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Transcription:

Matt: Hello, and welcome to another episode in the Avalere Health Essential Voice series focused on COVID-19. My name is Matt Kazan, and I’m a Principal on the Policy team here at Avalere. I’m joined today by Richard Ashworth, President and CEO of Tivity Health.

Today’s episode will focus on the impact of COVID-19 on seniors’ health and wellbeing. Richard, thank you for joining us today.

Richard: Thank you for having me.

Matt: Let’s dive right in. Could you tell our listeners about Tivity Health and how you all have adapted your mission during the COVID-19 pandemic?

Richard: Yeah, I’d love to. Tivity Health is focused on helping individuals improve and optimize their health without clinical intervention. We’re focused on health and wellness through things like physical activity, proper nutrition, social engagement, and mental enrichment. Our goal is to be the modern destination for healthy living with a digital platform that offers seniors a whole range of solutions. In fact, our SilverSneakers flagship product provides fitness options through Medicare Advantage and Medicare supplement plans to almost 18 million seniors nationwide.

We really know our members. We’re an advocate for them. So, when the pandemic came along, it was a big opportunity for us. Since our top priority is their health and safety, we quickly pivoted and began offering virtual fitness classes. When stay-at-home protocols first shut down our fitness locations, we were not offering any virtual classes, and now, we’ve got more than 3,000 live instructor-led virtual classes offered every week. We’ve had over 2 million visits or classes conducted with our instructors, all while physical distancing. I think it’s a fantastic example of a strong pivot.

It’s critical for seniors to stay physically active because it helps them improve their balance, flexibility, and helps prevent falls. There is a ton of positive data around maintaining physical activity. We don’t want anyone to stop their healthy behaviors, whether that’s eating good food, getting a good workout in, talking with family, or engaging with friends, while remaining protected from COVID-19.

Matt: That’s great. It sounds like there have been several changes over the last 12 months.

Let’s dig into our topic today. Avalere recently partnered with your team at Tivity to release the results of a November 2020 survey related to COVID-19 vaccines. What was your impetus for fielding the survey to your SilverSneakers membership?

Richard: It was born out of our desire to be helpful. We know that our members’ lives were significantly disrupted, just like yours and mine. We wanted to know more about how we could help them.

We’re also aware that our members really trust our SilverSneakers brand. We began distributing Pulse surveys last April, and we knew that the information we could get is reliable. We know that it’s timely, of course, because we’re talking about the COVID-19 vaccine.

Through that first launch of the survey, we saw the enthusiasm that our members had not only in our digital assets and our new offerings, but also in just answering questions and giving us good, deep insights. Thousands of them shared their experiences.

As the name implies, it’s a pulse survey. We go to our older adults and members during this really challenging time and ask them some questions. We ask them about physical activity, about social connection, technology, buying habits, nutrition—all the things that have changed.

The partnership that we had with Avalere to put this together gave us really telling insights that can help us as a country, as policymakers, as healthcare providers, and as family members to support this population.

Matt: It’s fantastic that you have an audience so willing to share their thoughts as the pandemic unfolds.

As I mentioned, most of the survey was about COVID, but before we dive into the specific vaccine piece, talk about what you learned related to seniors’ day-to-day lives and how the pandemic really changed that.

Richard: Yeah, great question. A lot of what we’re seeing in the information we received is an exacerbation of problems that existed before the pandemic. Our findings are pretty broad. The impact on seniors has been significant, but the impact on all of us has been significant. For older people that have pre-existing conditions, it’s been a real struggle.

Overall, though, what we learned is that the pandemic has really threatened their health status even if they don’t get COVID-19 because of the impact of social isolation, loneliness, and not having access to the same nutrition or the ability to be physically active.

In the survey, about 30% said their eating habits had deteriorated during the pandemic, and 43% said they had avoided routine medical or dental appointments. One of my biggest concerns is that 2 out of 3 seniors reported they felt socially isolated in the last week. We know that the lack of physical connection has a direct link to poor health, so we have to find ways to help seniors stay connected to friends. We talk a lot about social distancing, but what we’re really talking about is physical distancing. How do we help with that?

There’s good news here, too, though. Many people assume that our seniors aren’t very tech savvy. That’s really not true. The majority reported using technology to connect with their friends and family. Nearly half of them had used technology to have a doctor’s appointment or a meeting, and 40% had engaged in some virtual fitness. This tells me that this population is able to connect digitally through this pandemic, and we need to break through some of these misconceptions that seniors can’t use technology because in situations like this pandemic, the digital or online vehicle is a really important one.

Matt: Yeah, there’s no question that one of the many consequences of the pandemic will be the continued and maybe increased use of digital health once we get past the immediate public health emergency.

Let’s focus on the vaccine itself because I know this was a big focus of this survey. What would you highlight as some of the key takeaways that you learned in these responses related to seniors’ preferences for the vaccines?

Richard: The good news here is that vaccine confidence is on the rise. More than 75% of our seniors said they’re willing to take the vaccine “immediately,” as in, right now. When we did this last November, that was only at 47%. I think that’s really positive news. The “however” to that is that 26% believe they will have quick and easy access to the vaccine, which means two-thirds believe that they won’t, so there’s work to be done on awareness around convenience.

One of the big barriers we saw last fall was around price. We saw improvement in that one. That was one of the big misconceptions around the vaccine and we knew that education was needed. We had been very vocal about consistency of communication and transparency of information.

In November, 62% thought they’d have to pay for the vaccine. That was a major barrier for them and one of the reasons they were not going to get the vaccine. In the most recent Pulse survey, that number was down to 31%. I think that’s really good progress, but still, almost 1 in 3 seniors believe there’s going to be some financial impact to them, and we know that’s a barrier.

