Payers and public health: A new collaboration to support COVID-19 vaccination uptake

Authors: Ana Isabel Gallego, MPH | Hang Pham-Singer, PharmD | Zachary Withers, JD | Sami Jarrah, MPH | Michelle E. Morse, MD, MPH | Dave Chokshi, MD, MSc

Editor’s note: Manatt worked closely with the New York City (NYC) Department of Health and Mental Hygiene, as well as payers and providers, in an innovative collaboration to promote vaccine uptake. The percentage of New Yorkers with at least one dose of the COVID-19 vaccine increased from 71% to 82% over the course of the program. Manatt’s role in this critical effort included helping NYC organize and launch a learning collaboration with Medicaid and Medicare Advantage health plans. The learning collaboration provided a catalyst for NYC to foster closer relationships with health plans and collaborate on pandemic response and related public health activities. Manatt also advised NYC and affiliates on key strategies related to pandemic response, including consumer outreach and engagement strategies around COVID-19 testing and vaccination. As part of this work, Manatt supported NYC in developing and implementing a vaccine incentive program for health plans to drive further engagement with consumers to get vaccinated.

This unique initiative was highlighted in a recent case study published in the July issue of NEJM catalyzes innovations in care delivery. A summary and key recommendations are below. Click here to read the full article.


The New York City (NYC) Department of Health and Mental Hygiene, as a local health department, partnered with health plans to pay for provider-initiated outreach for COVID-19 vaccine counseling to unvaccinated people through a program of called the Vaccine Exposure and Counseling Program (VOCP). The collective effort and use of contingency contracting—with a budget of $35 million in funding from the NYC government—allowed a period of six weeks from idea to execution. Seven insurance companies covering more than 90% of the NYC Medicaid market and a significant portion of the NYC Medicare Advantage market (insurance products that have a disproportionately large representation of people of color in NYC) administered the program as a contribution in nature for effort.

Providers implementing the VOCP reported that they felt counseling efforts were valuable in increasing vaccination uptake, but also described operational challenges. Shortly after VOCP began, the federal government contacted the health department to learn more about the program. Two months later, the US Centers for Medicare & Medicaid Services authorized state Medicaid programs to cover such counseling. The New York State Medicaid program subsequently adopted a reimbursement policy with similar guidelines for counseling addressing some of the operational challenges of the VOCP model.

Main Agreement

  • The VOCP demonstrates how a local health department (LHD) can act quickly and in a synergistic manner with state and federal government agencies.
  • The VOCP also shows that LHDs and payers can quickly resolve issues together, even when the LHD does not regulate the payer.
  • Each individual in managed care is assigned to a health care provider, theoretically making it possible to quickly contact more than 3 million NYC residents to counsel them with critical public health information. However, this does not happen in practice. The VOCP is a first attempt to enable proactive paid access to certain patients for public health purposes.
  • An additional success of VOCP is how innovation can catalyze long-term changes in population health management infrastructure and provider behavior. In particular, VOCP helped accelerate the implementation of payment for COVID-19 vaccine counseling at the local, state, and federal levels.
  • In emergencies, speed matters for public health. VOCP was a program for individuals who remained unvaccinated despite numerous efforts to increase access to the vaccine. Any additional vaccination in this group represented a marginal benefit. A retrospective evaluation using health plan claims data and immunization registry compliance is planned to assess the impact of the program in the future.

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