The National Adult Immunization Plan (NAIP) provides a comprehensive overview of the challenges to fully immunizing adults. To focus adult immunization efforts nationwide, the National Vaccine Program—in collaboration with diverse stakeholders—has developed the National Adult Immunization Plan: A Path to Implementation. This report, a supplement to the NAIP, presents implementation priorities and essential activities that advance those priorities. Each priority and suggested activity is designed to meet a specific NAIP goal and objective. Please email us to tell us how you are supporting the NAIP. Priority Area 1: Address technical, legal, administrative, and practical barriers to greater use of electronic health records (EHRs) and immunization information systems (IIS) to collect and track adult immunization data Hide/Show Priority Area 1 NAIP Goal 1: Strengthen the adult immunization infrastructure NAIP Objective 1.4: Increase the use of electronic health records (EHRs) and immunization information systems (IIS) to collect and track adult immunization data Suggested Priority Area 1 Activities: Federal government partners can work with EHR developers to include standardized Best Practice Alerts (based on the Advisory Committee on Immunization Practice recommendations) within their immunization modules as a standard component. Federal government partners can encourage providers and EHR systems that support adult vaccines to build functionality for accurate evaluation of vaccine history and forecast of vaccines due. These systems need to use relevant historical data and/or services from IIS to make these timely decisions. Guidance on these decisions is provided by the Clinical Decision Support for Immunization (CDSi) resources, which provide an implementation-neutral foundation for development and maintenance of clinical decision support engines.1 Federal government partners can work with other partners, such as the Association of State and Territorial Health Officials, the American Immunization Registry Association, and the Network for Public Health Law, to develop ways to address non-technical barriers to IIS data sharing across jurisdictional boundaries.i Federal government partners can explore technical and policy options to implement inter-jurisdictional exchange of immunization data, including exploring the effectiveness of the Public Health Immunization Cross-jurisdictional pilot project, which allows participating sites to exchange immunization data across jurisdictions.i Federal government partners can facilitate on-boarding of health care providers waiting in the IIS onboarding queue through novel strategies such as supporting centralized service centers. Federal government partners and research organizations can study the impact of requirements originally associated with the Medicare and Medicaid EHR Incentive Program on adult provider IIS use. ONC can design and launch a new pilot program in multiple states to test novel economic incentives to encourage providers to use existing EHR platforms or upgrade platforms to submit and accept immunization records to and from the state IIS. Federal government partners can support an IIS assessment process that independently measures and encourages alignment with interoperability standards, functionality standards such as de-duplication, and data quality. Federal government partners can continue ongoing pilot work to examine consumer access to IIS data, explore integration of IIS data with existing consumer portals, identify states in which laws and regulations do not allow patient access to IIS data, and develop tools and guidance for states interested in to reducing legal, operational, and resource barriers. Federal government partners and research organizations can assess the extent to which the use of EHRs and IIS impact patient safety. For example, stakeholders can examine the impact EHRs and IIS on the ability to identify vaccine recipients when a safety concern occurs and link these concerns with specific lots. Federal government partners and research organizations can assess how EHRs are incorporated in adult provider work flow in different settings including pharmacies, with special emphasis on usability and capture of needed data. Priority Area 2: Evaluate the impact of current adult vaccination quality measures and the feasibility of future quality measure development projects Hide/Show Priority Area 2 NAIP Goal 1: Strengthen the adult immunization infrastructure NAIP Objective 1.5: Evaluate and advance targeted quality improvement initiatives Suggested Priority 2 Activities: HHS can work with partners to compile a list of current federal and non-federal performance measures on adult immunization, removing redundant measures and harmonizing existing ones, with the goal of reducing the total number of adult measures in circulation.i Federal government partners can work with private sector partners to assess the feasibility of an adult vaccination composite measure, inclusive of multiple routinely recommended vaccinations. Federal government partners can categorize existing quality and performance measures into groups corresponding to each of the four adult immunization standards – assess, recommend, administer or refer, and document – so that progress can be tracked for each standard. Federal government partners can monitor developments with respect to new value-based payment