SAN DIEGO SIGNS ON WITH BLUE SHIELD PROGRAM
County officials say agreement gives them flexibility in vaccine rollout
Long after San Diego was supposed to join a statewide coronavirus vaccine effort led by Blue Shield, the county has at last struck a deal with the health insurance company.
The county signed a memorandum of understanding with the state acknowledging that it is joining a network of vaccine providers overseen by Blue Shield, according to documents obtained by The San Diego Union Tribune.
The move comes after discussions between the county and the private company dragged on for weeks. During that time, local officials mostly kept quiet, never openly opposing Blue Shield’s involvement in the way that officials in Santa Clara and Los Angeles counties did.
“There were discussions around just helping them understand the unique circumstances the county has faced, our need to be f lexible,” said Supervisor Nathan Fletcher on Thursday, during the county’s weekly coronavirus briefing.
Discussions with local officials throughout California led to a concession from the state and Blue Shield: Counties will retain the right to redistribute incoming doses to health care providers and other organizations that help to run vaccine superstations and smaller sites.
As of Friday afternoon, nine counties — including San Diego, Los Angeles and Riverside — had signed a memorandum of understanding with the state, along with Kern County, which contracted directly with Blue Shield. Combined, the 10 counties account for nearly half the state’s population, according to the California Department of Public Health. Most San Diegans are probably less interested in the particulars of the deal than knowing when and where they can get their shots. When doses are plentiful, that shouldn’t be an issue; the region’s immunization sites have the capacity to inoculate 34,000 people a day. And Blue Shield could be helpful if the company delivers on its promise to make the vaccine rollout more efficient and equitable.
But when supply slows or stops, the company’s involvement adds another layer to an already complex system of vaccine manufacturers, the federal government and the state, each of which affects the flow of doses
into San Diego County.
“There’s an extra layer of bureaucracy, and we don’t know where the holdup is,” said Dr. David Brenner, vice chancellor for health sciences at UC San Diego, which has contracted with Blue Shield as part of the University of California system. “I just wish it was more transparent.”
Blue Shield’s primary responsibility, spelled out in its contract with the state, is to enroll vaccine providers into a statewide network and monitor how many doses each member has and how many they’re using.
“The thing that we think we can do best to help is to make sure the state, all the local health jurisdictions, know where the vaccine is at all times — from the moment it’s allocated by the federal government to the moment it’s injected into somebody’s arm,” said Paul Markovich, CEO of Blue Shield, during a March 12 call with reporters.
The insurance company will summarize that data in daily reports to the state and factor the information into an algorithm that will recommend how to divvy up doses.
That formula splits up doses based on each ZIP code’s number of vaccine-eligible residents, with extra weight given to areas with higher numbers of older adults. Those allocations are then adjusted so that socioeconomically disadvantaged areas, as measured by ZIP codes that fall into the bottom quartile of the state’s Healthy Places Index, get 40 percent of the supply. Blue Shield can recommend that the state increase, decrease or cut off a provider’s supply altogether, though the company must first consult with counties on any allocation changes, with the state making the final call. The company can also recommend that the state issue “network incentive payments” to reward providers that meet or exceed goals set by Blue Shield and the state.
The carrots-and-sticks approach is meant to ensure vaccine gets into the arms of Californians as quickly as possible. But San Diego already appears to be doing a relatively good job of that, with 40,762 doses doled out per 100,000 residents as of Thursday — one of the highest rates of any county in the state.
The region’s rollout did get off to a sluggish start, with limited initial data on how many doses were in the county and how many were going into arms. The same was true statewide; at one point in January, data reported by the Centers for Disease Control and Prevention showed that only 1 out of every 4 vaccine doses sent to California had been administered. When Gov. Gavin Newsom announced that Blue Shield was stepping in to help run the vaccine rollout, it was in part to boost these underwhelming numbers. But UCSD’s Brenner doesn’t see a clear need for a third-party to step in given the progress made by the county and health care providers in inoculating as many people as possible, as quickly as possible.
“The excuse that was used was that vaccine was not getting in people’s arms, and they didn’t know why,” Brenner said. “(But) we feel like we’re doing a great job, and we’re sort of collateral damage through this feeling statewide that there was not a good distribution of vaccine.”
The state’s contract with Blue Shield could cost up to $15 million, with California’s total vaccination costs likely to reach $1.37 billion during the 2021-2022 fiscal year, according to the state’s Department of Finance, which noted that much of these expenses will likely be covered by the federal government.
Brenner adds that UCSD’s vaccine supply, which it receives as part of the University of California system, remains low. That’s true despite Blue Shield’s Markovich telling reporters that the company helped route more vaccine to the UC system after discovering that it had fewer doses than the state’s records showed.
In general, improved vaccine record-keeping could be a good thing, as knowing the amount of vaccine a provider has on hand helps the state determine how many additional doses it needs, according to Darrel Ng, communications adviser for the state’s coronavirus vaccine task force.
Current records don’t always reflect reality. An inventory of self-reported doses shows figures last updated weeks ago for some San Diego providers, and indicates that the county’s Health and Human Services Agency had 24,365 doses on hand as of Tuesday.
“In essence, it’s what they have in their refrigerator or freezer,” Ng said in an email.
That was news to county spokesperson Mike Workman, who said on Wednesday that the county had no more than 500 to 600 doses in storage. It’s possible the larger figure includes doses redistributed from the county to local providers, though neither Ng nor Workman could say for sure.
Clearing up this confusion is part of Blue Shield’s role. The company’s contract requires providers to enter vaccine administration data into the state’s MyTurn system (myturn.ca.gov) within 24 hours of each shot.
But MyTurn, which many Californians use to learn if they’re eligible for vaccine and to schedule appointments, has had its own issues. Case in point: The vaccine superstation at the Del Mar Fairgrounds recently closed for three days after a MyTurn glitch made 1,800 more appointments available than the site had vaccine for.
And the emphasis on regular and rapid reporting could leave behind smaller organizations, such as the San Diego Black Nurses Association, says Samantha Gambles Farr, the organization’s president. The group has immunized about 1,100 San Diegans, most of them Black, at churches and community centers. Much of that work has been led by Samantha Williams, the group’s COVID-19 task force chief, and Lisa Cosby, community health chair. The organization receives vaccine doses through the county, which also helps the group by taking paper immunization records and entering them electronically. That takes a few days, says Gambles Farr, which could make it seem like the organization isn’t using its supply.
“It could be a challenge for us,” she said of Blue Shield’s MyTurn reporting requirement. “We do not have an infrastructure. We are 100 percent a volunteer organization comprised of nurses who are oftentimes working full-time jobs.”
Blue Shield has said that it will prioritize health equity, and the Black Nurses Association is one of many groups serving southeastern San Diego. So Gambles Farr is hopeful the new partnership will support the organization’s current work.
“I believe every entity is going into this with good faith,” she said. “Our purpose is to serve our population, to serve our communities.”