1.
Population Management Approach to
Reaching Eligible Key Populations
March 10, 2021

2.
Continuing Education Credits
This activity has been planned and implemented
by the Community Health Center, Inc./Weitzman
Institute and is accredited to provide continuing
education for the healthcare team.
This series is intended for physicians, nurse
practitioners, physician assistants, pharmacists,
and nurses.
Please complete the survey – linked in the chat,
and emailed to all attendees – to request your
continuing education credit
A comprehensive certificate will be sent out at the
end of the series.

3.
This week’s COVID-19 ECHO session
is a collaboration with
This resource is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant
number U30CS29049 entitled "Training and Technical Assistance National Cooperative Agreements (NCAs)" for grant amount $2,045,000 with 0% financed with
non-governmental funds. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor
should any endorsements be inferred by HRSA, HHS or the U.S. Government.

4.
Disclosure
• With respect to the following presentation, there has been no
relevant (direct or indirect) financial relationship between the party
listed above (or spouse/partner) and any for-profit company in the
past 12 months which would be considered a conflict of interest.
• The views expressed in this presentation are those of the presenter
and may not reflect official policy of Community Health Center, Inc.
and its Weitzman Institute.
• We are obligated to disclose any products which are off-label,
unlabeled, experimental, and/or under investigation (not FDA
approved) and any limitations on the information hat I present,
such as data that are preliminary or that represent ongoing
research, interim analyses, and/or unsupported opinion.

5.
COVID-19 Update in the United States
Stephen Scholand, MD;
Infectious Disease Specialist, Midstate Medical Center
March 10, 2021
Reuters

6.
29,093,946 cases on 3/9/21 with 527,643 deaths
https://coronavirus.jhu.edu/us-map
COVID-19 in the United States

7.
https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html
Cases
declined;
some
resistance

8.
How many ‘jet liners’? A320 seats 182 passengers

9.
Pressure on Hospital Systems
https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html

10.
The Danger of Variants
“1 month ago, B.1.1.7 made up around 4% of cases in
the US. Today, it's up to 30 to 40%. And what we've
seen in Europe, when we hit that 50% mark, you'll
see cases surge."
Dr. Michael Osterholm, Director of the University of
Minnesota's Center for Infectious Disease Research & Policy
“The U.S. shouldn't loosen Coronavirus restrictions
until daily new cases fall below 10,000.”
Dr. Anthony Fauci, Director of the National Institute of Allergy
and Infectious Disease

11.
www.cdc.gov/coronavirus/2019-ncov/transmission/variant-cases.html

12.
COVID-19 Vaccinations Across the Nation
https://covid.cdc.gov/covid-data-tracker/#vaccinations

13.
https://covid.cdc.gov/covid-data-tracker/#vaccinations

14.
Interim Public Health Recommendations for
Fully Vaccinated People
• IPHR4FVP (joke!)
• Fully Vaccinated:
– ≥2 weeks after 2-dose series (Pfizer or Moderna)
– ≥2 weeks after 1 (Johnson and Johnson [J&J])
www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated-guidance.html

15.
• Visit with other fully vaccinated people indoors without
wearing masks or physical distancing
• Visit with unvaccinated people from a single household
who are at low risk for severe COVID-19 disease indoors
without wearing masks or physical distancing
• Refrain from quarantine and testing following a known
exposure if asymptomatic
www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated-guidance.html
Interim Public Health Recommendations for
Fully Vaccinated People

16.
• Take precautions in public like wearing a well-fitted mask and
physical distancing
• Wear masks, practice physical distancing, and adhere to other
prevention measures when visiting with unvaccinated people who
are at increased risk for severe COVID-19 disease or who have an
unvaccinated household member who is at increased risk for severe
COVID-19 disease
• Wear masks, maintain physical distance, and practice other
prevention measures when visiting with unvaccinated people from
multiple households
www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated-guidance.html
Interim Public Health Recommendations for
Fully Vaccinated People

17.
• Avoid medium and large-sized in-person gatherings
• Get tested if experiencing COVID-19 symptoms
• Follow guidance issued by individual employers
• Follow CDC and health department travel
requirements and recommendations
www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated-guidance.html
Interim Public Health Recommendations for
Fully Vaccinated People