The other big barrier that we saw was around side effects, which is natural. That’s the number 1 reason why there is hesitancy in getting the vaccine. This number is significantly less now than what we saw in November. At that time, 50% of respondents said they were less likely to get the vaccine if there were major side effects, compared to only 20% now. So, this tells me that the sources they go to for information are confirming for them that the side effect profile of the vaccine is low.

I’m a pharmacist by training and spent a long time at Walgreens. I know pharmacies are becoming a big distribution point for the vaccine and I think it’s really positive when your pharmacist or physician, government agencies, and your family are all telling you, “Hey, this is pretty safe.” That’s really moved that number along. They trust the CDC, their typical healthcare providers, their doctor, their pharmacist, and even their health plan. They’re looking to these trusted places to get guidance and information, and the consistency and validity of the information coming from those sources helps them make good, informed decisions.

Matt: It’s good to hear that the numbers are trending in the right direction, though we have a little way to go on some of those key measures.

Richard, knowing what you know now about the results of this survey, how has that shaped your view of the ongoing vaccine rollout process today?

Richard: I think there have been positives and negatives and we’ve seen steady improvement, so overall, I’m bullish on it. As a country, as a healthcare system, I think we’ve made some good progress. I just don’t want us to get complacent on this. We’ve seen a steady increase in the available sites for seniors to get the vaccine. That is a big positive. They told us in the survey that they prefer to get the vaccine at their doctor’s office, their pharmacy, or local clinic—convenient, familiar places. I think this is really important. I’m not saying we shouldn’t do the “vaccine days” down at the arenas or in hospitals, but I think we should have local and familiar choices for them. That was really clear in the survey.

As you know, there’s also good news about the vaccine and its availability. The J&J emergency use authorization was a big example of that. The agreement between them and Merck is an incredible collaboration that will progress us even faster through these phases of distribution, but there are still some misconceptions. Only 26% believe that the vaccine will be available to them within a month, so that means 3 out of 4 may not even be trying to find the vaccine at this point. I think that’s a challenge, and one that we have to be clearer about.

The rollout process has been mixed. They told us the vaccine came out in record time, and we should be thankful for that, but we have to put that same spirit of innovation and scientific breakthrough into the commitment around process, distribution, and removing barriers. Asking people to go onto a website at a certain time and trying to schedule appointments is a natural barrier for this population and something we need to look at as a country and as a system.

Matt: So, as we wrap up, based on the results of the survey and some of the other things that you’re seeing, what guidance would you offer for future communications and outreach to seniors around the vaccine specifically, and the pandemic generally?

Richard: I’d point people to the joint whitepaper we did, Accelerating Recovery – An Analysis of Senior Preferences to Guide COVID-19 Vaccine Planning. We identified 4 focus areas to increase confidence in vaccine adoption. These are the ones that will help the recovery go faster and more efficiently:

First is consumer education. We’ve got to be proactive and transparent in providing information about side effects, access, and efficacy. This is not the time to withhold information. Be direct and straightforward about what we’re seeing. I also think that the news is positive, which is also helpful.

The second focus area is around financial responsibility. With 30% of folks still believing they are going to have some financial hardship as a result, we need to be sure seniors understand that the vaccine is available and it’s no cost to them. That’s something that we as a community can do better, and it’s probably one of the easier areas.

The third one is around convenience. Let’s keep expanding distribution points, where people can get the vaccine, and focus on those that are familiar and trusted. We’ve seen clinics popping up at churches in some communities. That’s the kind of grassroots activity that I think we need and it’s really powerful, especially when we get into different demographics and backgrounds. Some areas operate much better locally than they do at a broader level.

And the fourth one is around data. We need to keep tracking distribution so that we can target areas that are adopting at a lower rate or populations that have more hesitancy. That way, we can make sure that we’re putting the right focus and energy and money in the right spots so we can all get toward that herd immunity.

The impact on low-income, minority, and rural communities is pretty profound. There were unique and serious impacts in those populations pre-COVID, and COVID has exacerbated them. As we move toward recovery, it’s important that we recognize that and put very specific efforts against it. These populations are traditionally underrepresented in healthcare. This is proving to also be true in vaccine adoption and vaccine availability. These individuals are often at higher risk for severe cases, so it’s imperative that we figure that out.

Among the minorities that we surveyed, vaccine uptake has been similar. However, minorities did have more difficulty getting reliable transportation and their wait times at the vaccination sites were longer. Seniors in small towns and rural areas are more skeptical about the vaccine in terms of its safety and efficacy compared to those that are in urban and metro areas, so that will also result in lower uptake.

I think tapping into community sources to increase education and awareness and solve some of those needs like transportation is really important. Minority populations, for example, were more likely to seek guidance from faith-based organizations than some of their white counterparts. In my hometown of Chicago, on the South Side, aldermen carry significant influence, as does the church community. Getting them activated to help ease some of the fears and provide education is really important. The more local we can get, I think, the better it will be. That’s how we can improve trust and accelerate vaccine adoption.

Matt: That’s great. And as someone whose family came from the South Side of Chicago, I can confirm that last point.

Richard, this has been absolutely fascinating. Thank you so much for joining us today and thank you all for tuning in to Avalere Health Essential Voice. Please stay tuned for more episodes in our COVID-19 series. For more information about Tivity Health, please visit www.TivityHealth.com, and if you’d like to learn more about Avalere, please visit our website at www.Avalere.com. Thank you so much.