While the development of COVID-19 vaccines at “warp speed” has been very impressive, the continuing role of the private sector shouldn’t be forgotten as we struggle to quickly get vaccines into all those waiting arms. By marshaling the resources of two powerful allies — our insurance firms and retired clinicians — we can fix this critical distribution problem, also in record time.
As a former health insurer CEO, I know insurance companies can be one key to making sure we all get our COVID shots. They are keepers of all the data on care delivered no matter what the setting. Insurers can use this knowledge within privacy guidelines to target those needing vaccination and use consumer marketing to get them to the right place.
Yet getting all of us to COVID vaccination sites won’t be enough without far more staff. Thankfully, millions of retired nurses and doctors also are ready to help.
These two assets don’t seem to be part of most state plans
now being announced. It’s not enough to focus on just getting
vaccines out to providers or worrying about staff shortages in hospitals or
paying for treatment through the CARES Act.
Making sure the vaccine actually reaches all those arms is a management
challenge beyond our stressed health systems’ normal capability.
Nurses, in particular, are the most dedicated professionals anywhere doing whatever is needed for their patients. But they have been retiring at an accelerating pace as the baby boomers reach retirement age. Fear of COVID and deteriorating working conditions have driven out more, even despite rapid increases in compensation. This has created a staffing crisis for providers just trying to cope with the crush of patients needing care in general, and it’s worse during this crisis.
What will bring these heroes back are patient needs and safe ways to volunteer. Some states are actively soliciting these while others still have license barriers that prevent registered nurses from giving COVID shots. But there simply aren’t enough pharmacists and doctors to do the job for millions in need.
My wife, a nurse who long since retired from patient care but kept her RN license active “just in case,” said exactly this recently. She would gladly step up if needed and asked. Fortunately, all states have existing registries of clinical volunteers standing by. If these were better known and organized, we probably would have enough staff to do all the injections at sites set up by health-care providers, health departments, employers and others without taking staff away from bedside needs. They are out there and just need to be asked to serve once more.
The second problem is the fractured health system where folks get care. Hospital systems and their affiliated physicians are the largest provider of shots. But they only cover a fraction of care to those they think are their patients. Folks wander all around getting care in many places. It has been a challenge to get information shared across systems, although CVS and Walgreen do notify providers when they give shots.
Yet for almost everyone (except for the uninsured), there is
one player that knows everything that happens—our health insurance companies. So in considering this problem, my thoughts
turned to these omniscient folks. Every
time a service is provided, the data eventually goes into their systems. All that is needed is a billing code and
insurance number, even if there is no cost to the patient.
Furthermore, companies like Humana
Kaiser Permanente and Blue Cross/Blue Shield have been become quite aggressive in reaching out to their enrollees about care needed for chronic conditions and recommended tests to determine future needs. Insurers can guess who needs what treatment from their claims records and encourage compliance through outreach. It is just good business since these conditions often lead to much higher claims later.
Insurers know they will pay more for COVID-19 care in the future if their enrollees are not vaccinated against the virus as soon as possible. It is in their commercial interest to make it happen. Furthermore, their data systems are quite capable of generating names, following priorities (such as age group and complicating conditions), and directing care to available sites. All it takes is coordination and some programming.
However, just notifying those enrolled in their plans probably isn’t enough given the reluctance many people who have reservations. A new article in the New England Journal of Medicine suggests 12 actions needed to get us all vaccinated. It suggests standard consumer marketing approaches (such as segmenting the market) and relies on behavioral economics knowledge (such as framing the decision properly). We need to replicate the marketing techniques here that we do so well in other areas of commerce—ones that don’t save lives.
Now that the miracle of pharmaceutical innovation has delivered us vaccines in less than a year, it is incumbent on all of us to staff, fund and market in a coherent management framework to finish the job. We cannot leave it to understaffed public health departments to somehow get us to all march in the same direction. This is far too important for the wellbeing of all those we love and for the future of the economy to do anything less.
J.B. Silvers is a professor of health finance at Case Western Reserve University, a hospital board member and a former health insurer CEO .