This week’s announcement that Healthcare giant Blue Shield of California had been tapped to take over the state’s much-criticized coronavirus vaccination rollout took many by surprise, and prompted concerns among some about equitable distribution to hard-hit communities.
Los Angeles City Councilwoman Monica Rodriguez had to do a doubletake just hours after she and her colleagues left a meeting with county Public Health Director Barbara Ferrer.
“Within a couple of hours the news came that Blue Shield would be involved in the distribution effort, which to me felt like the absolute antithesis of the conversation we were having with the county and with Dr. Ferrer,” said Rodriguez, whose 7th District includes some of the hardest hit areas, including Pacoima and the northeast San Fernando Valley.
Rodriguez said it was “problematic” that just as the county, city and local clinics were digging in to the planning for Phase 1B of the rollout — during which teachers, agricultural workers and public safety crews will be eligible for the inoculations — a private insurance company was stepping in.
“Insurance companies are not in the business of serving the uninsured,” Rodriguez said, adding that under the new arrangement those “most connected” to healthcare resources — people with health insurance — would be more likely to get vaccines than those in underserved communities.
Blue Shield would work with Yolanda Richardson, secretary of the Government Operations Agency, who leads the state vaccine team.
Eventually, Kaiser Permanente, another Oakland-based nonprofit, would join the effort to hasten distribution to the state’s 40 million residents. Both could leverage giant networks of members and providers.
Blue Shield contracts with tens of thousands of physicians and hundreds of hospitals throughout the state. Kaiser has its own health insurance plans as well as medical offices.
Blue Shield employees worked with the state last year to help boost COVID-19 testing. Paul Markovich, Blue Shield’s CEO, served as co-chair of the state’s testing task force from March to June, during which time testing increased from 2,000 per day to more than 100,000 per day, according to Blue Shield.
While leaders everywhere have battled the slower-than-expected arrival of vaccines, California also needs to administer its allotment more efficiently, said state officials.
Darrel Ng, spokesman for the state Department of Public Health, said part of an insurer’s general responsibility is to reward providers that do a better job.
“For instance, providers often get paid more money if they hit certain health metrics such as mammograms or flu vaccinations,” he said.
The contract with Blue Shield is still being finalized but its task is to “create, contract with and manage a statewide vaccine administration network” and to allocate doses directly to providers, which will include pharmacies, public and private health networks and hospitals, pop-up sites and community health centers with an eye toward equity, according to the statement.
Kat DeBurgh, executive director of Health Officers Association of California, cautioned that swift distribution of the vaccine should not come at the expense of counties’ and local providers’ ability to get the most vulnerable populations inoculated.
“We want to make sure they don’t just allocate to providers who are only getting out the doses the quickest,” she said. “Speed is important. I don’t want to say we want to sit on vaccine. But sometimes you really need to make sure doses get to the clinics who speak the language of that neighborhood … ” County health departments know who the trusted providers are in such communities, she said.
In L.A. County, Latinos are more than three times more likely to die compared to White non-Latinos, their rate of deaths per 100,000 people shooting up more than 1,000% since late November, according to the county’s public health department.
While there’s agreement that the process has been sluggish in many areas, it has gone more smoothly in others.
Robert Myrtle, professor emeritus of health services administration at USC, pointed to the city of Long Beach, where vaccine administration has moved more quickly than surrounding areas.
“They have credibility, have done a fairly good job with the limited number of doses available, and there is accountability,” he said. “I do not know if Blue Shield has the scope/state wide coverage to reach out to all the communities who need vaccines.”
Anthony Wright, executive director of consumer advocacy group Health Access, said he hopes the centralization will empower efforts to reach out to underserved communities.
The state has incentives, he said, “to demand accountability and results on both the efficiency and the equity aspects of this distribution.”
State officials said they expect the transition to the new system in mid-February, hoping that by then the federal government will be sending much more vaccine.
For now, Myrtle said: “Distribution of vaccines is a highly complex challenge. There is no “one best solution,” but you need to keep what is working, and find solutions to reach where things are not working.”
Reporter Elizabeth Chou and the Associated Press contributed to this story.
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