models in the wider health care system and explore opportunities to ensure vaccination is represented in measurement efforts to improve quality. Federal government partners can support quality improvement initiatives that aim to reduce racial/ethnic disparities in vaccination rates. Priority Area 3: Evaluate the impact of financial barriers, such as co-pays, on adult vaccination uptake Hide/Show Priority Area 3 NAIP Goal 2: Improve access to adult vaccines NAIP Objective 2.1: Reduce financial barriers for individuals who receive recommended adult vaccines Suggested Priority 3 Activities: Federal government partners can monitor changes in grandfathered health plans (i.e., private plans not subject to Affordable Care Act requirements that eliminate patient cost sharing for recommended adult vaccines), the number of Americans covered under grandfathered plans, and variation across plans in coverage of adult vaccines. Federal government partners can examine and report variation across Medicare Part D plans in patient cost-sharing for ACIP-recommended vaccines. Federal government partners can track state Medicaid coverage of vaccines for adults, including which vaccines are covered, vaccine and vaccine administration payments to providers, and in-network provider requirements. Federal government partners can work with other partners to identify successful programs for identification and vaccination of uninsured adults and develop a toolkit to support implementation in additional jurisdictions. Priority Area 4: Research the total costs of providing vaccination services in a provider setting to improve understanding of costs associated with the range of activities that are needed to ensure efficient and effective immunization services (e.g., ordering, handling, storage, administration, patient recall/reminders, and counseling) Hide/Show Priority Area 4 NAIP Goal 2: Improve access to adult vaccines NAIP Objective 2.2: Assess and improve understanding of providers’ financial barriers to delivering vaccinations, including stocking and administering vaccines Suggested Priority 4 Activities: HHS can support health services research examining the factors affecting provider decisions to stock and administer adult vaccines. HHS can support studies to examine the costs to vaccinate by different provider types (e.g., OB/GYN, family practice) and in different regions of the United States. Using the data from the studies above, federal government partners can develop guidance on how providers can calculate their own time costs, given labor costs within their region. HHS can examine variance across Medicare Part D plan sponsors for vaccine payment. NAIIS partners can use medical claims data to support the development of a payer “report card” that rates payers on reimbursement for adult vaccines. HHS and NAIIS partners can develop and disseminate guidance on accessing the business case for adult vaccinations. Researchers can evaluate how the transition to value-based care across the healthcare system will impact adult immunization provisions, including ongoing questions about provider network adequacy. HHS can explore how medical claims data can be used to describe the frequency with which claims for adult immunizations are rejected, types of rejection, and reasons for rejection. Academic partners can explore how the decision to stock and administer adult vaccines and the role of cost considerations in that decision vary across entities such as integrated delivery networks vs. individual providers. Priority Area 5: Identify legal, practical, and policy barriers that may impede expansion of the adult immunization provider network, and communicate those challenges Hide/Show Priority Area 5 NAIP Goal 2: Improve access to adult vaccines NAIP Objective 2.3: Expand the adult immunization provider network Suggested Priority 5 Activities: National and state advocacy organizations and coalitions can consider legal and policy changes regarding the use of non-physician health care professionals to assess and administer vaccines. Provider and advocacy organizations can disseminate information to increase awareness of web-based systems that allow providers to submit electronic claims directly to Part D plans. HHS can support research on how to define and measure network adequacy with respect to immunization delivery with the goal of using this information to develop recommendations. NAIIS partners can develop additional tools for vaccination clinics (including temporary clinic settings looking to expand beyond influenza vaccination) to ensure appropriate vaccine handling, storage, and administration. Priority Area 6: Encourage all providers, including providers in complementary settings,2 to implement the NVAC Standards for Adult Immunization Practice, which includes assessing patients’ vaccination status at every clinical encounter, strongly recommending needed immunizations, and either administering vaccines (including documentation in an IIS) or referring patients to others who administer vaccinations Hide/Show Priority Area 6 NAIP Goal 3: Increase community demand for adult immunizations NAIP Objective 3.2: Educate and encourage health care providers to recommend and/or deliver adult vaccinations Suggested Priority 6 Activities: NAIIS partners can develop playbooks of best practices (including use of incentives) to encourage adoption and implementation of the standards