Despite a longstanding CDC recommendation that adolescents receive the human papillomavirus (HPV) vaccine, which protects against sexually transmitted HPV infections that can lead to cancer, nationally less than 30 percent of adolescents were given the first dose between 2013 and 2016. The CDC estimates about 34,000 cancer deaths were attributable to HPV each year during 2011-2015, most of which might have been prevented by the HPV vaccine. But HPV vaccination rates are staggeringly low compared to the recommended tetanus-diphtheria-acellular pertussis (Tdap) vaccine, which 82 percent of adolescents nationwide have received, according to the Blue Cross Blue Shield Association’s The Health of America Report, Adolescent Vaccination Rates in America.
In Alabama, HPV vaccination rates are in line with the national average. But Blue Cross and Blue Shield of Alabama (BCBS Alabama) experts believe that’s still not enough. Two BCBS Alabama experts, Dr. Anne Schmidt, Senior Medical Director, and Tara Talley, Operations Manager for Healthcare Networks, shared how they are working with physicians to close the HPV vaccine gap.
Q: How is BCBS Alabama encouraging physicians to boost the HPV vaccination rate?
A: (Talley) We believe completing the HPV vaccine series is one measure of providing quality care to our adolescent members. So we include a few HPV measures in our value-based payment programs for physicians. We track the percentage of adolescents who have had their recommended vaccines, including HPV, by their 13th birthday, unless there’s a medical reason why they can’t. We also measure physicians on whether a woman has had a Pap and HPV test done within the last four years, tests that screen for HPV-related cancers or the presence of an HPV infection. If physicians do well on these measures, BCBS Alabama recognizes that achievement with additional reimbursements.
Q. What other resources does the health plan have to boost vaccine rates – apart from providing incentives to physicians?
A. (Schmidt) Most importantly, we have data. We know where the gaps are in terms of adolescent vaccinations, and we can target our efforts to close those gaps. We also have a network of doctors to whom we can provide opportunities for education about the issues. And we have the ability to communicate directly with members. We send notifications and reminders. We provide financial assistance to nonprofits addressing HPV, and our company has been vocal on the airwaves about the need to get vaccinated.
Q. What do doctors in your networks say about their work with parents to get adolescents vaccinated against HPV?
A. (Talley) We do hear that physicians receive more pushback on this vaccination than on other routine vaccinations. Some barriers include parents’ misunderstanding of the HPV vaccination. They may feel that because their child is not sexually active they don’t need the vaccine.
Q. But the idea behind the vaccine is to protect adolescents before they become sexually active, correct?
A. (Schmidt) Right. We feel providers need to deliver a strong message to the parents. They need to link HPV infection with cancer instead of sending the message that HPV infection is a sexually transmitted disease. If you can link HPV to cancer, instead of sexual activity, that will go a long way toward dispelling any misunderstandings.
A. (Talley) There’s also some confusion around the timing of the vaccination, and the fact that in Alabama this vaccine is not required for school entry. [See the National Conference of State Legislatures list of state legislation and statutes on vaccine requirements.] We’re also hearing from physicians that parents don’t always know what HPV is and the fact that there’s a vaccine to prevent this virus from causing certain cancers.
Q. How do you help physicians change the conversation with parents about the HPV vaccine?
A. (Schmidt) We’re encouraging them to focus on facts and testimonials, and to call this a routine, rather than an optional, vaccine. And again, we try to drive home the message that this vaccine can prevent cancer.
Blue Cross and Blue Shield of Alabama is an independent licensee of the Blue Cross Blue Shield Association, an association of independent, locally operated Blue Cross and Blue Shield companies.