The Network for Regional Healthcare Improvement (NRHI) is a national non-profit membership organization with a mission to support local leaders in their efforts to address regional health issues related to patient outcomes, care delivery, quality, and cost. NRHI supports and spreads regional collaboration across the United States. The network reaches approximately 70% of the US population. NRHI provides the infrastructure for Regional Health Improvement Collaboratives (RHICs) to convene and participate in shared learning, consensus building, and exchange of research, evidence, and best practices allowing for greater collective impact.
RHICs across the country are taking swift action to support key stakeholders responding to the emergent community needs resulting from COVID-19, most recently vaccine deployment. These regional entities are critical in identifying urgent and unmet needs, convening stakeholders across healthcare and other sectors, building will among local leaders, and acting quickly to implement solutions that are based on data and evidence, careful measurement, and are watchful of equity, quality, and safety. The following features below depict the critical role RHICs are serving with COVID vaccination efforts.
Better Health Partnership, Cleveland, OH
Better Health Partnership, based in Northeast Ohio, was approached during the summer of 2020 by a collaboration of six Federally Qualified Health Centers (FQHCs) to help support their COVID response efforts by providing project management, data analysis, strategy design, and execution. A key accomplishment has been the development of a collaborative website that provides the public with a one-stop-shop to view FQHC testing and vaccination information. In December 2020, four FQHCs partnered with United Health Group and faith-based leaders on the Stop COVID Cleveland initiative –bringing more than 3,500 free COVID tests, 2500 health and wellness kits and nearly 2,000 food boxes to individuals living in an underserved area of Cleveland.
As vaccine supply has increased, Better Health has worked closely with state and local officials to share data showing populations at risk for inequitable access to vaccines and advocating for additional vaccine supply for FQHCs to ensure that communities of color and low-income populations have equitable access to vaccines. At the state level, Better Health’s advocacy efforts were successful in securing additional vaccine allocations for FQHCs to stand-up two pop-up vaccination events that targeted African American and Hispanic communities. Two FQHCs, Circle Health and Centers and Neighborhood Family Practice, partnered with faith-based partners who hosted church-based vaccination events and led outreach and registration efforts. Both events far exceeded expectations with a west-side Cleveland event vaccinating 87% Hispanics and an east-side Cleveland event vaccinating 92% African Americans.
Better Health has also been playing a crucial role leveraging its reputation as a neutral convener and helping with broader vaccination coordination efforts. On a bi-weekly basis, Better Health leads a meeting with FQHCs, hospitals, public health, academia, United Way, funders, and other community leaders to share information, troubleshoot areas of concern and uncover efficiencies. On alternating weeks, FQHC-specific meetings and CEO-level conversations are convened to allow additional sharing of best practices, discuss data showing testing/vaccination progress and provide a safe space to raise concerns.
Common Ground Health, Rochester, NY
Common Ground Health in Rochester, NY has been invited to participate in the Finger Lakes COVID-19 Vaccine Task Force. Wade Norwood, CEO of Common Ground was asked to co-chair the task force, bringing his expertise and passion for engaging diverse communities and leaders, and for providing an equity lens to ensure fair distribution of COVID-19 vaccines.
The mission of the Finger Lakes COVID-19 Vaccine Task Force is to ensure equitable, transparent, and efficient immunization of at least 70% of the Finger Lakes Region. The federal, state, and local partnership recently placed a permanent vaccination site in the heart of the city specifically for those who live in the city.
On the critical vaccination site: “Today’s announcement is a giant leap forward toward COVID vaccine equity,” said Norwood. “Governor Cuomo’s and the President’s leadership in response to our community voice will be remembered as historic.” Norwood noted that communities of color have been twice as likely to die from COVID-19 as their White neighbors locally, yet to date they have been less likely to be vaccinated.
“With this new vaccine site, those who have been hardest hit by COVID-19, who have been pushed to the front lines of this terrible pandemic and at the back of the line for vaccination opportunity, will finally be first in line. We know that lack of transportation is a real barrier for folks who do not have a car. This site is much closer to home for residents of some of Rochester’s most distressed neighborhoods. It is also accessible by bus and for some by foot. This federal emergency vaccination site is, literally, a life saver.”
The Health Collaborative, Cincinnati, OH
The Health Collaborative based in Cincinnati has been mobilized in support of Covid-19 response since the beginning of the pandemic. Efforts have been multi-faceted and have included leadership of testing and vaccination efforts. To coordinate vaccination strategy for the Greater Cincinnati region, THC has leveraged its trusted partner status and has convened a 3x/week forum of vaccine partner representatives of the local health systems, public health, community partners including the United Way and Council on Aging, and pharmacies. This Vaccine Working Group has been charged with coordinating vaccination supply and rapid problem solving across providers in the region to maximize vaccine uptake especially among the most vulnerable populations.
