(mellow contemporary music)
Hello, welcome to Optum Forum 2020.
Olivia Banyon, Vice President for Cross Optum.
Cross Optum is the business unit
that sits within OptumInsight Life Sciences
and I'm here today
to talk to you about developing an all vaccines database
to address COVID-19 management efforts.
I'm delighted to be joined by Jennifer Brueckner,
my colleague within UnitedHealthcare.
Hello, I'm Jennifer Brueckner.
I'm Vice President of Clinical Program Delivery
and I lead our Enterprise Flu Core team.
Glad to be with you Olivia.
Thank you Jennifer.
All right, so I'm going to get started with a question
that I think is a really relevant question today
and that is, have you asked yourself
what you know about your own vaccine history
or your parents' vaccine history?
Likely, if you have children,
you have a lot more information
about what their vaccine history is
if they're young kids but today, this type of information
is very hard for us to really have access to
as consumers, as patients, as members, as providers.
So we're going to talk to you about
how do we make that more accessible to us today?
Let's get started with first really reviewing
the immunization data gap; what it is, why we have it,
what we need to do about it.
So, from the basic around the immunization data gap
begins with something that was a very, very important effort
and importation part of our history around the development
of the Immunization Information Systems or IISs.
The IISs were started up in about the 1970s
at a local or regional geography level,
at a state level or a city level in certain cases,
and the platform
was supposed to collect vaccination records for children
and it was really looking at,
the diagram on the right shows you the various sources
that we can actually get vaccination data,
and the IISs were supposed to be receiving data
from providers, hospital systems, employers,
educational systems, retail pharmacy,
all these various sources
were supposed to feed into that state level
or local level IIS.
And the IIS was really designed to give us access
as consumers, our providers access to that vaccination data.
The problem is,
is that this is set up in a very different manner
in every geography, in every state.
And so the type of data that's collected
or the completeness of data that's collected
is highly variable.
But this is a really important problem to tackle now,
especially in light of recent COVID-19 pandemic
but also the measles and meningococcal outbreaks
that really happened very recently
and reinforced the need for nationwide interoperability
of vaccination coverage.
Along these same lines,
we're at a crossroads today from a technology standpoint
where we're really compelled and we're set up
to use our technology in the right way
to share important medical information and data
but the IISs have not yet fully migrated
to leveraging these new technologies.
We know that there's organizations
who are increasingly vocalizing the need
for US interoperability of data.
Let's talk a little bit more about what registries are
and what some of the challenges are.
So, as I said,
registries are independent public health authorities.
The state registries that are supporting this data flow
and the IISs, as many of you probably know,
maybe don't have huge staffs
behind making the data interoperable,
leveraging new technologies
to optimize the state registries.
There are a lot of competing priorities
within the state health department.
And there's also a lot of effort required
to make sure the data is flowing correctly.
when the registries were really set up in the 1970s
there was a high variability
of what type of data was collected, how it was stored,
and how data was actually shared between different entities.
We know that there's about 90% of registries
will have some form of adult vaccinations.
The majority have a lot more completeness
with childhood vaccinations
but we're really beginning to understand
where we need to round out that data.
There's also some form of
when we think about data being shared with large payers,
like UnitedHealthcare in this instance,
about 70% of the registries
have some form of mandated reporting
between the registry and UnitedHealthcare
for the claims to go back to that registry,
the registry data to go back to UnitedHealthcare
so we can get to that more complete picture
of vaccination coverage for our populations.
Talked a little bit about the registry challenges
around the variability and completeness of data
and one of the reasons for that
is that all the data is not really mandatory
for reporting purposes.
That there's often high variability
in which provider groups are reporting into the registries
and sometimes it's quite difficult and cumbersome
for providers to report and also to extract data.
There's a very important challenge around having a common ID
between the registry and the user.
So that if we think about establishing
whether it's a master patient index
so that we can follow a patient across state lines
from one registry to another, often that doesn't exist
which makes it very hard to look at
a complete vaccination picture.
There's also a lot of different ways
that the data is stored
and how the data could be transferred.
Sometimes we're looking at data
being stored within flat files.
Sometimes some registries have evolved to HL7
but there are challenges in terms of the size of the file
for transmission of the data
and there's also different requirements
that are setup within the IMS
that make handling large file sizes very difficult.
