIC revealed the following:

  • Learning gaps among staff, providers, and patients
  • Limited development of EHR tools
  • Lack of coverage by insurance payers
  • Confusion between the adult RSV vaccine brands

Participation in the AMGA QuIC allowed for the following:

  • Discussion with AMGA members and vaccine experts
  • Quality improvement techniques
  • Education resources
  • EMR optimization

AMGA Maternal RSV QuIC: Season 2
The following interventions for Season 2 helped improve immunization rates:

  • Best Practice Advisory Alert in Epic: This alert pops up during patient rooming and alerts healthcare providers that the patient has not received the vaccine. It appears in season, starting on September 1 and remaining until January 31, or until the patient has received the vaccine.
  • Patient Education Resources: At each patient’s initial visit and 28-week visit, verbal and printed educational information is given and includes RSV information. [Sample of printed resource for patients is available in the slide presentation.]
  • Staff/Provider Education Resources: Additional education about the maternal RSV vaccine was needed, in part due to the stigma of the COVID vaccine, and was addressed with data and, to a degree, the spreading awareness among patients and their specific requests for this vaccine. [Sample of printed resource for clinicians is available in the slide presentation.]
  • Bypass Prior Authorization Process: As insurance companies began to cover ABRYSVO®, the time required to get prior authorizations was reduced/eliminated – there were no issues with commercial insurance or Medicaid covering the vaccine in Season 2 – and there were more vaccines administered, as a result.

Current Outcome Data
There was a direct correlation between the number of maternal RSV vaccines administered and infant RSV hospital admissions. As insurers began to cover this vaccine and patients became more receptive to it, more RSV vaccines were administered and the number of infant RSV hospital admissions decreased drastically.

QUESTIONS & ANSWERS

Q: Can you talk about your billing issues? Do you feel like those are resolved and providers are feeling confident?
Sherry Lindsey (Shannon Health): We have had not one denial now, so all insurances – commercial and Medicaid – are now covering this without any prior authorizations.

Q: How is the coordination going between when the infants are born and making sure they don’t get the passive immunization with nirsevimab?
Sherry Lindsey (Shannon Health): We go through MyChart, so our EMR team did make a link from the mom’s chart to the baby’s chart. So, when the baby is born, the pediatrician can see that the mom did get their ABRYSVO® vaccine and gives them a heads up.
Q [follow-up]: This sounds like it is working really well; do you know of any situation where a person might have gotten two vaccines?
Sherry Lindsey (Shannon Health): No. And the alert that comes on for our physicians and nurses when they come in for their routine prenatal visits does go away, and it marks that the patient has already received it and they don’t get another reminder after that.

Q: How are things going, now that you have the billing issue resolved, with other vaccines for pregnant women (flu, Tdap, COVID-19)? Are you seeing any increase in those vaccinations during pregnancy or what kinds of concerns are you hearing from providers regarding co-administration or preference for certain types of vaccine over others?
Sherry Lindsey (Shannon Health): I think the biggest hurdle has been for the COVID-19 vaccine. There’s such a stigma with it. Patients get on Google, they think it’s very harmful to the baby. So, there’s tons of education, but we’re a very pro-vaccination system. So, each time they come in, we go over Tdap, flu, COVID-19, and RSV. It’s a lot of education, but I haven’t seen any downfall with that in our practice.

Q: Any increase in influenza vaccine or pertussis/Tdap vaccine, for example, with the increased attention to RSV and prevention of RSV in their baby?
Sherry Lindsey (Shannon Health): Yes, we’ve seen that [effect] with putting that thought in the patient’s head (“This is why we’re going to give it”), so we tackle all of them at once. Once we started focusing on the RSV vaccine, it even triggered our staff and our nurses to remember to ask about those [other vaccines]. So, yes, I’ve seen that the flu and Tdap numbers have gone up, also.
L.J Tan (Immunize): I think that’s incredible data to collect and have across the Rise to Immunize network, showing that when RSV maternal immunization goes up, some of the other maternal vaccines also benefit.

Q: Right now, RSV maternal immunization is a single dose recommendation. Are you managing to capture that in the database, in your registries as well, for pregnant women, so in their second pregnancy, third pregnancy, their infants are going to have to get nirsevimab, right?
Sherry Lindsey (Shannon Health): Yes, we do have reports that we can run, but as far as the RSV vaccine, if this is their second pregnancy, it alerts us on that, too. When patients come in for their routine appointments, it does show that alert on there. Even when we share it with the pediatricians – we’re only on Season 2 of this, so I think that’s something we’re going to have to address and make sure that we’re giving it in the correct time (i.e., 32 to 36 weeks) and from September through January. All our physicians only give it during that time. So, we still have questions: what if mom delivers in summer, or is 32 to 36 weeks in summertime? But it’s a consensus with our physicians: they won’t give it out of that timeframe as of now.

Q: There is a recent publication from CDC where they looked at the proportion of infants protected by either maternal vaccination or nirsevimab or both, and there was a pretty high proportion of both the mother having received the RSV vaccine and the baby having received nirsevimab; and ACIP says, for most babies, only one is needed. Are you able to look at that in your own system, i.e., the proportion of babies who end up getting one or the other or both and what that breakdown is?
Sherry Lindsey (Shannon Health): We do have reports of that we can run. I think putting it in the discretion of our physicians and also the pediatricians, when they are alerted that the mom did get that injection – that’s something I don’t know, but I can certainly find that out for you and see the correlation between the two because of the differing opinions of providers.

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Announcements
  • Per CDC, this is a severe flu season across all age groups.
    • According to FluView, there is co-circulation of H3 and H1 and, typically, influenza B shows up in the early spring – so it is not too late to get vaccinated.
    • Please ask your membership to continue vaccinating and to reach out in the patient population with reminders that it is not too late to vaccinate. Influenza vaccination remains the best defense against complications from the flu and immunization coverage rates for influenza are down.
  • The ACIP meeting, previously scheduled for the last week of February 2025, has been postponed indefinitely.
  • The NAIIS meeting originally scheduled for February 27, 2025 remains cancelled.
  • Registration is open for the Adult and Influenza Immunization: Looking Back, Moving Forward, May 13–15, 2025. This summit will be held at the Crowne Plaza Atlanta Perimeter at Ravinia.
  • 2025 NAIIS Poster Session: The May 2025 NAIIS Meeting will include a poster session.
    • Deadline to submit an abstract: March 1, 2025. Submitters will be notified if their poster is accepted by March 15, 2025.

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