"It really is HPV that's pulling us down": Findings from a health plan quality improvement learning collaborative...

The human papillomavirus (HPV) vaccine could prevent 37,000 HPV-related cancers annually in the U.S. yet uptake is suboptimal. Health plans cover 95% of children, implement quality improvement (QI) interventions, and report the Healthcare Effectiveness Data and Information Set (HEDIS®) Immunizations for Adolescents (IMA) measure. The American Cancer Society (ACS) convened payors in the ACS HPV Vaccination Learning Collaborative from 2022 to 2024 in three 12-month cohorts. Participants set QI targets, implemented interventions, and joined best-practice sharing calls. ACS provided a data reporting tool, resources, and one-on-one support. Plans submitted aggregated vaccination data. We used Wilcoxon Signed Rank test to assess average rates pre- and post-intervention. Ten participants consented to 60-minute semi-structured interviews that we transcribed and analyzed thematically. In 2022, we engaged 27 plans (35 service lines) from 19 states with 264,089 enrolled 13-year-olds. In 2023, participants represented 14 plans (16 service lines) from 11 states with 127,554 enrolled 13-year-olds. The 2024 collaborative included 26 plans (39 service lines) from 17 states with 249,927 enrolled 13-year-olds. We saw significant percentage point (pp) increases in 2023 for HPV completion (+3.0pp, p < .01), meningococcal (+3.3pp, p < .05), tetanus, diphtheria, & pertussis (Tdap) (+4.8pp, p < .01), and IMA (+3.0pp, p < .01) and in 2024 for HPV completion (+3.0pp, p < .001), Tdap (+1.7pp, p < .05), and IMA (+2.0pp, p < .001). Qualitative successes included intervention adaptations, age 9 initiation, data use, and collaboration. Barriers included project duration, turnover, and provider buy-in. We found the QI learning collaborative model acceptable to health plans and supported implementation of QI interventions to increase HPV vaccination.