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Editor’s Note: With the uncertainty of the rapidly evolving COVID-19 pandemic, much of the focus of our staff, our members, and our broader community has been understandably redirected. We are intentionally posting fewer articles on our blog in recognition that many of our readers are immersed in response to the pandemic. However, we remain committed to sharing perspectives from health services researchers working on more general issues to expand access to care, reduce costs and improve quality. This post is an example of the ongoing important work happening across the field of health services research.

Immunization is considered one of the greatest public health achievements. Yet while overall immunization rates remain high, in some states rates have declined. Some communities have seen large pockets of unvaccinated children in certain populations, resulting in deadly virus outbreaks. In 2000, measles was declared eliminated due to a high rate of coverage with the measles, mumps and rubella (MMR) vaccine. Yet, in 2019, the US experienced the worst measles outbreak since 1992 and threatened the elimination status. To end the outbreak and maintain the measles elimination status, multi-stakeholder partners, including religious leaders, local physicians, health centers, advocacy groups and local and state public health departments, collaborated to administer about 60,000 MMR vaccine doses in the impacted communities, develop and target pro-vaccination communication campaigns in English, Yiddish and Spanish, and leverage local public health statutory authorities. In addition, a new state law has been enacted effectively eliminating “non-medical exemptions” for required vaccines requiring children to have the MMR in order to attend school, unless medically exempt. The measles example highlights the need for federal and state public health officials to rely on critical community partnerships to effectively curtail and prevent outbreaks. 

Similar collaborative efforts were the focus of the recent Annual National Conference for Immunization Coalitions and Partnerships (NCICP). Some presentations displayed state efforts to improve and leverage Immunization Information Systems (IIS) across Medicaid and public health agencies to identify gaps in immunizations. Others focused on maternal immunizations and a variety of strategies to increase vaccine acceptance among pregnant women. One session described an effective ad campaign targeting pregnant women on social media and through collaborative partnerships with individual state WIC programs to provide resources and education. 
The Center for Disease Control and Prevention’s Dr. Nancy Messonnier noted the vulnerability of communities to virus outbreaks without strong public health partnerships. She announced the CDC’s latest strategic framework to promote confident decision making while empowering families and strengthening community trust, Vaccinate with Confidence. This strategy seeks to improve communication between providers and parents/patients, trusted community leaders and at-risk populations in order to filter out misinformation, improve knowledge of vaccines and rebuild trust among communities. 

Overall shared learnings

AcademyHealth and Immunize Colorado presented opportunities and barriers states face when trying to improve immunization rates among Medicaid-covered children and pregnant women. With funding from the Centers for Disease Control and Prevention, AcademyHealth, the National Academy for State Health Policy (NASHP), and Immunize Colorado formed a five-state Community of Practice (CoP) to explore effective collaborations between Medicaid and public health agency immunization programs to address these immunization challenges. 

Reflecting on the first two years of the three year project, states identified many areas for technical assistance and support including identifying and securing additional funding for their Immunization Information Systems (IIS), establishing cross-agency data sharing agreements between Medicaid and public health, conducting analyses to accurately track vaccinations among pregnant women. States also leveraged provider and community outreach to expand knowledge about vaccine safety and access, and using claims data to identify gaps in coverage rates.

Most of the CoP states have experienced cross-agency collaboration between Medicaid/CHIP and public health, specifically related to developing data sharing agreements and enhancing the IIS. These collaborations have resulted in significant improvements in the monitoring of coverage rates. Colorado improved their match between patients in the Medicaid Management Information Systems (MMIS) database and the IIS and Montana increased the number of immunizations in their MMIS. Kentucky extended their outreach activities with school-based clinics and community partnerships with pharmacists to improve HPV vaccination rates among their adolescent population. 

States experienced these successes while also facing challenges in the form of changing state administrations, competing policy priorities and/or staff turnover. Additionally, the HITECH federal funds administered by the Office of the National Coordinator for Health IT (ONC), a reliable funding source for state health IT infrastructure enhancements, are due to sunset in 2021. States will have to work with their Medicaid agencies to request 90/10, 75/25 or 50/50 federal Medicaid match for their Medicaid Management Information Systems (MMIS) to support information exchange with the IIS. 

States are using immunization data in new ways to drive improvements in immunization rates.  Another session at NCICP focused on how Immunize Colorado is mapping local level immunization and exemption rates and creating visualization resources to communicate the level of risk for vaccine-preventable disease outbreaks. Additional themes focused on the economic impact of outbreaks, the importance of systems and policies that protect our immunization infrastructure and programs. Overall, these resources provided important insight into local risks for preventable disease, outbreak response, support for emergency preparedness and public health surveillance efforts.

Policy Next Steps 

The NCICP Conference, the CDC’s new vaccine communication framework, and the five-state CoP partnership highlight the necessity of collaborative partnerships between public health agencies, Medicaid officials, immunizing providers and families to increase vaccination rates among all communities. These partnerships are even more critical for improving awareness among pregnant women and children covered by Medicaid. States are sharing complete and timely immunization data, reviewing claims and reimbursement data and policies, aligning and incentivizing quality metrics across payers, and identifying needs and gaps in order to deploy targeted interventions. We need these types of innovative and multi-faceted approaches to protect all communities from the growing risks of vaccine-preventable diseases and outbreaks.

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