Given the early data on the length of the immune response affected by the COVID-19 vaccine and the number of COVID-19 mutations that have been identified to date, it’s a real possibility that annual (or semi-annual) COVID shots will be needed, much like the flu shot today. This introduces a new public health concern in an area where there are currently major gaps, with just under a half of commercial health plan members and over a quarter of Medicare members not receiving the flu vaccine in 2018. There are multiple reasons for this gap, one of the most significant being the impact of social determinants on the sentiments surrounding the vaccines and access to care.


Ensuring widespread annual vaccination of these two viruses will be a key public health concern, with a significant part of the burden falling on health plans. Here are three key areas that health plans should consider as they face the possibility of having to manage another annual vaccine:


1. Social disparities: Fortunately, there’s a good model for how an annual COVID vaccine will work: the annual flu shot. The not-so-good news is that research suggests significant social disparities exist when it comes to flu shot rates, with lower vaccination rates among Black, Hispanic and low-income seniors. It’s reasonable to expect (and early data suggests) that these disparities will equally apply to an annual COVID vaccine if healthcare access and health literacy aren’t addressed. Furthermore, if there are barriers faced in receiving the COVID vaccine, this will further exacerbate the already significant health disparities in the U.S. 

Health plans can and should begin taking action to understand and address these underlying disparities. As a first step, the existing flu shot should be used as a proxy to understand the unique conditions for each health plan’s population, which will in turn inform strategies and associated interventions to address social disparity drivers which are preventing adoption of the COVID vaccine. Importantly, health plans don’t need to address these social disparity drivers alone, since
partnership models are particularly impactful when deploying SDoH interventions.


2. Member experience: With the annual COVID vaccine, health plan members would need to get two vaccines a year. While this doesn’t seem onerous, those who have worked on flu shot adoption know that one of the greatest challenges is getting patients into the site of care at the right time in the fall to receive the vaccine, which is, in part, why the healthcare system has gone to such lengths to diversify the sites of care to administer it. Similarly, for a COVID vaccine, health plans will need to make sure that patients can use the same site of care as the flu shot so that both vaccines can be received together. This will mean working with pharmacies and employers to establish the necessary procedures and measurement (addressed below).

In addition to securing access for vaccine administration, health plans will also need to create well-designed communication campaigns so that members understand where they can receive the vaccine and associated OOP costs for each site of care. Lastly, early experiences with the current mRNA vaccines have shown that in the short term, some patients do experience side effects that are more significant than those associated with the flu vaccine. Following up with members on how they’re doing and emphasizing that the side effects are normal and shouldn’t be of any concern will enhance the member experience and should avoid any long-term negative sentiments towards the vaccine.


3. Measurement: Currently, flu shot measurement is haphazard given the highly distributed nature of administration. This is the underlying reason for CMS to measure this though the CAHPS survey as opposed to HEDIS for Stars ratings. The COVID vaccine is expected to impact members’ health more than the flu shot, so health plans need to track and measure administration for their members, and know which variant of the COVID vaccine they received. Knowing the variant will help in the near-inevitable future scenario where an outbreak occurs with a new strain. In this scenario, members whose vaccines are not protective against the new strain need to be quickly identified, contacted and given an effective vaccine variant.

Additionally, we expect that CMS will eventually adopt the annual COVID vaccination rate as a Stars measure. If health plans can establish effective tracking, then it could help dissuade CMS from using the CAHPS survey for tracking and thus avoiding the response and recall challenges currently associated with the flu vaccine measurement.

Lastly, precise measurement means that the COVID vaccine rates can be used broadly throughout the health plan for use cases such as: 

  • Predicting member vaccinations and subsequently designing interventions to increase compliance
  • Including the COVID vaccine rate in value-based care measures

There are many other challenges for health plans, such as interoperability to enable measurement, and incorporation into premiums beyond the first-year vaccine which may be covered by federal funds. All of these challenges, however, are an opportunity for health plans to continue to create value for their members and contribute to improvements in the overall health of the population. Health plans must begin planning for this eventuality so that they don’t find themselves in a reactive position on this very critical topic.