In Mendocino County, California, public health officials and community clinics say they passed their vaccination step.
Despite the remoteness of the county and its largely rural population spanning wooded mountains, rugged coastlines and idyllic vineyards, around 40% of eligible adults have received at least one dose of a Covid-19 vaccine.
But now they’re facing turmoil again as health insurer Blue Shield of California takes over the state vaccination program with the aim of speeding up vaccinations.
Instead of tracking down the most vulnerable of the approximately 68,000 eligible residents of the district, municipal clinics and health care workers will learn data systems. Instead of administering vaccines, they navigate new software. And instead of stepping up the collaboration with the county that helped get vaccines under control, they’ll be building relationships with the insurance company.
“I’m not entirely sure what problem the state was trying to fix when it moved on to this contract,” said Carmel Angelo, CEO of Mendocino County.
What is happening in Mendocino reflects the frustrations, successes, and stumbling blocks that counties and clinics across the state are experiencing during this tumultuous transition.
The counties had received vaccines from the state before turning around and distributing them to clinics in their areas. In March, the state began transferring that responsibility to Blue Shield, which will begin supplying most vendors direct with cans starting this week under its no-bid deal with the state for over $ 15 million.
The counties continue to receive doses for their own vaccination centers and can share some with the community clinics. But they will no longer orchestrate how the doses will be assigned to clinics across the county. That is now the responsibility of Blue Shield.
This crazy quilting system makes it more complicated, not easier, for clinics and counties. “We were very nimble when it came to giving certain amounts to certain people,” said Dr. Andrew Coren, Mendocino County Health Officer. Now: “It will be difficult for us to cope with where there is more or less need.”
Prior to the Blue Shield acquisition, public health officials began holding meetings with local providers, including hospitals and community health centers, on Friday, which was not the case before the pandemic.
The collaboration helped vendors vaccinate people in hard-to-reach areas of the county as clinics could discuss which had extra doses and which needed more, said Scott McFarland, CEO of MCHC Health Centers, which operates three clinics in Mendocino County and one in Lake County.
“That’s why we’ve seen success,” said McFarland.
Of the six community health centers in the county, all have signed up with Blue Shield or are in discussions with the insurer.
Chloë Guazzone-Rugebregt, executive director of the Anderson Valley Health Center inland Boonville, said the doses administered in Mendocino county were hard to come by, the result of hours of personal contact with vulnerable and legitimate communities.
Guazzone-Rugebregt said she is reluctant to start over with Blue Shield because she feels she has no choice. She received the contract on a Friday evening in mid-March and was asked to sign the following Tuesday if she didn’t want to lose her allotment – though she still has no idea how many doses are promised.
Erika Conner, a spokeswoman for Blue Shield, said the insurer is trying to enroll as many providers as possible in the state vaccination system and work with them once they join.
“Our goal is to build a network that reaches every corner of our state, especially the communities that have been disproportionately affected by this pandemic,” she wrote via email.
McFarland said he was looking forward to the streamlined process that Blue Shield hopefully will bring. He’s not worried about his allocation as his major clinics have partnered with Adventist Health Ukiah Valley to run weekly mass vaccination events where up to 2,000 doses have been given per day.
He sees no reason why his collaboration with the hospital cannot continue.
“It can be a week, it can be two weeks, but in the end I think it will be a better system,” said McFarland.
Darrel Ng, a spokesman for the California Department of Health, said the Blue Shield project has already improved the nationwide distribution of vaccinations, especially in communities most susceptible to the virus. For example, he said, vaccines in these communities rose 30% from February 20 to March 20.
“This is proof that the state’s actions not only work, but also help promote justice,” said Ng.
The biggest change on the horizon that may disrupt clinics the most is the mandatory use of My Turn, the state’s centralized vaccine website. It’s intended to serve as an online hub where patients can find appointments and vendors can order doses and set up clinics while data is seamlessly sent back to the state.
Mendocino County was one of the first rural counties to try it, Coren said. Immediately there were problems.
For example, on March 1, two weeks before state guidelines did the same, Mendocino expanded immunization eligibility for people with certain health conditions. That was the jurisdiction of the county, but My Turn couldn’t understand the conflicting approval categories.
Therefore, providers have enrolled patients in a different category on My Turn for two weeks. This means that someone who became eligible due to their cancer may have been coded as a farm worker, teacher, or other eligible occupation.
However, using tricks to bypass the site’s quirks wastes time and skews county and state vaccination dates, which can result in future doses going to the wrong places or people. Issues My Turn specifically designed to prevent this from happening.
“It’s a big IT bureaucracy, so it can lead to big failures where there have been small failures in the past,” said Coren. “So it’s not perfect, it won’t be perfect, but I think we’ll see it improve.”
Ng said such issues will stop once every county uses My Turn and vaccinates by the same admissions rules this week. Everyone over 50 is eligible on Thursday, regardless of their job or state of health.
Focusing on data entry and website problems leaves clinics less time to face the looming challenge of getting everyone vaccinated – not just the first wave of enthusiastic buyers, Coren said.
“The problem is that it distracts our eyes and attention from some local issues,” like reaching out to vulnerable groups or overcoming language barriers, he said.
In the county’s wine-growing areas, many farm workers don’t speak English, have no legal status, can’t access high-speed internet – or all three.
Guazzone-Rugebregt’s clinic has managed to reach out to them and other vulnerable populations by being patient, flexible and time-consuming, she said.
For example, instead of relying on the population to find appointments online and provide the right records, they work directly with employers in the area to get rosters for farm workers or other eligible professions from which to work.
Lucresha Renteria, Executive Director of the Mendocino Coast Clinics, serves 10,000 people on 52 miles of coastline and 20 miles inland.
Getting people vaccinated requires personal connections that don’t need to be sent to a planning website or nationwide hotline, she said.
“People need to trust who they are interacting with in order to be able to receive this vaccine,” said Renteria. “Using their well-known medical provider, a name people already trust, is a great way to do this in a small rural community.”
This story was produced by KHN publishing the California Healthline, an editorially independent service of the California Health Care Foundation.
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