Sep, 15, 2021

Strategies for Working with Managed Care Organizations to Increase COVID-19 Vaccination Rates

Erin Campbell and Mary Beth Dyer, Bailit Health

COVID-19 vaccines are now widely accessible in the United States and free to everyone over the age of 12. Given the spread of the Delta variant, there is an urgent need to increase vaccination rates, particularly among Medicaid enrollees. States across the country continue to report Medicaid enrollees are getting vaccinated at lower rates than the general population. Recent reports have shown that in some states 20 to 35 percent of the Medicaid population is vaccinated as compared to vaccination rates of well over 50 percent in the same state’s general population.[1] This expert perspective explores how state Medicaid managed care programs and health plans can work collaboratively to increase COVID-19 vaccination rates for the more than 55 million Medicaid enrollees in comprehensive managed care plans.

Medicaid can also play an important role in achieving a more equitable distribution of the COVID-19 vaccine. Black and Latino(a) populations, one-third of whom are covered by Medicaid,[2] are experiencing disproportionately low vaccination rates. An analysis of data from 40 states found that in half of those states, Black people received smaller shares of vaccinations compared to their shares of cases and the total population.[3] The same analysis found that Latino(a) people also received smaller shares of vaccinations compared to their shares of cases in the states included in the analysis.[4]  

Given the urgent need to reduce the spread of COVID-19, state Medicaid agencies and contracted managed care organizations (MCOs) can deploy a variety of promising approaches to increase vaccination rates:

  1. Establish meaningful financial incentives for MCOs to increase COVID-19 vaccination rates equitably and publicly report MCO performance on vaccination efforts.
  2. Facilitate and require MCOs to expand data sharing agreements with state and regional departments of health to obtain vaccine registry data to aid COVID-19 vaccination outreach efforts.
  3. Enable MCOs to reduce barriers to vaccination for Medicaid enrollees by:
    1. Addressing enrollee barriers to obtaining the COVID-19 vaccine with financial and other supports.
    2. Encouraging MCOs to work with trusted providers, including community health workers, and community-based organizations to outreach to enrollees.

While this expert perspective focuses on the state-MCO relationship, the recommendations are equally applicable for states contracting with other types of Medicaid managed care entities.

1. Establish meaningful financial incentives for MCOs to increase COVID-19 vaccination rates equitably and publicly report MCO performance.

States should identify available financial and non-financial levers to meaningfully incentivize Medicaid MCOs to increase COVID-19 vaccination rates. Where feasible, states should work with MCOs to target efforts to reach populations that are experiencing disproportionately lower vaccination rates.

For example, Medicaid MCOs in Wisconsin have financial incentives to expand vaccination initiatives through MCO performance incentives. Wisconsin recently implemented a Medicaid MCO pay-for-performance (P4P) “Vaccine Outreach Program” with the goal of reaching 80 percent COVID-19 immunization among non-pregnant adult Medicaid enrollees. MCOs received total COVID-19 vaccination incentive funding up front. MCOs earn P4P funding according to a tiered incentive structure based on enrollees fully immunized by specified dates. MCO performance targets for September 30, 2021 are based on immunization rates of 40 to 50 percent and targets for December 31, 2021 are linked to rates of 60 to 80 percent immunized. The Medicaid agency will assess MCO performance based on information in the Wisconsin Immunization Registry and recoup funding an MCO did not earn.[5] To increase accountability, Wisconsin also intends to publicly report Medicaid MCO performance on COVID-19 vaccination efforts. Florida is taking a different approach by permitting Medicaid MCOs with a certain level of COVID-19 vaccination rates to offset other financial penalties applied by the state. Specifically, MCOs can offset penalties if at least 50 percent of the MCO enrolled Medicaid population 50 years of age or older obtain at least one dose of a COVID-19 vaccine by September 30, 2021.[6]

2. Facilitate and require MCOs to expand data sharing agreements with state and regional departments of health to obtain vaccine registry data to aid COVID-19 vaccination outreach efforts.

