Immunization Nation: “We’ve built a complex, well-oiled vaccination system,” says head of operations for Israeli HMO Maccabi

By Einat Paz-Frankel, Start-Up Nation Central

Israel vaccinated approximately half of its entire population against COVID-19 within two months. This remarkable achievement was made possible thanks to the nation’s four Health Maintenance Organizations (HMOs), which serve its entire population and can successfully launch complex, large-scale processes within a short timeframe, as evident in Israel’s leading position among the nations that are quickly vaccinating their populations against coronavirus.

The Israeli HMOs — which both insure their members and provide them with healthcare services — developed uniform (single ID) Electronic Medical Records (EMRs) that enable real-time segmentation according to gender, age, place of residence and medical background, which help to effectively prioritize vaccination, treatment, and follow-up. Some of this information is sent to the Ministry of Health’s smart control center, which anonymize the data and sends it to vaccine manufactures and the World Health Organization, thus helping to form a worldwide immunization strategy.

According to Maccabi, one of the four HMOs operating the nationwide vaccine drive, only 0.06% of recipients of the second COVID-19 vaccine dose contracted the virus seven days post-vaccination, which is a very encouraging result. Thanks to Maccabi’s rapid vaccine drive – having given two doses to nearly 1 million of its members since late December 2020 – dozens of healthcare organizations from around the world have contacted Maccabi to learn how to achieve similar success – and scale – including organizations from hard-hit countries such as the U.S., Italy, Brazil, Britain and the UAE.

We sat down with Sigal Dadon Levy – Head of Operations at Israel’s Maccabi Healthcare Services, who also serves as its Director of COVID-19 Vaccination Operation – to learn about the innovations behind the most ambitious vaccine campaign the country has rolled out.

Question: How many people can Maccabi vaccinate every day?

Answer: Maccabi vaccinates roughly 60,000 of its members every day. We’ve built a well-oiled vaccination system with thousands of people working in this very complex operation with incredible precision; there are specific complexities that characterize these vaccines, their storage conditions, transport, first dose, second dose, prioritization of populations, etc. All of these must be managed very meticulously, considering that from the minute we get the vaccines out of the special refrigerators, we have only a few days to administer them.

Q: How do you make sure every age group that needs to get the shots indeed gets them?

A: As soon as we define an age group as eligible, they can schedule appointments independently on our mobile app, website, or call the Maccabi hotline. We get multiple reports from these digital systems every day about the percentage of people who were vaccinated, etc.

In two weeks, we built a dashboard that would have otherwise taken months to launch, which includes all relevant data: At any given time, we can tell how many of the 60+ people, the main risk group, have been vaccinated in every community in Israel, we know how many were vaccinated at the national level, how many received the first dose, the second dose, the same for people who are housebound, who are immunocompromised, oncology patients, chronically ill, pregnant women, young people, and we can see in every population how many have been vaccinated, and even within communities we know where to increase our efforts.

Essentially, we built a patient journey that sends a text message with a notification of eligibility for vaccination, which allows the patient to schedule an appointment easily through a designated link.

Q: Why is it important?

A: It’s important to give the second dose on time (21-28 days after the first dose) and complete the vaccination process. The Ministry of Health was concerned about low response rates, and 10%-15% no-shows. At Maccabi, we have less than 1% no-shows.

From the moment a person is ready for the second dose, they get a reminder four, and two days before. If on the scheduled day and time they weren’t vaccinated, two hours later we send another message and then we call: Are they quarantined? Did they get sick and couldn’t make it? Data is crucial to this operation.

“HMOs are managing and treating 97% of COVID-19 patients”

Q: How do you cope with simultaneously vaccinating your members and treating many of them for coronavirus?

A: It’s very challenging; alongside the satisfaction and pride of the amazing work we’re doing vaccinating as many people as possible, there is great concern about the high rate of infection and morbidity, the number of patients in critical condition, etc. One needs to understand that we’re managing this campaign alongside a great number of COVID-19 cases – the HMOs are managing and treating 97% of COVID-19 patients through home hospitalization. Hospitals are also burdened as they’re treating patients in critical condition, but still, the majority of COVID-19 patients are treated by HMOs, and for that we also need doctors and nurses available 24/7, so we’re leading two coronavirus efforts: fighting the disease and vaccinating the entire population.

I’d say this is our biggest challenge yet. Still, I am very optimistic because I believe the rate of vaccination in Israel is very good, and we are already seeing wonderful, encouraging results among those vaccinated in terms of very low infection rates.

Q: What other major challenges are you facing, in addition to simultaneous, large-scale treatment and prevention efforts?

A: Manpower for the immunization operation is among our biggest challenges. We recruited nurses through HR agencies, and paramedics from within the army and military reserve. Overall, we hired more than 1,500 people (including medical and administrative workers, ushers, and security people), in addition to our permanent employees, to make this operation possible.

Nurses use a dedicated mobile app we developed to document vaccinations, and send the data to the patient’s medical record. There’s no need for a computer, as we operate this campaign out of many locations, including concert halls, sports stadiums and parking lots. The cost for Maccabi is expected to reach tens of millions of dollars over six months (excluding the cost of the vaccines themselves). Think how much it will cost on a national level.

Q: What’s behind the success of this operation?

A: First, management and then, automation and the digital tools that we use: the infrastructure of the EMRs, automation, patient journeys, digitization, online systems, etc. Maccabi’s starting point is excellent, as more than 85% of our members use our online services. That doesn’t exist in other places in the world.

Q: What tips would you give other countries and organizations?

A: Implement an Interactive Voice Response (IVR) system, an automated system that interacts with callers, gathers information and routes calls to the appropriate recipients. It’s incredibly cost effective. Telephone systems can crash due to high demand; it happened to us before we deployed IVR to the vaccine drive — the telephone systems simply couldn’t keep up with the demand.

In addition, we save time and efforts with digital processes, whereas other countries have to make up for it with manpower that must pick up the phone and call people to come get vaccinated. We’ve scheduled hundreds of thousands of appointments with our IVR system and our automated SMS campaign. The patients get a call or a text message saying they’re eligible for the vaccine, and after they confirm, they’re sent an appointment via a text message. If you want to change it, you can do that online. With that kind of a “push,” we filled up appointments in no time, within two days of getting the vaccines, our calendar was full.

Q: At the end of the day, when you go to sleep, what fills you with pride?

A: I don’t get much sleep; I work 17 hours a day and sleep about 4 hours at night as I think a lot about what we can do even better. What fills me with pride? Mostly the extraordinary commitment and mobilization of the entire management and employees of this organization, who work 24/7 with a spark in their eyes and a sense of mission, and that’s something that creates a great deal of pride.

Explainer video: Linor Grisariu, Start-Up Nation Central
Photos: Sam Itzhakov, Maccabi Healthcare Services

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