So, with all that said, Optum has put forth a vision
for enhanced vaccines data interoperability.
Our goal is to really serve as a catalyst
to drive interoperability,
to drive public-private stakeholder partnerships
that support the health and human services mission,
that support IIS interoperability.
We talked a lot about what the problem statement is
around fractured data and completeness of data
but we also have identified
that we share common stakeholder needs
across different entities,
whether we're looking at large payers like UnitedHealthcare
or public health authorities
like the state health departments or vaccines manufacturers
who have a need to understand where potential outbreaks
and gaps in vaccinations are.
So we've really stood up a vision
for how we can drive data standardization
and data liquidity among all of these stakeholders.
What can we bring to bear, to accelerate this mission
of IIS interoperability?
So we've developed a mission and it's a complex,
it's a big problem to solve for
but we are compelled to do this now given the pandemic
and given the other disease outbreaks I mentioned earlier.
So our mission is accelerating HHSs interoperability mission
for the IISs so that we can get a better sense
of vaccination coverage at both an individual level
and a population level, allow us to identify gaps,
understand where disparities exist in different populations,
and prioritize areas of unmet need across the US.
We're also looking to help states
move toward HL7 standardization.
It's a rich language and the market is ready to do this now.
We're looking to provide service solutions.
So if you can imagine, what can we do with better data?
How can we demonstrate potentially even evidence of immunity
in terms of personal portable vaccination records
for ourselves, for our families
and how can we assist vaccines manufacturers
in understanding vaccination trends
or maybe even better help with supply and demand
This doesn't happen overnight.
We've put together a five-year roadmap
to ensure that we are working towards solving
for this interoperability mission.
So there are three primary ways we're going to achieve this.
We're going to build a data infrastructure
that supports processes that are large enough
to manage vaccination records nationally,
we're going to help aggregate data from disparate IISs
where we're working with various health departments
and IIS vendors to aggregate the vaccination records
into one data infrastructure, and then we have to work
toward making the data interoperable.
How do we actually make the data bidirectional
so that we can better have this ability to share data
between all of those different entities,
between large payers, between providers,
and make it easier to access the data?
And so in doing so, we will really be standing up
what is the first public-private partnership
to use and build interoperable national registry platform
across state line.
We have a couple of priorities to make this happen
to focus on enhancing vaccine data interoperability.
First, we really need to understand
how we can enhance the data capture process
in an efficient manner.
So how can we get data
so that we can close gaps more quickly?
How do we actually and where do we focus first
in terms of supporting HHS's immunization gateway efforts?
How do we do a better job in understanding
how we can trace data and different files
and provide resources back to the states?
How do we move away
from some of these very inefficient manual processes
around data exchange
and start to automate a lot of these data exchanges?
We have to stand up technical protocols for data sharing
that allow us to support the quality reporting requirements
around vaccinations and we need to be able to understand
how we round out the data
so we have a more complete picture of both childhood
and adult vaccination.
So, really because it's such an ambitious effort
that we're talking about today, why lead this?
And we'll talk more about this with Jennifer
in a few minutes, but if we look at the partnership
between UnitedHealthcare and Optum,
we share a lot of reasons why we would lead this effort.
Number one, we do want to improve vaccinations
across all populations.
For UnitedHealthcare, that includes supporting
over 50 million covered lives across 40 states, plus states,
where United has members.
We really are aimed
to look at how we are tracking vaccinations
not just year to year but over a lifetime
in effort to increase overall population health
and reduce health care spending.
From Optum's perspective, why would we do this?
We really, it's an opportunity
for us to demonstrate our technology competencies
and drive toward HL7 interoperability goals.
We're really looking at demonstrating
how we can bring to bear our advanced analytical engines
so that we can not just collect static data
but actually make use of the data
and make the data valuable to our partners.
We're looking to support consumers and patients
and providers by making vaccination history more accessible
and more useful to them.
And finally, we really are looking at serving as a bridge
where we will be looking at evolving our efforts
to be more nationally representative over time
to make sure that we have coverage across payers.
Let's talk a little bit about,
and this is where we have some urgency here
in light of the COVID-19 pandemic
and with the vaccines on the horizon,
there are real-world applications
of why a single-source immunization database is important
and what we can do about it.
