Becker's Hospital Review

89 Executive Briefing Sponsored by: Population Health Management: The Importance of Vaccination in Prevention SPONSORED BY: Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., has paid for and provided editorial input on this material. A s the U.S. healthcare system transitions from volume- to value-based care, the role of healthcare providers will also be transitioning. In a value-based care system, pro- viders focus on efficiency and quality, rather than the quantity of patients they see. Providers will have to think about improving the health of the population as a whole and not just individual patients. There are opportunities to emphasize quality improve- ment (QI) and practice redesign in ways that could fundamen- tally improve healthcare in the United States. The Triple Aim framework serves as an approach for organiza- tions to successfully improve the health of individuals and pop- ulations. According to the Institute on Healthcare Improvement (IHI), the 3 tenets of the Triple Aim are improving the care expe- rience, reducing the per capita cost of healthcare, and improv- ing the health of populations. To improve the care delivered, healthcare organizations should expand in vision, reach and practice to affect health through population health interventions. One method to help prevent illness is through vaccination. Vaccines have been recognized as one of the 10 great public health achievements of the 20th century by the Centers for Disease Control and Prevention (CDC). For patients achieving immunity, vaccination can help reduce disease burden, disease transmission, and the need for disease-specific therapeutic intervention. Charles-Edward Amory Winslow, founder of the Yale School of Public Health in New Haven, Connecticut, defined public health many years ago as "the science and art of preventing disease, prolonging life, and promoting health through the organized efforts and informed choices of society, organizations, public and private communities and individuals." This definition can be helpful when thinking about healthcare's modern emphasis on population health management. The goal of population health management is to keep a patient popula- tion as healthy as possible. While a portion of population health management focuses on high-risk patients who generate the majority of health costs, another component is systematically addressing the preventive and chronic care needs of every pa- tient. For providers, this means being knowledgeable about the health of all their patients and proactively working to achieve desired health outcomes. The primary focus of medical care has been on tertiary preven- tion, which is the effort to help avoid or defer the complications of diseases after they have developed. While tertiary prevention strategies, such as disease management, can be quite complex and multi-faceted, vaccination interventions may be achievable due to a few key reasons. Vaccinations typically occur in a sin- gle-care setting such as a doctor's office or pharmacy; are one- time or relatively infrequent events (with the exception of multi- dose regimen completion); and rely on patient acceptance, but not significant lifestyle change, such as diet, exercise or medi- cation adherence. An area of preventive care ripe for improvement is adult vacci- nation, as vaccination rates among adults remain low for most routinely recommended vaccines, according to the CDC. For example, during the 2014–2015 flu season, the vaccination rates for individuals over the age of 18 was 43.6%, falling well short of the U.S. Department of Health and Human Services (HHS) Healthy People 2020 target goal of 70%. While influenza seasons can vary in severity, during most sea- sons people 65 years and older experience the greatest burden of severe influenza disease. For instance, during the 2015–2016 season, individuals ≥ 65 years of age accounted for only 15% of the US population, but they made up 50% of influenza-as- sociated hospitalizations and 64% of pneumonia and influenza deaths. According to the CDC, 63% of this patient population received an influenza vaccination for the 2015–2016 flu season. Low vaccination rates leave a large portion of patients unpro- tected against a potentially serious virus. In this evolving healthcare landscape, sustainable systems for vaccinating children, adolescents, and adults are needed. High vaccination rates cannot simply be achieved using one-time or short-term efforts. To create enduring vaccine delivery systems, greater understanding of strategies to increase and maintain In this evolving healthcare landscape, sustainable systems for vaccinating children, adolescents, and adults are needed.

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