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How one Managed Medicaid health plan found the best path forward using analytics.

When it comes to COVID and vaccinations, there is a vast sea of opinions on how to increase adoption. Scientists, politicians, clinicians, and the expansive social media universe (I never knew how many of my social media friends were epidemiologists until this pandemic) all seem to have a voice on the way they would do it. Everyone talks about using data to drive their opinions on this very important topic but, in many cases, that’s just not true. Often, people rely on personal experiences and biases as they assert the best way to increase vaccination rates in this pandemic era.

At Softheon Technologies, I and my team help health plans use a vast array of data to remove “best guess” and “hunch-centric” decision making with analytics-driven decisions on their next best moves. We did one such study on COVID and vaccination rates with a health plan in the Southeast. I want to share this experience in the hope that you, as part of your health plan or other organization, you take the initiative to continue to really embrace a data-driven approach on how to best vaccinate and protect your population.


Guiding and supporting a member population through the COVID pandemic is fraught with challenges. For one Managed Medicaid health plan in a Southern state, several factors hindered a genuine desire to help their population navigate this very real health crisis. This health plan wanted to create an outreach strategy to drive increased vaccinations across its member population. However, finding the best path forward was difficult as COVID vaccinations were free and rarely made it into their claims data. Also, their state did not push vaccination data to health plans in the state. This meant the health plan had no real way of knowing who had and had not been vaccinated.

This health plan decided to act. It partnered with a technology vendor* with deep healthcare analytics experience and initiated a proactive effort to extract all available state vaccination data and match it with available claims and other member data. Next, the health plan secured Social Determinants of Health (SDoH) data for its members. This data was aggregated, cleansed, and processed to create an accurate and enhanced dataset. The analysis revealed some powerful insights and prompted some targeted outreach strategies.


The data revealed that overall vaccination rates in the health plan’s state were very low compared to the rest of the United States as well as the desired plan expectation of vaccine rates for their members. As of June 2021:

  1. 80% of members had not been vaccinated
  2. 14% of those vaccinated had not received a second shot

The data also showed that the following segments of the population were more likely to be vaccinated. Insights included:

  1. The rate of dual-eligible members vaccinated was around 30% higher than non-dual-eligible members
  2. Older members were more likely to be vaccinated
  3. In the 30-60 age group, females were more likely to be vaccinated than males

Further, some interesting social factors were discovered, and some vulnerable population assumptions dispelled. the health plan found that:

  1. Contrary what they believed would be true, members living with the highest social vulnerability index had the highest vaccination rates. This was a surprise to the organization.
  2. Vaccination rates for Black members did not depend on residence type (metro/rural) but that was a significant factor for Hispanic/Latino and White populations (i.e., the more rural the zip code, the less likely they were to be vaccinated).

Finally, members who had at least one ER visit in the last 12 months had an 8% (female) and 5% (male) higher chance of vaccination.


Insights without action have limited value. It’s the next best steps, the path informed path forward, that move you to a future, better state. In this case the intervention plans included:

  1. Promote use of the Johnson & Johnson vaccine to increase the fully vaccinated population
  2. Target vaccination efforts toward the dual-eligible population
  3. Leverage alternative outreach strategies such as bus tours, increased provider engagement, and trusted community advocates to increase vaccination rates in rural communities
  4. Rely on trusted community advocates to reach those who rated the lowest in social vulnerability
  5. Aggressively expand vaccine promotions within the ER care setting


As a nation, COVID vaccination rates are still too low. Medicaid populations are lagging in this arena. Data-driven strategies are a crucial component in the effort to develop outreach strategies and improve vaccination rates. This is only possible when you can aggregate previously disparate data into a single source of truth and apply the right advanced analytics to point you in the right direction. There is a path forward—one that promises better outreach, better interventions, and better results.

That, my friends and colleagues, is great news.

Peter Everett, is the CEO of Softheon Technologies

*The case study presented in this blog was part of work done with Softheon Technologies (Softheon) and one of its many partners. Softheon provided the software and expertise to derive the results presented.