Employers and Vaccination: Removing Barriers and Promoting High-Value Preventive Care - Q&A With Michael Thompson

December 24, 2019

AJMC

AJMC®: What is the mission of the National Alliance of Healthcare Purchaser Coalitions?

Thompson: The National Alliance is the umbrella organization for regional employer coalitions across the country, and it’s the only employer network with both a national and regional structure. Our focus is on driving improvements in health and value across the system.

AJMC®: What are the role and value of preventive care within the broader healthcare system?

Thompson: In the current system, there is more emphasis on preventive care, as many stakeholders believe that avoiding illness is a sound investment, particularly when there are clear evidence-based practices to follow for their population. Besides wanting to mitigate the onset of more serious healthcare costs, they also want to keep their people healthy and at their best while they’re on the job. Somebody who gets sick can be absent from work, infect others at work, and be less productive when they don’t feel well, and none of this is ideal.

AJMC®: Since the passage of the Patient Protection and Affordable Care Act, how would you assess current efforts to increase preventive care?

Thompson: At a minimum, the Affordable Care Act mandates that preventive services should be reimbursed at 100%, and many employers were already on that page. They were very supportive of employees getting these services. Beyond that, I think employers often will take it upon themselves to offer preventive-type screenings and preventive immunizations on-site for their employees, with the intention of making prevention still more convenient and facilitating access for employees to these services and benefits. Generally, I think employees feel good about the idea that the employer is putting a priority on their health and well-being.

AJMC®: Based on your experience at National Alliance and your impression of these efforts, how would you characterize the awareness of the employers regarding the cost savings associated with immunization and the overall benefits of wellness?

Thompson: Many of the employer efforts around wellness have had mixed results, whether it’s efforts to improve nutrition or improve physical activity. Some services, like immunizations, are a no-brainer. If we can systematically keep people from getting ill with a small investment, then it just makes good sense to do so. I think employers are anxious to ensure they are supporting their employees and their families and that their service providers are supporting their employees and families in meeting the preventive service guidelines.

AJMC®: What are some of your organization’s successes with employers that actively invested in immunization for their employees?

Thompson: Employers have been generally supportive of flu shots and will often provide these at the workplace. While they won’t insist their employees get them, they want to make it as convenient as possible, and that can take their immunization rates up by multiples, because the right thing to do is the easy thing to do.

AJMC®: Would you describe the challenges regarding communication and working with employers with respect to immunization and its importance?

Thompson: As with anything, I think employers are conscious of the payback from the extraordinary efforts [to immunize employees]. I think that the more the case can be made that there is a payback, direct or indirect, to employers to ensure that their employees are immunized, the more that will resonate with them. There are a lot of things they could do, but they can’t do everything, so they need to prioritize, and [this is] where they are going to get the biggest bang for their buck in terms of both their time and their employees’ time and effort. Generally, immunization is not a stand-alone campaign; it’s part of a broader focus on improving health and well-being of employees, and the key is making the case that it’s a critical part of that overall portfolio of strategies that they’re trying to communicate.

AJMC®: What tips or guidance can you offer to help employers encourage employees to take advantage of preventive services?

Thompson: We know that employers are aware that encouraging employees to periodically see a doctor and build a relationship with the on-site clinic or their primary care physicians is important to maintaining employees’ overall health and improving engagement with their employees. Immunizations can actually serve as a helpful reminder to go get a physical or see a provider more periodically to take care of what otherwise would be routine care.

AJMC®: How do you see this spectrum evolving over the next several years, and what next steps are needed to ensure that the adoption of preventive care increases among employers?

Thompson: We have been very strong advocates for an increased focus on more comprehensive and engaged primary care for employees and their families. As part of these efforts, we have created a strong vision and initiative to encourage advanced primary care. Obviously, ensuring that the necessary preventive services are in play are part of that strategy, but it’s not the whole strategy. It’s a relatively small part, but it is underscored by the critical need to establish stronger provider-patient relationships in the primary care setting. Immunizations can be part of that.

AJMC®: As you look more broadly at this spectrum and the payers in particular, what would you like to see emphasized over the next few years and as you continue your efforts in this space?

Thompson: In general, I think we are very supportive [of] oving to planned designs that remove barriers to high-value care and create more friction to access to low-value care. We’re looking for plans that have a more nuanced understanding of what are good investments in people’s health. [Then we can] remove the barriers so that we can mitigate the downstream cost and support the health and productivity of our workforce.

Employers are very supportive of evidence-based preventive treatment, especially where the evidence is strong. They want to see things covered and promoted and barriers removed. Where there is no evidence or where the evidence is weak, they want the opposite. While there’s a strong emphasis on promoting high-value care, there’s also equally strong evidence to eliminate low-value or unnecessary care, as well. With that filter, I think health plans and employers can be on the same page, recognizing that a healthy employee is a productive employee, and it’s not just about healthcare costs.