MODERN HEALTHCARE: Hello, Dr. Gary Little. How are you doing today?
DR. GARY LITTLE: I'm doing great, Kadesha. How are you?
MODERN HEALTHCARE: I'm doing well. We are here to talk about how health systems and senior executives can prepare for the expanded eligibility for COVID-19 vaccine. Before we dive into our discussion, I just want to read a couple of data points to kind of frame our discussion.
As of April 4, 2021, over 165 million doses of the COVID-19 vaccine have been administered in the US. In early March, 52% of frontline health workers report getting at least one dose of the COVID-19 vaccine. By May 1st, 46 states and Washington DC, plan to expand eligibility to all adults. And vaccines have reportedly been thrown out, thawed, or expired, basically wasted — including nearly 5,000 in Tennessee in February alone.
Let's talk about how health care systems can prepare for this expanded vaccine rollout. What landmines and blind spots would you say health system leaders need to be ready for, in these early days of the broadened eligibility?
DR. GARY LITTLE: I think the biggest thing is, really, matching that demand to supply. Right now, as you know, the vaccine supply is still limited. So, even though the eligibility requirements are opening up to allow all adults to have them, it really is managing that supply and demand, and delivering expectations to your patients, and to the community at large. To know that even though the eligibility requirements have opened up, vaccine's still in limited supply. So, it may not be tomorrow when you get your vaccine — that there still may be some wait time to get that vaccine.
The other piece is, as more people become eligible, there's the perception or reality that those newer eligible people will start to jump the line in front of people who are, more in need of it, or more vulnerable. So, you know, some of our older populations who still haven't been able to get vaccinated for one reason or another, a lot of people in our underserved communities, who have been harder to reach or having more vaccine hesitancy.
So, you have to still think about those populations and how we're going to get them vaccinated. Thinking about your strategies around accommodating this additional volume of people who wanna be vaccinated, but still making sure you address those vulnerable communities who are having a harder time getting vaccinated.
MODERN HEALTHCARE: So, it sounds like it's really a matter of managing expectations. Just because the eligibility guidelines expand, number 1, doesn't mean that supply will meet demand, and it also doesn't mean that everyone who is eligible will all of a sudden start flooding your facility.
DR. GARY LITTLE: Yeah. It’s managing those expectations, making sure you have clear communications out there of how people connect with you as a health system to get vaccinated. So, if that's using, you know, web portals, a phone number that they call — you know, what are the channels that you're using for people to connect with you to get vaccinated? So, they can either get on your waiting list or get an appointment. You know, whatever your strategies are, it's setting those expectations but also having clear and available ways for people to connect with.
MODERN HEALTHCARE: So, how should health systems navigate ever-changing state guidelines about who's eligible, who's in what group? These guidelines have changed quite a bit over the last few months, and it can feel like a moving finish line. How should hospitals navigate staying on top of their state guidelines?
DR. GARY LITTLE: For us, what we did — we really set up a close relationship with our state vaccine team, and we established weekly touch points with them. So that, you know, we could ask questions, clarify guidance, understand exactly what the state was intending with new guidelines or new eligibility criteria. That's the first step — it's just, really connecting closely with your state vaccine team, so that you have that channel. It's also a way for you to inform them what you're seeing in your vaccination efforts, and really lobby for changes or modifications to those eligibility criteria.
The second thing is, as a health system, we have connections with employers in our area, with other, you know, business organizations. We've got relationships with community grassroots organizations, faith-based organizations. And so, the other piece of our strategy has been really working with all those groups to let them know that, you know, when their people, their employees become eligible. Those relationships that you probably already have, plus any expanded ones that you developed during the pandemic — really leveraging those relationships to be that source of truth and facts so that, you can help them when it's time to get vaccinated.
The other piece that we did with those groups was not only just interpreting the state guidelines and eligibility requirements. We also put on town halls for those groups to answer questions about the vaccine and about COVID-19 in general, and about vaccine hesitancy. And just, to answer and dispel those myths that were out there, so that their employees could make informed decisions about getting vaccinated.
MODERN HEALTHCARE: Yeah. If you ask five people in the health system, who's eligible for the vaccine, or where do people sign up and when, you're going to get five different answers. So, with your communications and outreach to these different groups through these different channels, what have you seen worked to streamline it, so that the message is consistent, and there's no conflicts in what you're putting out there?
DR. GARY LITTLE: The channels you use have to be tailored to the population that you're working with. For the general population, we directed them to a specific website on COVID-19 vaccines, where they could go, and it had frequently asked questions there. It had the ability for them to answer questions about themselves, and then assign them to the state eligibility group, so that they knew where they fit in line. It also allowed us to notify them.
