Individuals who have difficulty leaving their home may have particular challenges receiving a vaccination at physician offices, clinics, or mass vaccination sites. In-home vaccinations are a valuable strategy to support individuals with physical disability, chronic illness, injury, conditions such as agoraphobia or severe anxiety, and those who may require the help of another person or medical equipment to leave their home. To address the logistical challenges and potential health risks for these members, some health plans that serve individuals dually enrolled in Medicare and Medicaid have begun offering in-home vaccinations.

During a recent session of the Resources for Integrated Care Integrated Care Community of Practice (ICCoP), Commonwealth Care Alliance (CCA), a Massachusetts-based health plan and clinical care provider, described their approach to home-based vaccination for dually eligible members.  See their press release for additional details on this program.

1. Use Trusted Providers When Possible. CCA notes that these members often have chronic conditions requiring regular care and are therefore accustomed to welcoming CCA providers into their home. They find members are more likely to agree to an at-home vaccination if a trusted CCA provider broaches the subject during a home visit and schedules the appointment. While it may not be possible for the trusted provider to deliver the vaccine, having this individual perform the initial outreach has been critical to CCA’s success.
2. Work with Community Partners. CCA contracts with community paramedics to provide off-hour services to their members, and has now enlisted these paramedics to deliver COVID-19 vaccinations in members’ homes. Even if members are not already familiar with the specific paramedic administering their vaccine, they are comfortable with the idea of allowing a paramedic into their home. Other plans in the ICCOP also report success working with community emergency medical technicians. In addition, CCA works closely with community partners such as local Area Agencies on Aging and meal delivery programs, who can alert them to members whose condition may have changed to the degree that they would now benefit from an in-home vaccination.
3. Use a Single-Dose Vaccine. CCA prefers to use a single-dose vaccine when they are providing in-home vaccinations for members who are less connected to the plan or who are less accustomed to having providers visit their home. The single dose eliminates the need for a return visit, thus simplifying the process for these members and the plan. This vaccine is also easier to transport than two-dose vaccines, since it requires only normal refrigeration. 
4. Anticipate and Try to Avoid No-Shows. Even members who have difficulty leaving the home can be no shows! On some occasions, a member has been hospitalized, at a medical appointment, or otherwise out of the house when the nurse or paramedic with the vaccine arrived. To avoid this problem, CCA reminds the member of the upcoming appointment by telephone or email and maintains open communication with the member before the appointment. CCA will also engage family members or caregivers, if appropriate, to confirm the member will be home at the scheduled time. CCA will also have a contingency plan for using the vaccine, such as locating another member or staff person to receive the vaccine, should a member not be at home or not answer the door.
5. Schedule Strategically. CCA schedules their home vaccination appointments in the same geographic area to more easily keep the vaccine at the required temperature. Another health plan participating in the ICCOP noted that for their initial home vaccination effort, they took care to schedule appointments in multiples of five or six to mirror the number of doses in the vial and avoid wasting vaccine. Finally, in-home vaccination appointments need to allow for the 15 to 30-minute wait following vaccine administration to observe for potential adverse reactions.

Resources for Integrated Care invites you to share your own promising practices related to vaccinating members at home through our survey. We may share your submissions in upcoming technical assistance including future blog posts.