While most Americans got the COVID-19 vaccine as soon as they could, and a smaller but significant percentage of others are diehard anti-vax, a sizable number of people can be classified as hesitant, but persuadable. 

THE PROBLEM

This is why CareSource, a Dayton, Ohio-based managed care payer, participated in a five-state program (Ohio, Georgia, West Virginia, Kentucky and Indiana) to boost vaccine rates. But the program initially had lower-than-average vaccination rates compared with other states.

As a managed care organization, CareSource often serves populations that are the most vulnerable and experience the most challenges around engaging in their healthcare. Add in the pandemic, and this was a truly underserved community in need of support, education and persuasion.

"No single solution or message could reach the entire community because each person is at a unique stage in their journey to vaccination," said Sarah Chapman, director of digital strategy. "Additionally, solutions need to be accessible for people of all learning styles or reading levels.

"We sought to move beyond a 'check the box' approach to COVID awareness and education and engage members in a way that would maximize impact," she continued. "We used a survey to identify where members stood regarding the vaccine. The educational texts that followed were keyed to the member persona that the survey associated with the member."

PROPOSAL

Vendor mPulse Mobile uses a conversational AI platform designed to create deeper relationships between healthcare provider organizations and their patients.

"To deliver the personalized engagement needed over the range of health beliefs individuals could have, mPulse developed a Vaccine Engagement solution delivered through a combination of conversational AI-supported text outreach and bite-sized streaming health education experiences," Chapman explained.

"Outreach powered by conversational AI enables the rapid personalization at scale that this type of program requires," she added. "Including questions about intent to get vaccinated and the reasons why behind that choice provides the insights to tailor engagement and address the barriers they may have."

Delivering this conversational engagement through text messaging ensures high read rates and high levels of engagement, and gives the member a voice, she said.

"Bite-sized streaming health education complements conversational outreach," she observed. "A highly impactful short video clip was integrated into the program so when a member's response identifies a barrier, relevant streaming content can be shared, all orchestrated automatically within the solution."

MEETING THE CHALLENGE

CareSource implemented mPulse Mobile's COVID Activate technology and launched it to different lines of its business (Marketplace, Medicaid, Medicare Advantage/Dual Special Needs and MyCare Ohio) in five states (Ohio, Georgia, West Virginia, Kentucky and Indiana).

Overall, 664,000 members participated in the program. CareSource excluded members who had previously reported receiving at least one dose of the vaccine.

The goals of this program were as follows:

• Increase COVID-19 vaccination completion rates (doses 1 and 2).
• Influence health beliefs and update knowledge.
• Build self-efficacy and confidence relating to the vaccine.
• Assess readiness to change.
• Address any health equity concerns.

"The COVID Activate solution included 25 SMS workflows, one secure survey and one video link to educational content produced by mPulse's health streaming solution, The Big Know," Chapman explained. "Each of these pieces of the program were sent to all 664,000 members. A persona – Ready, Unsure or Non-Believer – was assigned to each member based on how they responded to each workflow.

"Social determinants of health values were calculated based on members' addresses, which also determined the workflows members received – resulting in members receiving an experience tailored to their needs and preferences," she continued.

This program had 128 rules to send out an appropriate automatic response to any questions or concerns a member might have after receiving a workflow. With every response that a member sent mPulse, the tailoring would continue. Automatic responses covered topics such as variants, availability, cost, fear/anxiety, effectiveness, side effects and herd immunity.

"Members received one message per week – addressing myths, misperceptions and misinformation, as well as concerns about inequitable distribution of vaccine," she said. "A key goal was to build health literacy among the members of the various plans. In addition, the workflows reassured members of the cost and employment impact – for example, the vaccine is free, side effects should not interfere with the ability to work.

"Lastly, CareSource addressed access issues related to transportation, work hours, evening and weekend availability, as well as concerns among the undocumented, disabled and unhoused," she added.

RESULTS

Total number of members who reported receiving both doses out of this cohort is 48,487, or 7% of the member population.

For members who reached the first dose and second dose check-ins, there was strong follow-through from the first dose onto the second dose (approximately 81% of members).

Most importantly, CareSource initiated behavior change among the 107,000 members who began the program classified as Unsure – 57,000 were moved to the Ready persona by the end of the program based on their engagement and responses.

The 127,000 members who began the program classified as Non-Believers were much harder to influence. CareSource's program succeeded in moving 839 into the Ready persona and 216 into the Unsure persona. The ability to drive these measurable shifts in attitudes toward COVID-19 vaccination were positive in impact compared with other core vaccination education initiatives.

ADVICE FOR OTHERS

"As the COVID-19 virus and our protective measures evolved, so too did the CDC's guidance," Chapman said. "A long-duration campaign of this type needs to allow for content updates while in flight. Depending on the regulatory environment in which a health plan operates, this may require special arrangements with regulatory officials.

"Rigorous testing of the campaign, through all its permutations, is essential," she advised. "This should be done on multiple devices – iOS and Android – as well as multiple carriers to ensure proper message delivery and accessibility."

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.