for adult immunization practice. NAIIS partners can conduct national standing orders workshops across the country to help practices and medical systems implement and sustain standing orders. Federal and NAIIS partners can develop tools and guidance to support incorporation of the standards into practice work flow (e.g., referral to providers who offer vaccinations, how to deliver a strong recommendation). NAIIS partners can educate various stakeholder groups about the standards and their implementation through the use of stock presentations to minimize variation in messaging. Health professions schools (e.g., medical, dental, nursing, pharmacy) can ensure that students receive training on adult immunization, including the standards. Advocacy organizations can articulate how to incorporate the NVAC standards into laws or regulations. HHS can regularly monitor implementation of the standards and disseminate results to adult immunization stakeholders. HHS can promote the NVAC standards through their cooperative agreements with provider organizations as a vehicle to improve adult vaccination rates. Priority Area 7: Engage community leaders in reaching the public with information about the importance of adult vaccination Hide/Show Priority Area 7 NAIP Goal 3: Increase community demand for adult immunizations NAIP Objective 3.3: Educate and encourage other groups (e.g., community and faith-based groups, tribal organizations) to promote the importance of adult immunization Suggested Priority 7 Activities: All levels of government and community partners can expand and improve their use of social media to increase public awareness of adult vaccine recommendations. HHS can identify communities with the highest performance on adult vaccination measures and investigate the role of their communications strategies in helping to achieve high vaccination rates. Federal government partners can identify best practices for engaging special populations, including women, faith-based communities, and minorities, in improving immunization knowledge and attitudes. These best practices can be communicated and applied broadly through a national campaign, drawing upon resources such as Regional Minority Health Consultants within the HHS Office of Minority Health. State, and local government partners can identify community leaders outside the health care and public health systems (e.g., faith-based leaders, teachers/school administrators, adult day care center administrators, public library administrators, local recreation center administrators, and local business owners) to identify additional vulnerable populations who can benefit from vaccine education. HHS can engage community organizations in translating key adult immunization materials for non-English-speaking patients. HHS can review existing patient-facing apps for the management of various health conditions to assess inclusion of vaccine recommendations and conduct outreach to app developers who do not include vaccine-related content. Priority Area 8: Encourage ongoing efforts to develop and license new and improved adult vaccines, including support for research, development, and licensure of vaccines; improved effectiveness; and longer duration of immunity Hide/Show Priority Area 8 NAIP Goal 4: Foster innovation in adult vaccine development and vaccination-related technologies NAIP Objective 4.1: Develop new vaccines and improve the effectiveness of existing vaccines for adults Suggested Priority 8 Activities: HHS can collaborate with researchers and manufacturers to encourage and reduce barriers to the development of adult vaccines with small market potential (e.g., vaccines for emergency preparedness). NAIIS partners can produce materials to educate stakeholders on the cost, challenges, and barriers associated with bringing an adult vaccine to market. The National Institutes of Health (NIH) can provide pre-clinical research resources (e.g., pre-clinical testing and manufacturing services for vaccines, vaccine components including adjuvants, and vaccine delivery systems) to scientists in academia and manufacturers worldwide to advance translational research on vaccines against emerging and re-emerging infectious diseases affecting adults. NIH can continue to support clinical trials to investigate promising vaccine candidates for adults through the Vaccine and Treatment Evaluation Units (VTEUs) and other mechanisms. HHS can prioritize the development of vaccines that meet unmet medical needs (e.g., a universal influenza vaccine) and associated technologies and platforms for manufacturing. Federal government partners can facilitate open communication between manufacturers and the federal government to document the sources of uncertainty that manufacturers face, including unmet medical needs and potential target populations for new and existing vaccines for adults. Federal government partners can identify novel influenza strains with pandemic potential and identify priorities for vaccine seed strain development. To return to the page content, select the respective footnote number. 1 For additional information, please see: https://www.hhs.gov/sites/default/files/nvpo/national-adult-immunization-plan/naip-path-to-implementation.pdf 2 Complementary settings are defined as non-traditional settings for vaccination outside of physicians’ offices such as workplaces, schools, community health centers, and pharmacies.