Since 2022, the Data Validation & Administrative (DVA) Contractor Communications team has collaborated with the Centers for Medicare & Medicaid Services (CMS) Nursing Home Command Center (NHCC) to develop case studies highlighting practices and successes that increased resident COVID-19 vaccination and booster rates. These successes were enhanced by the assistance provided to nursing homes by Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) via COVID-19 vaccine, booster and up-to-date status referrals.
The QIN-QIO community has been extremely flexible responding to changing needs in COVID-19 vaccination processes, definitions, and referral criteria. Recent vaccination changes prompted the DVA to contact three QIN-QIOs (Alliant, HSAG, and TMF) that have a significant number of referrals and a higher-than-average response rate. The goal was to learn more about their processes for responding to referrals. Based on their feedback, the DVA identified the following five strategies to help your QIN-QIO enhance your response to referrals.
1. Contact the nursing home as close to the referral date as possible.
When a referral is received at HSAG, designated staff members reach out the same day to notify the nursing home that a referral was initiated by CMS. At Alliant, nursing homes with the greatest opportunity for improvement in bivalent booster rates are assigned first. In TMF’s region, 98 percent of nursing homes have been referred by CMS. While initial referrals are assigned as priority, follow-up contacts are triaged by assigned staff based on the identified need and actual up-to-date resident vaccination rates. For example, nursing homes with much lower up-to-date rates are prioritized for contact versus facilities with rates that are much higher.
2. Assign repeat referrals to the same team member.
Assigning as many referred facilities as possible to staff with existing relationships enhances the opportunity for successful encounters and engagement with the nursing homes. At TMF, facilities that have been referred or re-referred for Targeted Response-Quality Improvement Initiatives (TR-QIIs) are paired with the quality improvement specialist who has an existing relationship with the facility. At Alliant, if a facility was previously referred for a TR-QII outbreak case, the Quality Advisor (QA) who worked with that facility is also assigned the vaccination referral to decrease the chance the facility will receive inquiries from multiple people.
3. Maximize the skill sets of QIN-QIO staff.
Employing adequate staff who have the right skills, experience and expertise allows your QIN-QIO to be responsive and provide timely technical assistance. This includes clinical experience as a nurse or physician, certifications such as Certified Professional in Healthcare Quality (CPHQ) and Certified in Infection Control (CIC), and/or specific experience as a nursing home administrator or director of nursing. At HSAG, the team is staffed with approximately 15 designated staff members with the experience noted above who provide targeted assistance based on the volume of referrals the QIN-QIO receives each week.
At TMF, team processes, expectations and a culture of delivering value are established in orientation and regularly reinforced through team huddles and office hours. During orientation, for example, TMF shares expectations for referrals as well as the referral process flow, which is updated regularly as changes are made by CMS and the Centers for Disease Control and Prevention. Post-orientation, new team members shadow tenured staff, who have the experience described above, to understand application of the expectations. In team huddles and office hours, TMF focuses on having meaningful encounters during each nursing home interaction. Examples are provided to share successful tactics and to problem solve identified barriers.
4. Add consistent value and develop rapport at every encounter.
At Alliant, QAs use scripts and templates (Appendix 1) that have undergone a behavioral science review for all initial and follow-up phone and email messages. QAs initiate the contact process for new referrals by sending an email within 48 hours of their referral assignment. If a nursing home has not responded to the initial email within three to five days, QAs make a follow-up phone call using a script. If the phone call is not accepted or returned and there is no response to the initial email, QAs send a final follow-up email. Providing scripts and templates to QAs ensures messaging remains consistent and actionable while allowing flexibility to adjust as guidance changes.
Alliant also has found that being empathetic to each facility’s needs and really listening to the issues they are facing (staffing, for example) has been instrumental to their success. This approach also has helped the QIN-QIO identify optimal times of day to reach administrators and other front-line staff. For example, Wednesdays and Thursdays during regular work hours (but not before 9 a.m. or after 5 p.m.) are a good time to send emails.
Offering assistance that decreases a nursing home’s burden, such as developing a process for vaccinations and vaccine procurement, offering ideas to promote and inform residents about available vaccines, sharing valuable data, and ensuring nursing homes know that QIN-QIOs are an accessible resource have been successful strategies for both HSAG and TMF. These QIN-QIOs found that when they demonstrate they are a partner ready to assist, without creating complexities in a nursing home’s processes, there is more willingness from the nursing homes to participate.
5. Establish credibility by building relationships with state health departments and nursing home associations.
Presenting regularly on state calls sharing new guidance and practical approaches to common National Healthcare Safety Network questions, as well as raising awareness throughout the community about their organization as a trusted partner is how the HSAG and TMF teams have built relationships with nursing home stakeholders. Partnering with strike teams and nursing home associations also has been instrumental for Alliant in communicating information about the bivalent booster and demonstrating the QIN-QIO’s commitment to not duplicating efforts.
Appendix 1. Alliant’s Initial Contact Communication Template
This material was prepared by The Bizzell Group (Bizzell), the Data Validation and Administrative (DVA) contractor, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS). Views expressed in this material do not necessarily reflect the official views or policy of CMS or HHS, and any reference to a specific product or entity herein does not constitute endorsement of that product or entity by CMS or HHS. 12SOW/Bizzell/DVA-1112-07/18/2023