How do we make the data actionable?
Some of the things that are on this slide
are really just a few of the things that we're working on
and things like an immunity passport.
How do we demonstrate that we have either a vaccination,
the appropriate vaccinations at the right time
that could enable us or be required eventually
for travel purposes?
How do we have a mobile vaccination record
that not only gives you your history
around your vaccination status
but it reminds you what you may be due for,
if there is an additional vaccination in a series,
if it's a multi-series vaccination
or if there is a vaccination that's an annual vaccination
or there's a need for a booster
or you're a high-risk individual
that has a different vaccination requirement?
So, how can we enable
not only retrospective review of your vaccination
but prospective planning around vaccinations?
And then where do you get your vaccinations?
Today is a very different world for people
in terms of accessing care.
We've talked a lot about in the industry
a return to routine care and preventative care,
but we really are thinking hard
about what is going to enable consumers to feel comfortable
to go out and get vaccinated,
to understand that they don't have to feel at risk
going to get vaccinated?
So where can they find vaccination centers?
Are we looking at additional drive-through
vaccination locators, as we head into flu season,
as an example?
There are a lot of efforts that are ongoing in the market
that provide vaccination services
that don't require you to go into a health care system.
So how can we do a good job of connecting the data
around a vaccination need
with where you can actually take action
to get your vaccination?
And then on the bottom,
just thinking about a vaccination ordering portal.
If we think about the importance of this
for a large provider organization or health care system,
if we can understand where the biggest gaps are,
where the disparities are, where the outbreaks are,
where the highest need is, could we actually envision
developing a vaccine ordering portal
directly connected to this registry
that has allow more access to real-time data
so the manufactures can really think about how they manage
or potentially alter supply and demand,
fulfillment, and distribution?
And then other things like house calls targeting.
So house calls or other types of home programs
that are available today
and actually are showing a resurgence
where medical teams are going into the houses of elderly,
of other high-risk individuals
for the purposes of care provision.
How can we actually look at
where some of the gaps in vaccinations might be
to drive maybe a more formed targeting approach
around these house call types of programs.
Similarly, if we think about educational efforts,
market awareness, vaccine awareness, outbreak awareness
we can start to link the registry data
to where this education is provided.
There are also a few other use cases that we can think about
with this single source immunization database.
So, thinking about this as more than just data.
We talked about education
but there's also other types of marketing campaigns
that vaccine manufacturers could maybe target
more specifically to certain geographies, zip codes,
provider groups, and so on.
How do we actually look at
different types of performance metrics?
So, which providers might have higher vaccination status?
Which providers actually might be vaccinating lower
than average for a specific vaccine?
Can we use this data for research
around population cohort analyses?
Thinking about how do we actually visualize this data
in a way that is meaningful,
that can easily be utilized
by public health state department,
by provider organizations, by payers,
by vaccines manufacturers?
There's got to be a way that we can deliver this data
so that we can understand where these gaps are
and adjust them in a more efficient manner.
And then finally, I've talked a lot about HL7
and really looking at accelerating the move
to a more standard data dictionary.
So with that said, I am going to bring back up my colleague
Dr. Jennifer Brueckner
and we're going to have a little bit of a discussion
around UnitedHealthcare's perspective
on why this is important.
So welcome back Jennifer.
All right, so Jennifer, I think one of the things
that I wanted to start off with is really talking about
what do you think are currently the biggest challenges
with immunization data, from a payer perspective?
One of our biggest opportunities
is to be able to have complete and accurate data
from the time you're born up through adulthood
until the end of life so that we're able to maximize
every opportunity for you to get the vaccines you need
to live your healthiest life,
to be able to really understand
when you received all your vaccines,
when you can get those catch-up vaccines,
and when you're due for vaccines.
Many of us, including myself, may be challenged
to know every vaccine we received throughout our life.
So something a registry could be critical as a resource
to verify what vaccines we have received
and most importantly which vaccines we need to receive.
Thank you, but I know UnitedHealthcare
has been working with the state registries
for quite some time.
Could you describe a little bit
about how UnitedHealthcare currently engages
with the state registries for immunization reporting?
Yes, we reach out to registries and request information
on our members.
