Quality over quantity: making the case for vaccines

Consider the following numbers: 49,000. 200,000. 10.4 billion. 1.

49,000 is the number of deaths each year in the United States due to flu-related complications.

{mosads}200,000 is the number of annual flu -related hospitalizations.

10.4 billion dollars is the annual cost to the US healthcare system due to flu.

And 1 is the vaccine recommended annually for all individuals age 6 months and older to prevent flu.

One vaccine can go a long way toward bringing down these staggering numbers reflecting the burden of flu. Yet less than half of all Americans receive a flu vaccine each year. Even among seniors, for whom the flu vaccine is particularly important, nearly 30 percent of Medicare beneficiaries do not receive it.

That’s just the tip of the iceberg. The United States has made incredible strides on childhood vaccinations over the past century—immunization rates for most vaccine-preventable diseases among children are well over 90 percent—but we’re far behind when it comes to adults. Barely 40 percent of women age 19-26 years have received the cancer-preventing HPV vaccine. Only 28 percent of adults over age 60 receive the shingles vaccine. And a mere 20 percent of high-risk individuals receive the recommended pneumococcal vaccines. All of this despite the fact that vaccines are proven to save lives and reduce healthcare costs.

There are many reasons why vaccine rates among adults in the United States are not nearly as high as they could or should be. Cost-sharing is one; patients on certain health plans are responsible for covering the costs for certain vaccines, and those on low or fixed incomes may not be able to afford them. Access is another; not every doctor’s office or pharmacy carries every vaccine, and particularly in rural areas, the distance one has to travel to receive a vaccine can be prohibitive. Education and awareness is a third; there are many myths about vaccine health risks that scare folks off and few public health campaigns that clearly explain just how effective and safe vaccines truly are.

All of those barriers are worthy of our time, attention, and resources; with the United States rapidly approaching a population shift where seniors will soon outnumber children for the first time, increasing immunization rates among adults is more critical than ever. But there’s another potential solution we need to pursue that doesn’t get nearly enough consideration: quality measures.

What do we mean by quality measures?

The traditional, dominant healthcare model in the United States is known as fee-for-service. Under that system, a doctor receives payment for each individual test, screening, procedure, or any other service provided, regardless of patient outcomes. That system prioritizes quantity over quality. It also raises costs for both patients and insurers.

Today, our nation is moving steadily toward a new model that prioritizes quality of care over quantity of care. Under this model, providers receive payments—at least in part—based on actual patient outcomes rather than the total amount of services provided. This type of thinking creates incentives for both healthcare professionals and patients to choose a more targeted set of services that maximize the potential to keep patients healthy and functioning.

Along with a group of nationally-renowned vaccine experts—including members of the Adult Vaccine Access Coalition (AVAC)—we recently co-authored a white paper making the case that quality measures for vaccines are a simple, practical, and necessary addition to these emerging payment models. Encouraging adults to adhere to a recommended vaccine schedule has the potential to improve quality of life for millions and reduce the tremendous burden our communities and healthcare providers shoulder with respect to treating vaccine-preventable illnesses.

Two specific national measure developments currently underway will have a significant impact on vaccine quality measures. The first is implementation of the Medicare Access & CHIP Reauthorization Act of 2015, which updates Medicare’s payment process by using quality of practice as the largest precondition for payment. The second is the Core Quality Measures Collaborative—led by the Centers for Medicare and Medicaid Services along with insurers, providers, experts, and advocates—which is working to promote consensus on core performance measures.

We strongly urge both the Collaborative as well as the Medicare Incentive Payment System to support quality measures for vaccines. Doing so will send a strong signal that increasing immunization rates among adults is indeed a national priority. After all, when it comes to vaccines, the optimal number is zero. In other words, not a single individual should have to die or suffer from illnesses that can quite easily be prevented.

The United States healthcare system is on the verge of an exciting transformation. It is likely to be quite a journey; let’s make sure that we take all recommended vaccines along for the ride. After all, as Benjamin Franklin advised, “An ounce of prevention is worth a pound of cure.”

Michael Hodin, Ph.D, is the CEO of the Global Coalition on Aging. William Schaffner, M.D., is the medical director of the National Foundation for Infectious Diseases and professor of preventive medicine at Vanderbilt University’s School of Medicine

The views expressed by authors are their own and not the views of The Hill.


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