Diversity, Equity and Inclusion

Addressing COVID-19 Vaccine Equity

New partnership provides a roadmap for targeting disparities

By Lucas Nesse, JD

An example of this coordinated response is the recent public-private partnership between the State of Minnesota, Minnesota’s nonprofit health plans and county-based health plans to improve vaccine equity rates among disadvantaged communities. Recognizing that there were significant differences in the rate of vaccinations, these groups, including the Minnesota Department of Health (MDH) and the Department of Human Services (DHS), came together last year to form a unique and successful strategy to address vaccine equity. While MDH houses data on immunization and ZIP codes with the biggest structural inequity and vaccine disparities, health plans have the staff and expertise to reach members and connect them with lifesaving vaccines.

With a shared goal of driving increased COVID vaccination rates among those who live in areas with a high social vulnerability index (SVI), this Vaccine Equity Partnership focused on those individuals. The effort included a number of actions that will serve as a vital blueprint for advancing health equity in our state moving forward, including consistent fact-based messaging, robust outreach, and most important – listening to the needs of the community while answering their questions.

Consistency in messaging would be a crucial goal in outreach.

SVI and how it targets health disparities

The Centers for Disease Control and Prevention’s (CDC) social vulnerability index uses 15 indicators grouped into four themes that comprise an overall SVI measure. High SVI communities generally have higher rates of poverty, insufficient housing, racial/ethnic minorities, and lack access to transportation when compared to low SVI communities. SVI has been traditionally used by the state and others to determine where to best allocate resources to help those most in need.

Sharing SVI information with health plans allowed for a number of advantages, including focused outreach and aligned messaging to highly disadvantaged communities throughout the state. SVI was selected as a vaccine equity metric, in part, to help prioritize Black, Indigenous and other communities of color (BIPOC) disproportionately impacted by COVID-19 get vaccinated. More broadly, Medicaid members were also noted to be experiencing vaccination disparities and so were prioritized early, as well.

Using SVI, MDH ranked the ZIP codes and divided them into quartiles based on their SVI score. Through this methodology, MDH discovered that although Minnesotans living in high SVI ZIP codes represented 29% of Minnesota’s population, in May of 2021 they represented 32% of Minnesota’s COVID-19 cases, 39% of hospitalizations and 38% of deaths. Health plans participating in the vaccine equity partnership – including Blue Cross and Blue Shield of Minnesota, HealthPartners, Hennepin Health, Medica and UCare – were able to use this key SVI data from MDH to be focused in their outreach.

Methods of engagement

Early on, it was determined that consistency in messaging would be a crucial goal in outreach related to the partnership. This alignment is paramount in building trust with BIPOC populations given historical trauma related to the health care system, as well as misinformation found within all communities. Members would hear a consistent message about COVID vaccines across the board. Health plans would also help their family members get vaccinated, regardless of a family member’s health plan – something our partners called a “no wrong door approach”. 

Health plans used MDH/DHS-approved messaging about vaccine safety and efficacy, as well as FAQs to provide to their members. DHS also created a rapid approval process by which plans could create more specific messages for their members through a multitude of formats, including phone calls, text messaging, postcards, billboards, emails and other forms of outreach.

During phone outreach, health plan staffers directly scheduled COVID vaccination appointments, answered questions related to the vaccine, assessed the need for additional services – like transportation or interpreters – and coordinated further care as needed. MDH and DHS also met with health plans regularly to discuss successes and challenges related to their outreach, and ways to pivot if necessary.



Additionally, MDH provided plans with a list of local independent pharmacies and community-based organizations that the state had relationships with to better reach focus communities. This allowed health plans to make decisions on where to host vaccination clinics, expand community connections, seek collaboration and target outreach to unvaccinated members in economically disadvantaged areas and at increased risk for severe COVID disease.

Health disparities remain pronounced for Minnesota.

Partnership results and lessons learned

During the first four months of the partnership (Phase 1), more than 640,000 outreach attempts were made to reach members living in the highest-risk SVI ZIP codes, driving a 55% increase in the number of members living in high SVI ZIP codes who received at least one dose of the vaccine. Health plans were successful in decreasing barriers to vaccine access through scheduling transportation and interpreter services for members, promoting a variety of ways to receive the vaccine (such as mobile vaccination sites and drive-through clinics) and dispelling vaccine misinformation with the help of trusted leaders in the community.



These relationships proved to be vital in encouraging BIPOC communities to receive the COVID vaccine. By engaging trusted leaders, such as community health workers, who understand the issues and can communicate to their community in their own languages and their own cultural context, the partnership was able to reduce barriers. We learned that creating shared narratives, addressing misinformation and acknowledging past trauma experienced by people of color in the health care system are best done within a community setting and with buy-in from community leaders.

The partnership also bolstered trust between health plans and a variety of other groups, such as community-based organizations, as well as state and local public health agencies. This trust grew through sharing information and mutual problem solving to collectively accomplish the goal of vaccinating Minnesotans. Half of the participating health plans reported that they developed a new relationship with at least one community organization and three of them indicated that they developed a new relationship with at least one local public health agency and at least one other health plan.

Setting a pathway for solving health disparities

Minnesota health plans will continue working together on unified, statewide messaging on COVID-19 vaccines, especially as more children become eligible to get vaccinated for the disease. Most recently, health plans and the state came together on N95 and KN95 mask distribution efforts amid the Omicron surge earlier this year – another example of how we pooled our collective resources to protect our most vulnerable through this partnership.

But as we look ahead – and beyond this pandemic – health disparities remain pronounced for Minnesota. Diabetes, asthma, mental illness, as well as maternal and infant mortality, are all health issues in which deep inequities persist and will continue to widen if left unaddressed. However, through stakeholder partnerships like the one we formed to improve equity in COVID vaccination, we know it is possible to improve methods that reduce other health issues. There is also opportunity to use this partnership to address the social drivers of health – necessities such as food, housing, education and transportation – to bring about better health outcomes overall for under-resourced communities in our state.

One of the most important lessons we learned from the partnership was the value in aligning communication and resources. This approach worked well for the state and Minnesota health plans – and can create a roadmap for all parts of the health care ecosystem to work together, including providers and others on the front lines of care delivery. As we develop pathways to address health disparities more quickly, we must also expand the ways in which we engage. Sometimes that will mean working with a competitor, a regulator, an unfamiliar stakeholder, or a group that is on the opposing side of the industry. It won’t always feel comfortable or natural. Health plans set aside competitive interests to work with each other – along with state regulators – to get shots in arms and prevent more unnecessary deaths from COVID. This steadfast commitment to serve the best interests of Minnesotans over all else just goes to show that we can get so much more accomplished by working together. So, let’s continue to find that common ground to drastically reduce health disparities in our state.

For more information on the Vaccine Equity Partnership and participating health plans visit: https://www.health.state.mn.us/diseases/coronavirus/vaccine/mnsvivaxsum.pdf

Lucas Nesse, JD is CEO of the Minnesota Council of Health Plans.