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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.


And earlier


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


for forecasting?


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.


Thank you.


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


for UnitedHealthcare?


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,


preventable 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


and prioritized.


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.


Absolutely, so


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.


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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.

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