Given the lack of vaccination data on claims, Medicaid MCOs may not know which enrollees have received the COVID-19 vaccine. Some states require MCOs to expand arrangements with state and regional departments of health to obtain COVID-19 vaccination data. Massachusetts and Rhode Island give insurers (both commercial and Medicaid plans) access to their COVID-19 registries. California’s Medicaid agency is tracking enrollee vaccinations by linking to the state’s immunization registry and sharing this information with its MCOs.[7] These approaches enable MCOs to obtain COVID-19 vaccination status for its enrollees and target outreach efforts to enrollees not yet vaccinated. Another state recently reported that a Medicaid MCO is sharing COVID-19 vaccination status with primary care practices as part of care gap reports. These provider practices can use information on vaccination status during office visits to educate patients about vaccine safety, address patient concerns and questions, and offer or arrange for enrollees to obtain COVID-19 vaccinations.

3. Enable MCOs to reduce barriers to vaccination for Medicaid enrollees.

Barriers to vaccination present an obstacle to increasing the uptake of COVID-19 vaccines amongst Medicaid enrollees. States and Medicaid MCOs can address access barriers enrollees face through financial and other supports and with the help of the local community.

A. Address enrollee barriers to obtaining the COVID-19 vaccine with financial and other supports.

States and Medicaid MCOs have turned to financial supports to help reduce the barriers Medicaid enrollees face in accessing COVID-19 vaccinations. Financial supports can help offset child care or transportation expenses for Medicaid enrollees who may otherwise have difficulty obtaining the COVID-19 vaccine.  It is critically important that states and MCOs work with communities of focus to design financial supports or incentives that resonate, are empowering, and are non-coercive to both increase uptake and build trust in the health system.[8]

Other efforts to reduce access barriers to COVID-19 vaccines include transportation services to vaccination sites and providing child care or respite care while a caregiver is getting vaccinated.  MCOs should be working within communities to provide and make people aware of available non-emergency transportation to vaccination sites. State Medicaid agencies should first take the appropriate steps to identify funding sources for financial supports, which could include coordinating with other state agencies responsible for managing COVID-19 federal funds.

As a result of state and MCO collaboration, Medicaid MCO enrollees in Ohio who get their first COVID-19 vaccine shot by September 15 will receive a $100 gift card. Ohio MCOs also pay providers $100 for administering COVID-19 vaccinations. This increased reimbursement is intended to help offset the cost of office space and time needed to monitor patients after receiving the COVID-19 vaccine.[9]  In August 2021, Ohio reported a 57 percent increase in completed vaccinations for adult Medicaid MCO members since May 2021 when Governor DeWine challenged MCOs, providers and pharmacies to do more to combat the spread of COVID-19.[10] The previously mentioned financial supports are likely just one of many efforts that contributed to this increase in completed vaccinations.

B. Encourage MCOs to work with trusted providers, including community health workers, and community-based organizations to outreach to enrollees.

States should direct MCOs to enlist the assistance of trusted providers in their networks—including community health workers—community-based organizations, and other local community partners to help increase vaccination rates among Medicaid managed care populations. Partnerships at the local level can inform effective strategies for increasing vaccination rates, promote equity, build trust, conduct targeted outreach for COVID-19 vaccination efforts, and combat misinformation and safety concerns about COVID-19 vaccines.[11]

State and MCO collaborations have revealed promising outreach approaches, including MCO partnerships with local community health workers, faith leaders, barber shops, food banks, and housing authorities to help reach and vaccinate more Medicaid enrollees. In some states, MCOs have worked directly with pharmacies to arrange vaccination appointments for members most at risk and with other providers to offer vaccinations for homebound members or appointments outside of traditional office hours.

