By Melinda Young

EXECUTIVE SUMMARY

As the COVID-19 vaccines are rolled out to U.S. healthcare organizations, there will be challenges in access, logistics, and maintaining infection prevention practices.

  • The first step is determining which employees are eligible for the first phase of the vaccine rollout.
  • Leaders will need to identify where staff can be vaccinated and which vaccine they will receive.
  • Case management directors should emphasize the importance of continuing to follow COVID-19 prevention actions, including wearing masks, maintaining strict hand hygiene, and keeping away from group settings, until the pandemic ends.

Case management directors found themselves facing many questions and fewer answers as the new year ushered in a continuation of surges in the COVID-19 crisis. The good news was the early rollout of a possible solution: COVID-19 vaccines.

“There is some hope, and that hope is yet to be defined,” says Sandra Lowery, RN-BC, CCM, president at CCMI Associates in Humboldt, AZ. CCMI Associates provides case management, consulting, and education services.

“It’s going to be a bumpy road ahead, but hopefully, the vaccines will be effective,” Lowery adds. “We see this glimmer of hope now, and that’s the good news.”

Healthcare sites, insurance companies, and other case management employees face various logistical and cultural obstacles to vaccinating their staff.

Below are some challenges case management leaders will need to address:

• Access: The first challenge will be to determine who will be included in the first phases of vaccination, which are expected to be in limited supply.

“Who is going to meet the criteria, and which healthcare workers are considered frontline workers?” Lowery asks. “Every state will have its own policies. As they get various amounts of vaccine given to them, they will have different policies, but everyone will have frontline workers at the top of the list.”

Case managers who work in nursing homes, physician offices, and other ambulatory clinic settings might be considered frontline workers and receive vaccine access in the first or second phase. Case managers who work telephonically in other settings likely will not receive priority access, Lowery says.

Vaccine access also might depend on what case managers’ employers decide to do about administering the vaccine. For instance, not all healthcare employers will want to mandate the vaccine for all staff.

“I think the organizations are going to require vaccination for those who have face-to-face contact with their patients,” Lowery says.

For example, in workers’ compensation, if case managers work directly with injured employees, their employers could require them to be vaccinated, she adds.

Many organizations already require an annual flu vaccine. Mandating a COVID-19 vaccine also may become a priority, Lowery says.

In some areas, there may be less supply than demand for the initial vaccine rollout. This could be true especially in rural areas because the first phases of the rollout will focus on centralized vaccination in more highly populated settings, says Tinglong Dai, PhD, associate professor of operations management and business analytics at Johns Hopkins University Carey Business School in Baltimore. Dai also is core faculty at Hopkins Business of Health Initiative.

“That’s a wise use of resources,” Dai says. “For small clinics, it will be very challenging for them to get vaccination.”

Temperature and timing constraints may create opportunities for mistakes in handling the vaccine. This means case management departments might have to send their staff to a central location — possibly out of town and miles away — to be vaccinated.

“It would make sense for clinics to have a vaccine day,” Dai notes.

• Logistics: State health departments and hospital systems are among the first sites that will receive the vaccine and staff available to administer the shots. But some pharmacies, ambulatory clinics and offices, and other locations might receive the vaccine.

Employers will need to determine where staff can be vaccinated and the process for getting on the appointment priority list. They also will need to know which vaccine will be available and whether the vaccine can be delivered to their facilities.

If a primary care clinic or long-term care facility receives the vaccine, staff will need to know how to store it. The Pfizer vaccine, which was the first to receive an emergency use authorization from the Food and Drug Administration, needs to be kept at ultra-cold temperatures (-70 C) requiring special freezers. However, Pfizer has built thermal containers that can be stored in a freezer or at room temperature to keep the vaccine cold for more than a week.1

Other logistical considerations include maintaining records of who has received the first dose of the vaccine and when the second dose of the same vaccine is due.

Accredited organizations need to refer to existing standards for the treatment of expired medications and vaccines, says Frank Chapman, MBA, chair of the standards development committee at the Accreditation Association for Ambulatory Health Care (AAAHC). Chapman is the director of strategic development and the former chief operating officer of Ohio Gastroenterology Group in Columbus.