18.
Trusted Resources
• Nuvance health ~2400 articles reviewed:
https://spark.adobe.com/page/kUKj85Nwwrgfl/
• CDC:
https://www.cdc.gov/coronavirus/2019-ncov/index.html
https://emergency.cdc.gov/coca/calls/2021/
• WHO:
https://www.who.int/emergencies/diseases/novel-coronavirus-2019
• Johns Hopkins:
https://coronavirus.jhu.edu/map.html
• Others
https://www.thelancet.com/coronavirus
https://covidactnow.org/

19.
Population Management Approach to
Reaching Eligible Key Populations
Tierney Giannotti, MPA – Senior Program Manager, Population Health,
Community Health Center, Inc.
Yvette Highsmith-Francis, MM – Vice President, Eastern Region,
Community Health Center, Inc.

20.
Demand
Vulnerable populations
Hesitancy
Supply
External Advocacy
Populations with Resources
Education & Time
Inreach
Proactive Reactive
Vaccinate health center patients Herd Immunity
State & Federal Mandates Health center priorities

21.
State Mandate: Phased Approach
• Healthcare personnel
• Residents of LTC facilities
Late
Dec
2020
• People age 75+ living/working in CT
• Frontline essential workers
• Residents & staff of congregate settings
Jan 11,
2021
Feb 22,
2021
• People age 65+ living/working in CT

22.
Strategic Approach: Planning
Key Data Elements about Patients
• Date of Birth
• Date of Last Visit at Health Center
• Preferred Language
• Insurance Status
• City of Residence
* Employment Status
Identify Population
• Patient Registries
• EHR Reports
• Data Warehouse

23.
Strategic Approach: Application
Q: How many patients are 75+?
A: Depends on how you define “patient”…
– Anywhere from 1,893 up to 8,349 patients
Q: What if there is a need to ramp up slowly, or supply is less
than the patient subgroup?
A: Consider key variables:
– Patient proximity to vaccine site; transportation
– Digital divide-patients with/without emails and mobile phones
– Insurance status of patients
– Patients’ preferred language

24.
Methods of Outreach: Postcard

25.
Methods of Outreach
 Text Campaigns: 68% reach rate among 65+
 Robocalls: 73% reach rate among 65+
 Live Calls: Ranges from 7% to 28% appointments scheduled
 Emails: High percentage of missing/invalid email addresses
Multiple and varied approaches
result in greatest success

26.
Planned Care Dashboard

27.
Current Timeline for Vaccine Eligibility

28.
State Mandate: Phased Approach
• Healthcare personnel
• Residents of LTC
facilities
Dec 23,
2020
• People age 75+ living/working in CT
• Frontline essential workers
• Residents & staff of congregate settings
Jan 11,
2021
Feb 22,
2021
• People age 65+ living/working in CT
By Jan 11
n=2,659 doses
By Feb 22
n=71,966 doses
By Mar 8
n=98,214 doses

29.
We Can’t Do This Work Alone
– Office of the Governor
– CT Department of Public Health
– Local health districts
– School districts
– Community based organizations
– Private Businesses/Institutions
Trusted Community Partner

30.
Using the “Hub and Spoke” Model
– Mass Vaccine Drive through locations
• High volume vaccine distribution
• Regionalized locations
 Airport runway
 Malls
 Universities
Hubs

31.
Vaccinating On An Airstrip

32.
Bringing the Vaccine to
“Wherever You Are”
– Primary care locations
– Mobile strike teams
• High touch
Congregate Living Facilities
Senior Centers
Homeless shelters
Farms
Spokes
 Schools
 Places of Worship
 Public Housing

33.
Our Most Important Resource
– Our team trained and redeployed
– National Guard
– Temporary hires and volunteers
Staff: Vaccinators & Logistics

34.
Thank You!
To learn more about The Path Forward series
WeitzmanLearning.org/the-path-forward
To view previous COVID-19 sessions:
WeitzmanLearning.org/coronavirus