Flu Vaccine & Population Health: Impact of a Comprehensive Immunization Program for the Elderly

Copyright (c) 2012 Will Pettinger, BS, MBA

It happens every year. Urgent care clinics, physician offices, the local drugstore, even neighborhood supermarkets start to encourage everyone to "get their flu shot today!" While supporters and detractors of this particular immunization both have their valid points, annual development and deployment of influenza vaccines is a lot more complicated than most people realize. The financial impacts of this preventive medicine treatment may also surprise some readers.

The flu shot does not just magically appear on doctor's and pharmacist's shelves. Each year the CDC partners with the manufacturers of vaccines, and determine which of a variety of influenza viruses are most likely to cause an epidemic or pandemic in the coming year. Once the specific strains are identified, the suppliers then get busy isolating and incubating the virus. This process takes many months and huge amounts of financial investment. Manufacturers are always playing a guessing game when trying to determine how many doses they should make for the upcoming flu season. Of course, they do not want to produce too much, or they will end up destroying a lot of valuable inventory. But, if they guess wrong, and the flu season is particularly strong this year, then they end up not having enough to sell, and cannot make more in time to satisfy demand.

The CDC recommends that everyone over the age of 6 months receive a flu shot each year, as soon as the innoculations are available to patients. The shots are typically distributed starting in late September and are released for use in late September to early October. The effectiveness of the vaccine typically lasts for 4 to 6 months.

Children under 5 years of age and adults 65 years and older are particularly vulnerable to getting influenza. Pregnant women and children from age 6 months to 2 years are even more susceptible. The CDC (Center for Disease Control) has a great, user-friendly series of brief FAQs on the flu on their website. Because of annual variations in the flu, it is extremely difficult to provide accurate predictions of how many people in the US die from influenza each year. However, the Journal of the American Medical Association published an article in 2003, compiled by scientists at the CDC that referenced an average number of deaths at 36,000 per year.

More recently, a posting from a website called healthystates (in their immunizations tool kit) developed some very interesting implications for the flu vaccine and population health initiatives. Their research shows that persons over the age of 65 that get vaccinated for influenza save an average of $182.00 in medical care. Currently, only about 50% of adults aged 65 and older actually get the flu vaccine. So, in a population of 40,000 seniors that go from 50% to 80% vaccination rate means that an additional 12,000 patients will be vaccinated. A health system that organizes this campaign would recognize approximately $2.2 million dollars in cost savings.

Many health systems lack the ability to integrate data from diverse electronic medical records that would help them identify, contact and follow up with the patients in their network. This type of strategy is often referred to as "Population Health" or "Population Health Management." Identifying patients that are overdue for preventive care or health screenings is called "Care Gap Analysis" or "Care Gap Identification." Once patients that require additional care or screenings are identified, a responsible Population Health tool will then be able to sort the patients according to relative risk, age, gender, and other demographic data, and then to automatically reach out to these patients through automated phone calls, emails or text messages to alert them to the need for additional medical attention.

In our example of flu vaccines, let's consider a case where there is a shortage of vaccines for this season, so the health system would have to ration the doses out. For argument's sake, let's assume that this particular health system has developed a protocol that calls for immunizing pregnant women first, then to treat patients over 65 with poorly controlled diabetes. The ideal situation would be that a disease management professional, responsible for implementing these types of protocols, would quickly identify these patients with a simple web-based user interface. Within just seconds, they would filter their patient population for each at-risk group, check the available number of vaccinations again the patient population in question, and have the population health management program start making phone calls, sending emails, or composing text messages to those specific patients in order to get them into their clinics and have them vaccinated. All this could be done in less than one minute.

We face huge challenges in the US with ever-expanding healthcare costs. Bridging the gap between fee-for-service and performance-based reimbursement plays a pivotal role in our ability to start delivering value-oriented wellness care, and a comprehensive, easy-to-use population health management tool is a critical component in this transition. This example of being able to quickly implement an influenza vaccine program with restricted supply shows how quickly and easily existing technology can start bridging the gap today!

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