As part of the Vaccine Working Group, the City of Cincinnati and Hamilton County led the development of an equity plan to ensure that at least 20% of the vaccines allocated to the region are reaching minority and high-need populations. In response to this plan, the region’s vaccine allocation has been increased to support this comprehensive effort which defines priority communities for outreach and aligns efforts across partners to reach targeted communities. The additional allocation is being provided to the regional FQHCs, strike force mobile clinics in high-need neighborhoods and in senior living facilities provided by public health partners, open community clinics for vulnerable populations supported by 4 local health systems, and to 2 fixed clinics supporting low-income Medicare patients in diverse and under-served areas. The Equity Plan’s impact is being monitored aggressively through regular reporting and the attention of this nimble and collaborative Vaccine Working Group.
Washington Health Alliance, Seattle, WA
In Washington state, the Washington Health Alliance (Alliance) is working with public health officials and business community leaders to help vaccine distribution efforts in King County, the largest county in the state. King County is working to vaccinate its 1.8 million adult residents, starting with those at highest risk, with the goal of reaching 70%, or 1.26 million people, by the end of the summer. To reach that goal, 16,000 people must be vaccinated every day. Partnerships with the business community are considered key to increasing the number of vaccinations delivered throughout the region.
Given the Alliance’s 17-year tradition of successful collaboration with all healthcare stakeholders—purchasers, providers and health plans, the Alliance was invited to join the King County Vaccination Partnership with the goal of accelerating vaccinations. This group includes leaders from King County as well as representatives from three chambers of commerce (Seattle Metropolitan Chamber of Commerce, Bellevue Chamber of Commerce and Seattle Southside Chamber) plus an organization called Challenge Seattle. Challenge Seattle is a collaborative effort of CEOs from 19 of the region’s largest employers designed to tackle the greatest challenges of our time. The goals of the King County Vaccination Partnership include:
- Developing a toolkit for communicating with employers on business issues;
- Being the source of accurate information about testing availability and accuracy about vaccines that business leaders can share with employees; and
- Supporting employers to organize pop-up vaccination sites, in collaboration with providers across the state.
The Alliance participates in weekly meetings and regularly provides important information to its more than 185 member organizations on the vaccination effort, including new high-volume vaccination sites, mobile vaccination teams, community-based pop-up vaccination clinics, and worksite-based vaccination centers. In addition, the Alliance makes informational materials, including infographics, videos, and articles, available to support employers who would like to encourage employees to get vaccinated.
Wisconsin Collaborative for Healthcare Quality, Madison, WI
Leaders of the University of Wisconsin (UW) Neighborhood Health Partnerships Program (NHP) partnered with the Wisconsin Collaborative for Healthcare Quality (WCHQ) and researchers at the UW Health Innovation Program (HIP) to develop a tool that will help community-level decision makers prioritize their COVID-19 vaccination outreach in Wisconsin communities. The tool, available at https://nhp.wisc.edu/covid-19/, estimates the relative risk of COVID-19 mortality and potential barriers to COVID-19 vaccination in many Wisconsin ZIP codes. Jessica Bonham-Werling, Director of NHP and Associate Director of Research Operations at HIP is spearheading the effort.
“While public health and health care communicators and marketers have been running flu vaccination campaigns for years, the urgency and importance of getting people vaccinated for COVID-19 will present a new challenge. We have built a tool that will help target outreach and guide the development of messages that meet specific community needs to motivate people to get vaccinated as quickly as possible.”
The relative risk of COVID-19 mortality for each ZIP code was calculated using electronic health record data, voluntarily provided by over 20 Wisconsin health systems to WCHQ. The team produced a similar analysis earlier in the pandemic, but this update was created using a risk calculator that was recently published by Johns Hopkins University researchers in Nature Medicine based on all the knowledge that has been gained about COVID-19 risk factors. This calculator uses sociodemographic factors and information on pre-existing conditions to predict death from COVID-19.
“Wisconsin health systems and medical clinics are committed to protecting the people living in their communities, but we can’t help those we cannot reach,” according to WCHQ President and CEO Gabrielle Rude, Ph.D. “The fight to beat this virus requires new tools that not only identify areas of the state with people who are most at risk, but that also enable our health systems and public health professionals to develop outreach strategies that help us communicate with those who are hard to reach.”
Potential barriers to COVID-19 vaccination were calculated for each ZIP code using seasonal flu vaccination data from the Wisconsin Department of Public Health. There are many potential barriers to seasonal influenza vaccination, including rates of insurance coverage, access to health care and concern about vaccine safety and efficacy. While there are important distinctions between COVID-19 and seasonal flu vaccination, flu vaccination rates can help health professionals anticipate the challenges ahead and plan accordingly.
NRHI & RHICs- Key Partners in a Pandemic
The importance of convening local leaders across stakeholder groups and sectors must be underscored as we work in a systematic and unified way to address the path forward from the COVID-19 pandemic. RHICs have the capabilities to build key partnerships and create answers quickly during a crisis. The Network for Regional Healthcare Improvement provides the foundation and resources so its members can learn from one another, quickly adopt solutions, and commit to problem solving together.