That member information can be so valuable
helping not only myself in programming
so that we're able to target individuals
that need that additional encouragement or education
to get vaccinated but also supplying that information
to providers and members
so that they can make educated decisions
about the next step in their clinical care.
That makes a lot of sense and you have three large teams
who are working toward this on a daily basis probably.
How would you summarize what the goal
of these engagements with the state registries are
It would be to increase the timeliness
of obtaining this data and to partner with the registries
so that we can share the information we have
as well as the information they have bidirectionally
so that we have accurate, up-to-date information.
So, for example, our providers can make clinical decisions
on next steps and care.
So, Jennifer, could you describe how this impacts
your population health management goals?
I know you have oversight and responsibility
for population health management within UHC as well.
Yes, it actually helps us reach some of our goals
along with we've been working with the CDC since 1980s
on our Healthy 2020, 2025, 2030 goals
and this additional information helps us identify
who is currently vaccinated and up to date
and who we need to reach out to,
to really encourage and educate
to obtain additional vaccinations.
Great, thank you.
So, Jennifer, I know it's somewhat of a complicated process,
but maybe you could share with us
how UnitedHealthcare currently engages with state registries
for immunization reporting.
Yes, we've developed relationships
with different information registries
and we've been able to send them our member information
and be able to receive back the immunization data
for those members
and that enables us to reach out to those members
that are still noncompliant,
that have not received the vaccinations they need
so that we can encourage and educate them more
about those vaccines and get more of those individuals
to be vaccinated and protected from those illnesses.
Yes, so that kind of describes also
what the goal of engaging with those state registries are.
Maybe, could you describe a little bit more
about the goal for the state registry engagement
as it relates to your providers?
Absolutely, in addition to getting that information
so that we can reach out to the members and educate them,
we can also provide this information to our providers
so they can use this information to make clinical decisions
on what vaccinations those individual patients, members need
in order to meet their goals
and also to prevent unnecessary illness,
We also can use this information to further understand
where there's opportunities.
There may be areas where inadequate vaccination is occurring
and we can use our resources
as well as providers in those areas
to advocate for vaccination
and really help close some of the opportunities that exist.
Great, thank you.
You're very passionate about this.
I think it rubs off on people.
Now, thinking really about turning to COVID-19
and the pandemic we're in.
Do you think this pandemic is going to change
the way immunization data is collected and shared
and if yes, how?
Yes I do.
I do think there's going to be a need
with the potential vaccines
that are going to become available
for us to need to be able to easily and efficiently
be able to track
not only what brand COVID vaccine you received but when
so that the appropriate timing of a subsequent vaccine
to complete a series can be completed
and so that everyone involved could have easy access
to the information, whether it's yourself as a member,
whether you're a provider
looking to provide say a second shot in the series,
whether you're UnitedHealthcare looking at okay,
how many of our members are getting vaccinated?
Where are there areas of opportunity where we can encourage
and provide access so that adequate coverage
is occurring throughout all of the United States?
That's, I think we're probably going to,
as we talked about in the presentation,
see a lot of these changes become accelerated
I would definitely agree.
So, if you then, in closing,
could you tell us in your own words
how UnitedHealthcare views
this immunization interoperability project?
Yes, this is so important.
As we move forward and really want to change
and improve people's lives for the better
we need to embrace
every opportunity to prevent avoidable illness.
Just like with the upcoming flu season,
this is something we can do, we can prevent,
so we want to leverage every opportunity
in the coming weeks and months
to ensure everybody has the catch-up vaccinations they need
and also have the opportunity to get vaccines
as they become available, like the flu shot,
and soon, the COVID vaccine.
since we don't yet have a COVID vaccine,
I think we do have one final parting message
that we wanted to share with everybody.
Please, go get your flu shot.
Thank you Jennifer
and thank you all for attending Optum Forum 2020.
We value your feedback and appreciate your time
to come to this session.
(mellow contemporary music)
Vaccine data offer valuable insights
Vaccine registries provide insight into immunization gaps and how these gaps impact population health management. This actionable data informs patient outreach and education, and aids health care providers in assessing clinical care.
Join Olivia Banyon, vice president of Cross-Optum, and Jennifer Brueckner, vice president of clinical program delivery at UnitedHealthcare®, to learn more about this topic. They discuss how data from state registries can affect population health management during COVID-19.