Blue Shield stops overseeing California vaccination program

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SACRAMENT

As public health officials continue their efforts to vaccinate millions of hard-to-reach Californians against COVID-19, they are doing so largely without the help of Blue Shield of California, the company whose oversight, according to the Gov. Gavin Newsom, was key to improving the sluggish distribution of doses earlier this year.

The company’s reduced role announced last month wraps up a controversial chapter in states ‘ongoing efforts to fight COVID-19, a chapter that began with questions about Newsom administrations’ management of who should be the first in line when supplies were tight and resulted in the governors’ surprising decision. to put the insurance giant, a longtime political donor, in the driver’s seat.

Newsom said Blue Shield will speed up state distribution of life-saving vaccines and improve the slowness in accounting for unused doses. But now, with the hindsight of Blue Shield, the outcome of that decision remains unclear. Many county officials who initially criticized Blue Shields’ involvement remain skeptical about the effectiveness of vaccination programs, while others say the company has improved state operations by standardizing how Vaccine vendors reported the doses administered, allowing officials to more accurately assess where to send more.

Some might want to rewrite history and say we just needed to give the existing plan more time. But we didn’t have time, said Sami Gallegos, spokesperson for the California Department of Public Health. The crisis needed a solution and lives depended on our acceleration.

Whether the state would act faster under the $ 15 million Blue Shield deal has been questioned by county officials since Newsom announced the change in late January. Amid objections from vaccine suppliers, Blue Shield and the state did not finalize contracts until mid-March, when the number of doses sent to California was rapidly increasing.

San Joaquin County Supervisory Board Chairman Tom Patti is adamant that the state’s vaccination program led by Blue Shield has slowed his region’s ability to get vaccinated. Patti, a Republican, said the county had successfully fought for some changes to the terms that Blue Shield and the state had insisted on as a prerequisite to getting vaccines, but the contract changes required still San Joaquin to abandon its own program targeting hard – reaching populations.

This whole process was a hindrance and in no way helped, Patti said. There was no benefit whatsoever.

Some Fresno County officials expressed concern in February about the contract, saying they feared it would mandate an online scheduling system that could make it more difficult to vaccinate farm workers in their area.

Six months later, Joe Prado, acting deputy director of the Fresno County Department of Public Health, said in a statement that the contract with Blue Shield offered great strengths, such as a vaccine market to scale. state which allowed counties to view and transfer their vaccine stocks among other counties.

Kat DeBurgh, Executive Director of the Health Officers Assn. of California., said it is difficult to assess how state immunization rates would have changed, if at all, without Blue Shield. Society now plays a limited role as vaccine needs have changed, she said. When Blue Shield stepped up earlier this year, DeBurgh said the state had limited supply and high demand.

We now have a stable supply and we are trying to ensure that the demand increases, she said.

Part of the impetus for the overhaul under Blue Shield was the revelation that life-saving vaccines were sitting on shelves in some areas and the state’s flawed data system made it impossible to track how many doses were available at any one time. given. To counter this, the state began requiring most vendors to use its My Turn appointment system, which itself was initially inundated with complaints of issues and compatibility issues.

DeBurgh said the My Turn system has finally become very useful. Not all vaccine suppliers were required to use the system, which alleviated some initial concerns.

It got better over time, she said. It was a portal that let you find out if you were eligible, make an appointment, and get vaccinated. It was very helpful.

Blue Shields’ involvement in determining where to send the doses in the state and which healthcare providers would be part of California’s new vaccine network frustrated county officials who had until then managed their own programs. Lack of membership from counties delayed the start of the program under Blue Shield, with almost all counties initially refusing to sign a contract with the insurance company outlining new rules for receiving doses of the. State.

Many county officials have argued that states’ decision to outsource oversight of how vaccines were allocated from February came after they addressed internal issues and the biggest obstacle to lack supply was disappearing.

California received 1.5 million doses in December and 3.4 million in January outside of federal programs shipped directly to pharmacies and other providers, according to data provided by the California Department of Public Health. That rose to 4.6 million doses sent to California in February, 5.9 million in March and 8.4 million in April at its peak.

The problem that existed was that there was not enough vaccine, said Jeff Smith, director of Santa Clara County. In my opinion, what Blue Shield did was they moved around the lounge chairs on the Titanic. They did not add any additional value to our response.

Blue Shield officials said the company helped build California’s capacity to deliver 6 million doses per week, up from 1.6 million before the contract. However, this maximum capacity was largely unnecessary since the largest number of vaccines the state had ever received in a week was 2.4 million doses.

It was really frustrating, Smith said. It took a lot of time and effort which was diverted to process the contract with [Blue Shield]. Ultimately, we improved our own vaccine supply going directly through the federal government.

Lucresha Renteria, executive director of Mendocino Coast Clinics, which serves 10,000 people in northern Mendocino County, said the system under Blue Shield has become too bureaucratic and messy, forcing her to navigate multiple forms and websites to receive doses.

The system kept changing and it was difficult to know how to order vaccines, Renteria said.

Renteria said that by ordering vaccines she received double what she asked for. After a month, she said the clinic opted to order through the county public health department instead.

I know the state was thinking of doing this to improve it, but we only needed a few months to figure it out with our public health department, she said. By the time they implemented the [contract], we already understood. They were solving a problem that no longer existed and the bureaucracy created more problems.

As part of the contract, the state asked Blue Shield to ensure that 95% of residents in urban areas were within 30 minutes of a vaccination site and those in rural areas were within 30 minutes. one hour of access to a supplier. Blue Shield said they exceeded that target, with 99% of Californians within those distances.

Our reward has been to help save lives, Blue Shield President Paul Markovich said in a statement.

Under the Blue Shields contract, the company can charge reimbursable costs incurred up to $ 15 million and will not make any profit from the deal, the company noted. A spokesperson for the state’s public health department said the company had not yet charged any of its expenses.

Critics have argued that Blue Shield will earn more than goodwill and reimbursed expenses under the state contract. The company regularly has business with the California government that has major financial impacts. For example, a state budget bill signed by Newsom last month was a highly sought-after wishlist item for Blue Shield which requires health plans to share patient records and data via a exchange of health information by 2024.

Blue Shield, a longtime Newsom donor, said in a press release that the company is thrilled with the new law, which is expected to lower healthcare costs by allowing providers to see a more complete picture of medical history. patients.

Blue Shield has a lot to gain from the development of a [Health Information Exchange] because it would help him compete with California’s biggest health plan Kaiser Permanente, said Michael Johnson, a former Blue Shield executive turned company critic.

State officials have said Blue Shield will retain an advisory role for the duration of its contract with the state, which ends in December. This role allows the state to increase Blue Shields’ involvement or seek advice from company officials if a COVID-19 variant forces the state to speed up distribution of additional vaccine doses, a door says -speak of the public health department.

The overall cost to the state to create and manage the vaccine network is estimated at $ 202 million, according to the latest budget estimates released in May.

This is an increase from Newsom’s estimate of administrations in March, when the administration of the vaccine network was estimated at $ 151 million, most of which was tied to IT support. The state also tapped management consulting firm McKinsey & Co. for $ 13 million from February through April to help Blue Shield and the state with the vaccine delivery system.

Sarah Dukett, legislative attorney for rural California county officials, said it was likely some areas of the state wouldn’t notice a difference with Blue Shield’s hindsight.

I don’t think they did a bad or a good job, I just don’t think it drastically changed the priorities on the ground in rural counties, Dukett said. The biggest issue was still sourcing so I’m not sure what the impact is [Blue Shield] finally had.

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