For guidance on storage and handling of COVID-19 vaccines, organizations will need to refer to the Centers for Disease Control and Prevention, Chapman says.

• Infection prevention: “All safety protocols will need to remain in place for quite some time — even for staff members who have been prioritized for receiving vaccine,” says Eli Rosenberg, PhD, associate professor in the department of epidemiology and biostatistics at the University at Albany School of Public Health, SUNY – The State University of New York in Rensselaer.

“You can imagine a staff member who has been vaccinated might feel more complacent and think, ‘I can’t transmit the virus.’ We want to urge them to not have that complacency,” Rosenberg says.

Healthcare professionals should not lower their guard because early data from the Pfizer vaccine do not show that it prevents asymptomatic transmission of the virus. Study results show people who are vaccinated have a 95% chance of not developing COVID-19 illness. But it doesn’t provide evidence that the vaccine stops people from developing the virus at even a minor level that could be contagious to others.

Case managers should set an example for their patients: “If you’re letting up in any protocols, unvaccinated patients will take that message and that example of their healthcare providers not taking COVID-19 seriously,” Rosenberg says. “If we’re letting up now on precautions, these can have untoward effects.”

The vaccine rollout will take time, so staff should continue to follow infection prevention measures, Dai says.

“We’re not on an island, so unless we’re talking about the United States as a whole getting vaccinated, I don’t think we should stop practicing social distancing, masking, hand hygiene, and all of those important practices,” Dai says. “We have experts talking about how people should still wear masks and maintain some social distancing since we’re not sure how effective the vaccines are to prevent infection.”

One of the most difficult things leaders will need to do is to convince staff to maintain prevention vigilance, Lowery says.

After people become vaccinated, there will be a tendency to think they do not need to wear their mask at all times, she notes.

It will be difficult to maintain compliance with COVID-19 prevention activities. Leaders will need to provide staff with as much information as they can, and explain how the early vaccines have not proven they will stop asymptomatic transmission of the virus, Lowery explains.

“Case managers care about their patients, so you can make the point that they don’t want to feel like they’ve harmed anyone in trying to help them,” she adds.

“Then, it will be part of a major educational challenge to get everyone on board,” Lowery continues. “It may come down to the employer’s policy and someone saying, ‘This is our policy, based on science, and here is the information we have about what we need to do to protect you and those you serve.’”

• Options: It might not be possible to vaccine the entire staff for several months because the expected first doses of the Pfizer and Moderna vaccines will cover less than half of the American populace.2

Case managers who work telephonically might have to wait until the vaccine is rolled out to the general public before they can receive it.

If case managers met with some patients in person before the pandemic, their organizations could lobby local public health officials to prioritize these staff for vaccination.

“If case managers are going to work face-to-face — in hospital, clinic, and home health settings — then they should be considered [for priority vaccination],” Lowery adds.

But if case managers plan to continue to work through televisits until the pandemic ends, they might not be able to move up on the priority list, she says.

“Some government health departments don’t know what case managers do,” Lowery says. “They think of nurses, nurses’ aides, physicians, and maybe lab techs, but do they think of case managers? It’s kind of a newer thing, so case management leaders might need to advocate for their staff, plead the case.”

REFERENCES

  1. Johns Hopkins Carey Business School. Delivering a pandemic vaccine poses extraordinary logistical challenges. https://carey.jhu.edu/articles/delivering-pandemic-vaccine-poses-extraordinary-logistical-challenges
  2. Weiland N, Grady D, Zimmer C. Moderna vaccine is highly protective against COVID-19, the FDA finds. The New York Times. Dec. 18, 2020. https://www.nytimes.com/2020/12/15/health/covid-moderna-vaccine.html?campaign_id=60&emc=edit_na_20201215&instance_id=0&nl=breaking-news&ref=cta&regi_id=43012034&segment_id=46986&user_id=dcf13f00af010f5aab24b0ea015a94e8