So, if it puts you in say, for example, Group 3 — when the state made Group 3 eligible, we were able to then reach out to those who answered that questionnaire, and that were in Group 3 — to let them know, “Hey, now you are eligible. Here's how you go and get yourself an appointment.” So, you have to have one landing page that people can go to and get all their questions answered. Am I eligible? And here's how you figure that out. And then, okay I am eligible. How do I make an appointment?
MODERN HEALTHCARE: Yeah.
DR. GARY LITTLE: We also had one phone number they could call. So, for those people who are not web savvy and can't navigate web pages, or don't have access to the internet — we had one phone number that we publicized, that they could call and do the same thing that they would do on our web portal.
For some of our vulnerable communities, we relied again on those community organizations, community leaders to help us to get that information out. We leveraged, you know, what we did earlier in the pandemic with testing. You know, mobile testing, where we would set up on a site for those communities, where they don't require an appointment or anything.
They could just show up using grassroots communication. Whether that's flyers that we post up, or billboards, or advertising in local publications, newsletters, newspapers — you know, those kinds of things. And then even radio advertisement, to let people know where we're gonna be, and how to find out and ask questions.
You know, publicizing that phone number, or that landing page. So, you really have to tailor your communications to the target audience, but everything has to still lead to essentially one place for all that information to be housed.
MODERN HEALTHCARE: And that helps with the consistency. So, you don't have people going to three different locations and then those different sites have to all be updated consistently. It just makes everything a lot easier.
DR. GARY LITTLE: Correct.
MODERN HEALTHCARE: You mentioned setting up on different sites, and then letting community groups know about who can come to the site for a vaccine. Can we jump to talking about some of the logistical factors that health systems should consider for like efficiently managing these vaccination sites? And let's assume that, you know, there will be a jump in demand as the eligibility criteria expands. What are some of the logistical factors that health systems should think about?
DR. GARY LITTLE: Let's just start with location. Where do you want to put your vaccination centers? What geography and location are you looking to tailor to? That's one. Second is, what type of vaccination operation are you trying to run? For instance, if you're trying to run a massive vaccine operation, you know, several thousand people or more — do you have the venues that can accommodate that kind of volume? Are you planning on people walking or driving? All those kinds of logistics make a difference.
Again, depending on your population that you're targeting — older people may have issues with disability, so walking may not be the best type of event for them. But as we get into some of the younger populations, it may be not as big an issue. How are people going to get to you? If you're trying to get to some of those vulnerable populations, do they have access to a vehicle or not? Is your center accessible to public transportation? The other thing that always comes up, depending on the time of the year, is the weather, right?
MODERN HEALTHCARE: Yeah.
DR. GARY LITTLE: When it was cold, is it an outdoor venue or an indoor venue? You need shelter and coverings depending on what type of venue you're in. As it starts to get warm, you know, you’ve got to deal with the heat and the sun, and dehydration, and then ultimately things like thunderstorms. Then, it's just a lot of preparation and understanding how your operation will work from the time that you decide that — are appointments necessary or required?
Appointments really help in terms of making sure you know how much vaccine you need, so you can match that to the number of appointments that you have. It helps you prepare your vaccine. You mentioned, there were places that had spoilage of vaccine or had to waste vaccine. Well, you are able to match much better when you know how many people are coming.
The downside to appointments is for some people, having to navigate, you know, web based systems or smart phone apps or things like that. We have several strategies. We have some events that are appointment-required. But we also have events in our vulnerable communities where appointments are not required. And we do all the registration and everything on site with the vaccination at the same time.
So, you’ve got to think through all those logistics. The other piece is, on the back end, you have to have accommodations for people physically to wait for their 15 to 30 minutes after their vaccine, to make sure they're not having any serious, adverse effects from the vaccine. So, you have to have space to be able to do that — socially distance. So, as you look at your venue, you’ve got to think about all those things or how people are gonna arrive, and go through, and register, and get vaccinated, and then wait there 15 minutes, and then leave. A lot of detail that goes into it, and a lot of preparation — and luckily we've got some great people on our team who've just done an amazing job.
MODERN HEALTHCARE: I can imagine. It sounds like you just have to think through the top five worst-case scenarios, and then the next five worst-case scenarios to figure out, you know, how you will navigate that once it happens.
