Why Rhode Island leads on adolescent vaccination rates

Published March 1, 2018

Tiny Rhode Island is a powerhouse when it comes to vaccination coverage. A recent Blue Cross Blue Shield Health of America report, which analyzes claims data from the largest set of commercially-insured adolescents in the nation, finds that vaccination coverage rates for this age group (10 – 18) have climbed since 2013. But a closer look reveals rates for vaccinations like the Tdap booster, which protects against tetanus, diphtheria and pertussis, a vaccine to protect against meningitis, and the cancer-preventing HPV vaccine vary widely across the country. And on every measure, Rhode Island comes out on top. Blue Cross & Blue Shield of Rhode Island’s Vice President of Clinical Affairs Dr. Katherine Dallow sheds some light on how the Ocean State approaches adolescent vaccinations.

What’s happening in Rhode Island to make vaccination coverage rates for adolescents so much higher than in other states?
We benefit from a statewide vaccination program begun by the Rhode Island Department of Health more than 25 years ago. The program eliminates barriers to getting vaccinations, provides vaccines for free to all Rhode Island children and tracks vaccination rates through a robust registry.

Insurers like Blue Cross & Blue Shield of Rhode Island (BCBSRI) contribute to the state’s vaccination fund every year. The department of health then buys all of the vaccinations needed for the state’s children from the Centers for Disease Control and Prevention at a fraction of the normal cost. In this way, vaccines are free to providers and patients, including all of our members.
In addition, because the state supplies every medical practice with the amount of vaccine it needs, there’s a constant check and balance on expiration dates. Practices don’t run out or have too much expired vaccine on hand. And they can be quickly resupplied. 

How do you track vaccine coverage and measure success?
BCBSRI tracks vaccination coverage as part of its commitment to quality healthcare.  We also send out vaccination reminder cards to families with children every year, based on the child’s age. We also try to get the message out that well child visits, when vaccines are often given, are critical.

We have arrangements with several physician groups in which we pay them for their performance – for quality care versus the quantity of care. We used to reward these physicians for vaccination achievement thresholds, but pediatric practices throughout Rhode Island are doing such a good job on this measure we took it off the incentive list!

What kinds of vaccines do adolescents need?
Adolescents need some booster shots to extend the effectiveness of vaccinations they received when they were younger. Sometimes they need to catch up on vaccines they missed as a younger child. There are also the vaccinations recommended specifically for adolescents. Those include the HPV vaccine to prevent certain cancers, the meningococcal vaccine to protect against meningitis and the flu vaccine. 

In Rhode Island, the HPV vaccine (the first in a series recommended by the CDC) has been mandated for all 7th graders since 2015. That has led to a huge uptick in coverage for this vaccine.

Adolescents tend to see their primary care doctors less often than younger children, which may cause them to miss recommended vaccinations. How can you counter that trend?
Adolescents are unique patients. It’s true that their parents may not be bringing them to the doctor as often as they did when they were younger.  It’s still recommended that kids up to the age of 18 have an annual well visit. But between the ages of 12 and 18 we see a bit of a drop off in those visits. We’re working with state officials and provider partners to find ways to keep this age group engaged in primary care. Specifically, we’ve developed pediatric (including adolescent)-centered medical homes to keep the focus on these critical milestones.