California's new system of delivering, tracking and scheduling coronavirus vaccines is being rolled out in select counties, a first step in Gov. Gavin Newsom's plan to smooth out what has been a confusing and disjointed rollout hampered by limited national supply.
Newsom announced last month that his administration had tapped insurer Blue Shield to design and manage a centralized system to get doses out quickly and equitably. He said the state also needs robust data to ensure vaccines are distributed equitably and reach low-income communities, largely Latino and Black, disproportionately affected by the pandemic.
An initial list provided by the state showed 10 counties in the inland sections of central and Southern California chosen to be the first to make the transition to the Blue Shield system this week, although one county said Friday it would shift later. While the counties understand the goals, there's confusion about what changes will occur.
Brynn Carrigan, Kern County's director of public health, said she was told that starting Sunday everyone must make appointments through the state's vaccine sign-up system, called My Turn. In neighboring Fresno County, a spokeswoman for St. Agnes Medical Center said it had no plans to switch its scheduling system.
"It's scary to give up control of a system that we've spent a lot of time on, that's working really well right now," Carrigan said. "Our hope is there's not a lot of hiccups and this goes smoothly."
Darrel Ng, vaccine spokesman for the state's public health agency, declined to answer questions about what to expect during the transition. But he said the state and Blue Shield "have worked tirelessly to plan and implement phased changes to more efficiently and equitably administer vaccines." He said they will share more information next week.
Blue Shield spokesman Matthew Yi also declined to provide more detail, saying in a statement Saturday they are working "closely with state public health officials, local health jurisdictions, healthcare providers and others" to overcome the pandemic.
California has used stadiums, arenas, fairgrounds—even Disneyland—to build a large capacity to administer shots, but much has gone unused because of the limited availability of vaccines. Residents were frustrated when the state first started vaccinating the general population in January, with 58 counties and individual hospital systems setting their own rules for who could make an appointment and how.
While state officials have been clear on what they want the new system to accomplish, they have provided little information on how counties and other providers are expected to get there. And officials are upfront that they don't have answers yet to critical questions, including how they will measure equity, what the monthly equity target is or even the complete network of providers.
What is sure is that counties will not be allowed to add any more vaccine providers, because the state through Blue Shield will decide who administers shots.
Yolanda Richardson, the state official in charge of implementing the change, faced a barrage of questions and concerns at a community advisory committee meeting last week. She said the state has the expertise and the relationships to figure it out.
"This is too critical and too important for us to let this get out of our hands," Richardson said.
In addition to Fresno and Kern, other counties in the initial group include Riverside, Kings, Imperial, Madera, Merced, San Joaquin and Stanislaus. Starting March 3, another group that includes Los Angeles, which has 10 million of California's nearly 40 million residents, will be added.
San Francisco is among the counties being added in mid-March, though the dates and counties in each group are subject to change.
Joe Prado, community health division manager in Fresno County, said his team had a good talk with Blue Shield representatives and does not get the sense the insurer will hijack the county's system. But there will be new management metrics in place, including the county's ability to administer doses within a week, which Prado says will be easier once they get the anticipated three-week notice for how many shots to expect.
"Right now, without any direction or a plan from Blue Shield, nothing will change on Sunday," he said.
The fast-tracked, no-bid $15 million contract charges Blue Shield with creating a "statewide vaccine network" to ensure the rapid delivery of vaccines.
Among the requirements: Rural Californians should be able to reach a vaccine site within 60 minutes and urban residents within 30 minutes. Homebound people must receive the vaccine at their residences. The state must be able to administer 3 million vaccines per week by March 1, dependent on supply. Now it is doing about 1.4 million.
Blue Shield must work with the state to develop an algorithm to determine how vaccines are allocated and set incentive payments and performance aimed at getting providers to give doses out more quickly and to the right populations. The state also will set goals for what percentage of vaccines go to people in low-income or otherwise disadvantaged areas.
Some counties and providers wonder how Blue Shield and the health care network Kaiser Permanente, which has also been tapped to help out, will cultivate the trusted relationships needed to vaccinate the underserved populations Newsom hopes to reach.
St. John's Well Child & Family Center, a community health center whose clinics serve Black and Latino residents in south and central Los Angeles, plans to open three new vaccination sites and start inoculating worshippers at churches.
"It seems like we've got our groove on now, the counties are getting vaccine, particularly in the bigger counties, they're getting it into the low-income communities of color," CEO Jim Mangia said. However, he said "the incredible power that a non-elected body" like Blue Shield has over vaccine distribution is disconcerting.
Kaiser announced Saturday that it would ramp up its distribution of vaccines to seniors starting this week. CEO Greg Adams said California officials had increased the health care giant's allotment to more accurately match its large share of the state's health care market.
Kaiser is starting to schedule appointments several weeks out and beginning to offer inoculation appointments to members who are 65 and older.
Carrigan said there are currently more than 90 vaccination providers in her county of 900,000 people, and her office doesn't have a say which ones will remain under Blue Shield.
The county has been using spreadsheets to keep track of vaccinations and will continue to do so for people who already have appointments and for those who have received first doses and are awaiting a second, she said.
"We feel like in Kern County we have this system dialed in. We're ready. We just need more supply," she said. "So making changes without a lot of explanation, without a lot of details, is a little bit scary for us, to be frank."
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