DR. GARY LITTLE: Yeah, and start small and build from there, right? Don't make your first thing a 10,000-people vaccination event. Start, you know, with maybe a few dozen the first time. Then, move up to a few hundred, and then expand it from there as you get better and you learn your operation.
MODERN HEALTHCARE: With these events, and assuming that it is a bigger event, there's also the question of managing data on who you’ve vaccinated. Is it their first or second dose? And just collecting that sort of information for follow-up purposes, for EHR (electronic health records) purposes. How can health systems best manage important data on things like storage, compliance, the patient population, the volume, and staff training?
DR. GARY LITTLE: Our big goal at the beginning of this was, we wanted to vaccinate as many people as we could, as quickly as possible to get to that herd immunity. But we also wanted to do it fairly and equitably. So, collecting patient information about age, gender, race, ethnicity, was important to us. At the same time, this is a federal program that's administered by the states. There's required information that we had to collect and put into state databases. You know, that was probably one of the more complex things that we had to learn, as part of this.
Putting the shot in the arm is the easiest thing to do. It was all the other logistical stuff. As we collect that information for the state, we're also collecting it for ourselves. It really is used to help us tailor our vaccination efforts. You know, all those things that help us to make sure that we are targeting the right communities, and that all of our different types of events are representative of the community that we serve. And so, it was really important for us to have that data and we are using it constantly.
The state obviously uses that data as well, and they tailor their administration or allocation of vaccine across the state, based on that data that we're collecting. So, we really value that information and we collect it on the front end. I think part of the reason why, you know, I've been tapped to lead our vaccine efforts is, this is what I do as a Chief Medical Officer: look at data, interpret it, and then make decisions based on it. So, I feel confident that just about every health system, health department out there will be able to use this data in a way that will improve the vaccination efforts across the country.
As far as training — really, training for us was fairly simple. Other than the state database, once we got that, we did a great community partnership with one of our private companies who really helped make that process more efficient. In the beginning, all the state information had to be entered manually. Obviously, slow process, prone to error. Well, Honeywell helped us to convert that to a bar coding process, where we’re able to automate that process a little bit more — it increased our efficiency. But our training, other than that, really is stuff that we do every day. We do vaccinations, you know, all the time in our hospitals, in our clinic. So, that piece has been fairly simple for us.
MODERN HEALTHCARE: Are there any other support vehicles that health systems should turn to, during this expanded vaccine rollout? You've mentioned community organizations, you've mentioned private companies like Honeywell. Who else should health systems be turning to for support during this amplified vaccine rollout?
DR. GARY LITTLE: We serve seven counties here in North Carolina. We have direct connections with the county health departments, and have done partnerships with vaccine events with them, targeted to those communities. I mentioned our public-private partnerships with Tepper Sports — Charlotte Motor Speedway where we did a huge mass event there, and Honeywell. And I mentioned some of our faith-based organizations. You know, we've worked with community churches and mosques, business organizations, coalitions of different businesses — to really just, again, target and educate, and inform them about the vaccination efforts.
Volunteer organizations, you know, whether that's private companies who want to volunteer or other volunteer organizations. Team Rubicon, is one that comes to mind that has really helped us, you know, when we were doing mass testing and vaccinations. Universities and schools — we've done events at some of our local universities — Johnson C. Smith University, here in Charlotte. We've worked with University of North Carolina, Charlotte. Working with them as, you know, other pillars of the community who have connections into the community, whether through their direct employers or their faculty or staff, their students, and others.
So, it's really just broadening your reach and just leveraging those relationships as you normally do when you're doing community and population health. So again, I think health systems, health departments are really structured to do this. It's just, you’ve got to do it on a much more massive scale. We're all learning so, you know, I look forward to hearing from other health systems to see what they're doing that we can learn from as well.
MODERN HEALTHCARE: Health systems are reaching out to each other to share things that have worked, things that don't work, and it's been really great to see just the peer learning going on. Awesome. Thank you so much. We will be in touch with you to see how your vaccine rollout went, sort of, later in the summer, I guess. Hopefully, by then we'll be closer to the herd immunity we're all trying to get to.
DR. GARY LITTLE: Yeah, we hope so. Thank you for having me. It was my pleasure.
OUTRO COMMENTS: Thank you, Dr. Gary Little, for that insight on how health systems can manage vaccine rollout in the months to come.
Again, I’m your host, Kadesha Smith, CEO of CareContent. We help health systems reach their growth goals through digital strategy and content.
Look for more episodes of Next Up at modernhealthcare.com/podcasts or subscribe at Apple Podcasts, Google Podcasts, or your preferred podcatcher. Thank you again for listening.