Why are adolescent immunizations important?

Vaccines are one of the best ways to avoid serious and deadly diseases and can even prevent some cancers.

Adolescent immunizations are an important way to prevent serious and deadly illnesses, and even prevent cancer later in life. The immunizations recommended by age 13 include meningococcal, Tdap (Tetanus, diphtheria, pertussis) HPV (Human papillomavirus) and influenza. However, adolescent immunization rates have remained stagnant, primarily due to reluctance to get the HPV vaccine.

The HPV vaccine is recommended for children ages 11-12, however can be given to the child as early as 9 years old. The reluctance of some parents centers around the fact that HPV is a sexually transmitted virus, and children are not typically sexually active at that age. Research shows that children are not more likely to start sexual activity if they receive the HPV vaccine. Research also shows that the HPV vaccine is more effective over the long term when given at an earlier age.

What did we do to increase adolescent immunizations among our members?

HealthPartners focused on communicating with the parents of members about the importance of these immunizations and with providers to encourage them to use best practices when making vaccine recommendations.

How did we reach out to parents?

HealthPartners primary intervention was to update our Adolescent Immunization campaign. HealthPartners has many campaigns that use letters and emails to educate members about the importance of care, screenings and remind members when they are due for care.

We created new messages for targeting the parents of 11–12-year-olds and created a wrap-around Child and Teen Checkup campaign recommending annual well visits for all children.

We use two different educational messages .Our analytics determine which message parents will receive based on our understanding of which message will most likely cause the parent or caregiver to take action.

• Some members receive a message from a physician making the recommendation to immunize based on best practice evidence. Our research shows that certain members appreciate basic factual information about immunizations from a clinician
• Other members receive a stronger message that describes the dangers of not having their child immunized and information about the diseases vaccines will prevent. This is intended to evoke an emotional reaction that drives action.

Both messages include information about incentives available to Medicaid members when they complete all recommended immunizations by their thirteenth birthday. If the member doesn’t have a primary clinic, there is a link to help them find care in the network. These messages are delivered through email, push notification, the landing page when someone logs into their on-line account, and through Riverview Member Services. For members without an online account or email, we sent a postal letter.

We also worked with Community Health Workers (CHWs) to call members who need a well-child appointment, where they could talk to their clinician about needed vaccines. CHWs are trusted, knowledgeable front line health personnel who typically come from the communities they serve. They often communicate using the member’s primary language and help them make appointments for needed care.

How do we collaborate with providers?

Parents rely on their doctor for information on their child’s health. HealthPartners rewards health care providers who do a great job of providing care for our members with both financial rewards and recognition awards.

We included an article in our Fast Facts Provider Newsletter about the importance of adolescent immunizations which included resources for effective conversations with parents and caregivers. We included links to trainings recommended during the American Cancer Society/Health Plan Learning Collaborative.

We also discussed this topic at our Quality Connections forum, where Quality Improvement (QI) leaders from our network clinics share best practices on various QI topics. Two care groups presented their process for improving adolescent immunization rates including their outreach protocols, clinic processes and their provider training. 19 care groups attended this meeting.

What challenges did we face?

Many parents are not fully aware of the immunizations that their child needs, so our messages included information about what is recommended.

Mailing addresses and phone numbers can change which means we can’t reach the family.

The HPV vaccine is now recommended for both males and females, which is a change parents may not be aware of.

Some families who are reluctant to get the covid vaccine may become reluctant to get other vaccines as well. We included information about the safety of vaccines in our messages.

During the pandemic some providers paused routine preventive care and access due to staffing shortages continues to be an issue to members getting needed care.

Results

Our results show that we still have a lot of work to do to recover from the impacts of the Covid 19 pandemic on adolescent immunizations.

*internal monitoring data, not final HEDIS

Ongoing work

HealthPartners is committed to working to increase adolescent immunizations. In 2023, we will continue to reach out to members who need these immunizations. We are working with the clinics who care for our members to help them remind families of the importance of immunizations and to reward them for doing a good job with this. We will continue to provide an incentive to Minnesota Healthcare Programs (PMAP and MNCare) members.