The importance of preventive care strategies in a changing healthcare environment

The industry shift to value-based reimbursement models has underscored the importance of immunizations as a cost-effective preventive care strategy that can improve health outcomes for vulnerable patients.

Although vaccinations are integral to promoting patient wellness, hospitals face several obstacles when implementing adult immunization initiatives. Challenges include shifting away from the historic fee-for-service model, changing physician attitudes toward recommending vaccines and overcoming a lack of education about the importance of prevention medicine in adults.

In an Aug. 31 webinar sponsored by the Immunization Action Coalition and the National Adult and Influenza Immunization Summit and hosted by Becker's Hospital Review, John Bulger, DO, CMO for population health at Danville, Pa.-based Geisinger and CMO of Geisinger Health Plan; Scott Nygaard, MD, CMO and chief clinical integration officer of Fort Myer, Fla.-based Lee Health; and Jeffrey Silvers, MD, medical director of quality, infection control and pharmacy at Sacramento, Calif.-based Sutter Health, discussed the  importance of preventive care, challenges of implementing adult immunization initiatives and how to overcome some of these hurdles.

The importance of preventive care in adult populations

Preventable diseases in adults present a significant economic burden. In the U.S. alone, the cost burden for four vaccine-preventable diseases among adults over the age of 65 is $15.3 billion per year; the cost burden soars to $26.3 billion when including adults ages 50 to 65.

All three speakers agreed prevention strategies should be a core component of care delivery as the landscape shifts to value-based care. Dr. Nygaard emphasized that healthcare leaders need to begin thinking about health as prevention in order to address physician burnout and provide patients with proper care.

"In healthcare we've been waiting for the perfect time, the perfect policy, the perfect payment system … but it is time to stop making excuses. We need to lead the change … to improve people's health status beyond illnesses by including prevention and wellness," he said.

Dr. Bulger added that the healthcare industry needs to encourage adult immunizations as much as childhood immunizations.

"When we went to medical school we never talked about vaccines in adults, we talked about vaccines in children. We need to place them on a level playing field," he said.

In addition, Dr. Bulger and Dr. Nygaard emphasized that once hospitals begin participating in value-based programs, like managed care bundles and ACOs, it becomes a "no brainer" to provide adult immunizations, as managed care bundles and similar programs financially reward physicians for providing preventive services that keep their populations healthier and costs of care lower.

"The absence of disease is always going to be higher quality care, a better patient experience and a lower cost than treatment after contracting the disease," Dr. Nygaard said.

Challenges to implementing prevention strategies in healthcare

Hospital leaders face numerous challenges to implementing preventive care strategies, with one of the most daunting being the shift from the traditional fee-for-service delivery model, according to Dr. Bulger.

"We have a sick-care system in the country, not a healthcare system, and that's our first problem," he said.

Dr. Bulger referred to how physicians were traditionally trained to treat the disease or crisis at hand rather than preventing the disease in the first place. Value-based medicine essentially reverses that value model, meaning physicians are rewarded for keeping patients out of the hospital. Navigating this profound culture change is extremely difficult for all stakeholders and could slow efforts to implement adult vaccination programs.

Another challenge is leadership through this transition to value-based models, according to Dr. Nygaard. "[The industry] is struggling with leadership development to manage all of these changes," he said.

Finally, another barrier that curbs use of vaccinations is the subjective nature with which physicians can view the value or necessity of immunization. Though this is not a tangible barrier, Dr. Silvers said it can be a challenge to reinforce objectivity in the medical community about vaccinations and preventive medicine.

All three speakers agreed that a lack of education about the importance of preventive medicine contributed to the challenges.

Overcoming the challenges to implementing prevention strategies

Challenges to implementing adult immunization initiatives are clear. However, there are ways to overcome these hurdles.

Dr. Nygaard emphasized the need to change the way professionals view prevention. This can be done by "having candid conversations with individuals about the value of prevention to help them understand their responsibility as a clinician and value for their patient. We don't really think deeply about [our responsibility] … we think, 'Well it's just their choice of whether to be immunized or not,' but there's a wider population impact."

Dr. Bulger recommended implementing a mandatory employee vaccine policy to send the message to staff that vaccinations are important. "Mandating vaccines carried the message that physicians should bring up prevention with patients," he said.

Dr. Silvers suggested that support for immunization initiatives come from educating providers on the importance of adult immunizations.

"We can turn providers into believers if they [vaccinate] for themselves and their adult family members. When they do, then they are more likely to immunize their patients, too," he said.

In addition, Dr. Silvers suggested promoting adult vaccinations as a solution to other health problems plaguing the industry, such as antibiotic resistance, to spur support for immunization among physicians and patients.

"We can look at prevention as a form of stewardship … by selling vaccinations you're preventing unnecessary antibiotics and … stalling antibiotic resistance."

Strategies for effective immunization initiatives

To effectively implement a prevention strategy systemwide, healthcare leaders must employ various strategies, such as utilizing a team approach and leveraging their EHRs.  

"As a leader, I recognized I can't do this by myself … prevention programs as large as this need a multidisciplinary team," said Dr. Silvers.

On a tactical level, Dr. Bulger added that regardless of the reason why the patient made the appointment, a physician should always verify that a patient is up to date with his or her immunizations records. "Whenever you have chance to give the vaccine … give the vaccine," he said, citing that the health system may not see the patient for awhile after an appointment.

Additionally, all three speakers touched on the importance of leveraging the capabilities of an EHR to increase immunization rates.

"EHRs give you the availability at the point of care to provide time alerts to get staff to [immunize], but it also gives you the availability to have broader analytics capabilities to change your [company] culture and see how well everyone else is doing [with the prevention program]," said Dr. Bulger.

Overall, the mindset attached to the fee-for-service model poses a challenge to implementing prevention programs. However, by leveraging various educational opportunities and resources, health leaders can overcome these obstacles to improve population health with a cost-effective preventive care strategy. 

Listen to the webinar recording here and view the webinar slides here.


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