Counties across California are increasingly resisting the new state vaccination program administered by the Blue Shield of California, with Los Angeles County officials the last to ask for the ability to choose to leave amid a bipartisan chorus of concern.
To further complicate the launch of the state’s new venture with the insurance giant is the non-adherence of counties, with none of California’s 58 counties having signed the Blue Shield contract yet, according to representatives of urban county advocacy groups. and rural and local government leaders. Despite this, the state began moving forward with changes on Monday from 10 municipalities.
“Hesitations and uncertainties cover urban, suburban and rural parts of the state,” said Sarah Dukett, legislative advocate for California Rural County Representatives. “Not everyone is always in the same boat. I hope the state is listening to this, but they really do seem to be in full swing. ”
Governor Gavin Newsom announced in January that Blue Shield would take over as the independent supervisor of California’s COVID-19 vaccine supply chain, a move that came with growing criticism that the state was initially very slow in putting doses in the arms of residents. In an attempt to speed up delivery, Newsom said California would simplify the system under Blue Shield to create “more efficient delivery, speed, equity and transparency with vaccines”.
Under an agreement signed on February 15, California began to outsource functions to Blue Shield that were previously managed by state and local government officials. A separate agreement allows Kaiser Permanente to supervise doses in its own healthcare system and at additional vaccination sites, regardless of Blue Shield’s supervision.
On Friday, Blue Shield officials told the state’s Community Vaccine Advisory Committee that contracts with the counties were being finalized, although no timetable was provided. It is unclear how a potential stalemate with counties would affect vaccine distribution in these areas. Blue Shield is scheduled to assume full responsibility for managing the state network by March 31.
Newsom warned on Thursday that the changes “started this week; there will be other waves in the coming weeks. ”But the lack of support for the new system remains a significant obstacle.
In a March 2 letter to Newsom, the President of the Los Angeles County Board of Supervisors, Hilda Solis, and President Pro Tem Holly Mitchell, asked the county to be exempt from Blue Shield supervision, requesting an exemption similar to Kaiser Permanente. Solis and Mitchell wrote that Blue Shield employees “have not demonstrated an adequate understanding of the unique needs and characteristics of Los Angeles County, its diverse population and where our residents seek medical attention.”
Before the Blue Shield agreement was signed, Ventura County also asked the state to give up the system, saying that insufficient supplies, not poor supervision, were hampering the distribution of vaccines. State officials and Blue Shield officials told Ventura County that opting out was not an option, said Barry Zimmerman, deputy chief director of the county Health Agency.
San Joaquin, Riverside, Fresno, Imperial and six other counties are the first to be overseen by the Blue Shield this week.
Last week, the San Joaquin County Board of Supervisors asked the county council to explore options for opting out of the “tremendous bureaucratic system” that supervisors said would be implemented under the Blue Shield.
“The terms of the contract and the possibility of exclusion are currently under review,” said Jolena Voorhis, deputy administrator for San Joaquin County.
Riverside County is reviewing the Blue Shield contract and discussing options with other counties, but a county official declined to give further details.
The University of California health care system signed the Blue Shield contract last week, but only after changes were made to it. University officials said Blue Shield initially sought an “expansive” amount of medical data.
A major concern for counties is the requirement in the Blue Shield contract that all vaccine providers use the state’s My Turn nomination system, which was hammered this week for complaints of failures and compatibility issues. County officials have complained that the scheduling system is unable to reserve vaccine appointments for people living in underserved communities, a major component of the state’s efforts to ensure that doses are distributed equitably.
In addition, the use of My Turn created more work for some vaccine providers, requiring them to enter data twice – once in their own systems for billing and record keeping and a second time in the new state system. State authorities promised to create an interface between the two systems; however, it could take weeks or months to develop, county officials said. State officials said on Friday that completion is scheduled for two weeks.
“The Santa Clara County administration has serious concerns about the Blue Shield contract,” said Jeffrey Smith, a county executive. “The proposal does not make sense for large counties with well-established health service delivery systems that already offer health care and vaccines to a large and diverse population.”
Smith said the requirement that vaccine providers use the state’s My Turn system, which he called “a lower system controlled by Blue Shield”, is just another obstacle to equitable administration of inoculations.
“We believe that this would disable our vigorous stock disclosure program, leaving our most at-risk population to fend for themselves,” said Smith. “All we really need from the state is more vaccine. We don’t need a new, inferior delivery system. “
Los Angeles County supervisors, Mitchell and Solis, said in their March 2 letter to Newsom that they fear that vaccine providers in vulnerable communities will be excluded from administering doses under the new contract and noted problems with the transition. needed for My Turn.
Mitchell and Solis wrote that Los Angeles County administered 95% of the vaccine doses allocated to the county, which is equivalent to almost 2 million doses on February 26.
Supervisors wrote that the county has been “limited by scarcity of supply and variability in the amount of vaccine received from week to week”. The county has the capacity to administer 500,000 vaccines a week, they said, but available doses have limited consultations to 270,000.
Supervisors added that there is a lack of transparency in the calculation to determine how many doses a municipality receives, who makes the decision and what factors are being considered.
Under the Blue Shield contract with the state, the insurer will create an algorithm to determine where to allocate COVID-19 vaccines across the state.
When the contract was launched, Mitchell called the concept of relying on an algorithm “extremely worrying”.
Meanwhile, the state announced Friday that it had already exceeded 10 million vaccinations, with 1.67 million doses administered in the past seven days. It is too early to attribute this increase to changes in Blue Shield, said a spokesman for the California Department of Public Health.
Counties continue to receive vaccines, despite contract restrictions. Blue Shield spokeswoman Erika Conner said vaccine suppliers who were already receiving doses before the new contract continued to receive them during the transition period.
“Our goal is to improve the state network to support the state’s goal of increasing its capacity and being able to administer 4 million doses per week – and we are on track to reach that milestone,” said Conner in a statement.
Conner said the vaccine supply chain being created under the new system includes clinics in underserved areas, hospitals, medical groups and pharmacies. The Times’ request to the California Department of Public Health for a list of vaccine providers who signed up to be part of the Blue Shield system was referred to the insurer, which refused to provide the information.
Instead, Conner said in a statement that the company “will provide more updates on the status of the network in the coming weeks”.