Conclusion

Medicaid MCOs have an important and valuable role to play in the COVID-19 response, given the large number of individuals, families, and communities they serve who are disproportionately impacted by the pandemic. This expert perspective lays out three types of actions that state Medicaid programs and MCOs can take to minimize the deadly impact of COVID-19 and promote equity in COVID-19 vaccine distribution. The rapidly evolving nature of this pandemic prohibits waiting for clear information on best practices to increase vaccination rates. States and Medicaid MCOs should rapidly employ a variety of strategies and reassess their COVID-19 vaccination approaches, financial and other supports, and requirements over time, making modifications in response to enrollees’ input to improve the health outcomes of populations disproportionately affected by COVID-19.

[1] Raman, Sandhya. “Medicaid Beneficiaries Less Likely to Get COVID-19 Shots.” Roll Call, June 30, 2021.  https://www.rollcall.com/2021/06/30/medicaid-beneficiaries-less-likely-to-get-covid-19-shots/

[2] Kaiser Family Foundation. “Medicaid Coverage Rates for the Nonelderly by Race/Ethnicity.” Timeframe: 2019. https://www.kff.org/medicaid/state-indicator/nonelderly-medicaid-rate-by-raceethnicity/

[3] Ndugga, Nambi, Hill, Latoya, Artiga, Samantha, Parker, Noah. “Latest Data on COVID-19 Vaccinations by Race/Ethnicity.” Kaiser Family Foundation, August 18, 2021. https://www.kff.org/coronavirus-covid-19/issue-brief/latest-data-on-covid-19-vaccinations-race-ethnicity/

[4] Ndugga, Nambi, Hill, Latoya, Artiga, Samantha, Parker, Noah. “Latest Data on COVID-19 Vaccinations by Race/Ethnicity.” Kaiser Family Foundation, August 18, 2021. https://www.kff.org/coronavirus-covid-19/issue-brief/latest-data-on-covid-19-vaccinations-race-ethnicity/

[5] Wisconsin Government. June 2021. “HMO Quality Guide, Measurement Year (MY) 2021.” https://www.forwardhealth.wi.gov/WIPortal/content/Managed%20Care%20Organization/Quality_for_BCP_and_Medicaid_SSI/Home.htm.spage

[6] Florida Agency for Health Care Administration. Statewide Medicaid Managed Care Policy Transmittal. Re: COVID-19 State of Emergency: COVID-19 Vaccine Administration Initiative. August 19, 2021 https://ahca.myflorida.com/Medicaid/statewide_mc/pdf/PT_2021-26_Update.to.PT.2021-21_COVID-19.SOE.Vaccine.Administration.Initiative_Attach_08.19.2021.pdf

[7] Galewitz, Phil. “Medicaid vaccination rates founder as states struggle to immunize their poorest residents.” Kaiser Health News. Ohio Capital Journal, September 1, 2021. https://ohiocapitaljournal.com/2021/09/01/medicaid-vaccination-rates-founder-as-states-struggle-to-immunize-their-poorest-residents/

[8] Manatt Health. “Strategies for States to Drive Equitable Vaccine Distribution and Administration.” State Health & Value Strategies, August 2021. https://www.shvs.org/wp-content/uploads/2021/08/State-Strategies-to-Drive-Equitable-Vaccine-Issue-Brief-Final.pdf

[9] Wu, Titus. “Ohioans on Medicaid could get $100 for first COVID-19 vaccine shot.” The Columbus Dispatch, July 28, 2021. https://www.dispatch.com/story/news/coronavirus/2021/07/26/ohioans-medicaid-could-get-100-first-covid-19-vaccine-shot/8091379002/

[10] Ohio Government. August 11, 2021. “Ohio Sees Big Gains in COVID-19 Vaccine Rates Among Medicaid Customers.” https://medicaid.ohio.gov/wps/portal/gov/medicaid/news/press-release/08-11-2021-ohio-sees-big-gains-in-covid-19-vaccine-rates-among-medicaid-customers

[11] Manatt Health. “Strategies for States to Leverage Local Partnerships for Equitable Distribution of COVID-19 Vaccinations.” State Health & Value Strategies, June 4, 2021. https://www.shvs.org/strategies-for-states-to-leverage-local-partnerships-for-equitable-distribution-of-covid-19-vaccinations/