Will Blue Shield system have room for Sonoma County’s vaccination partners?

After completing its four scheduled vaccination clinics at the Sonoma County Fairgrounds this week, the Sonoma County Medical Association has put more than 6,000 shots into arms of county residents, according to executive director Wendy Young. It’s a remarkable track record for an operation that has overwhelmingly relied on volunteer labor.

But SCMA’s role as community vaccinator may be coming to an end. Unless the association can find an approved sponsor with a medical license, it could be squeezed out of California’s emerging vaccination system, which will use the insurance goliath Blue Shield to allocate every dose of coronavirus vaccine and track data on how much is being delivered and administered.

“At the beginning of this, as a medical association, I felt we should be able to find a way to be relevant,” Young said. “We’ve been serving our community for 160 years. This should be our time to shine. How can we be relevant? And I feel like we found a way to do that. But other people are not seeing it.”

State officials insist Blue Shield’s role as “third-party administrator” will only increase the flow of vaccine in California, and will help to ensure equity among recipients. But people involved in Sonoma County’s vaccination effort fear there is something to lose as well.

Donna Waldman, executive director of Jewish Community Free Clinic, said colleagues in other parts of the state were thrilled to see that Blue Shield would be taking over allotment of vaccines, because they didn’t think their local health departments were doing an adequate job of it. That’s not the case in Sonoma County, insisted Waldman, who said the department directed by Barbie Robinson “has done an extraordinary job” with its vaccine rollout.

Some worry the local effort will lose some of its agility under a system in which every appointment is made through the state’s MyTurn.ca.gov portal. Case in point: When Sutter Health ran out of vaccine and had to cancel critical second-dose appointments for its clinic at Luther Burbank Center for the Arts this week, it was SCMA that swooped into the breach, immediately finding slots for a number of affected seniors.

“Thank goodness that their all-volunteer staff was available to fulfill that lifesaving mission,” said Joel Levine, an 82-year-old retired doctor who got his substitute second dose — as did his wife — at the SCMA clinic in Grace Pavilion. “It would be a great shame for the establishment to shut down such a fine, well-equipped organization.”

MyTurn.ca.gov is already available to eligible Sonoma County residents — with zero available appointments showing, as of Friday — and it was Blue Shield that allotted the county its doses for next week. But the new system won’t begin in earnest here until Sunday, and will ramp up gradually through the month of March. The insurer says providers currently administering the vaccine will continue to receive doses during this transition.

Blue Shield of California had meetings with more than half of the 61 participating local health jurisdictions by Feb. 26, company president Paul Markovich said during a press briefing that day. “We’re spending a lot of energy understanding where their highest-risk populations are, their hardest to reach, and how we can help them make sure they are reaching those populations and vaccinating them,” Markovich added.

Starting next week, Sonoma County will no longer be receiving any shipments of vaccine, said Ken Tasseff, the county’s vaccination site coordinator. Blue Shield will be in charge of vaccine integrity — making sure it doesn’t spoil — and will direct manufacturers to send allotments straight to providers.

“Absolutely there’s concern,” Tasseff said. “We’re going to lose control over the vaccine distribution and allocation process. That being said, we have a lot of pieces in place, Plan Bs in place, to ensure that if there’s breakdowns in their system, that we’ve got backups. We are not dismantling anything until we are confident that the third-party administrator has it right.”

Supervisor Lynda Hopkins said the county has invited Blue Shield to town halls and Zoom meetings, but has gotten no response.

SCMA is not the only vaccinator that could be dislodged from the network. The Sonoma County Office of Education has been organizing clinics at Rancho Cotate High School that have immunized 4,200 school employees and child care providers since Feb. 8, part of the drive to get children back in the classroom and parents back in the workforce.

But SCOE is not a medical provider, obviously. An education office representative said a team of 40 volunteer school nurses trained for disaster services are administering the vaccine at Rancho Cotate. This clinic also might need a sponsor to survive.

Some local health care providers reported receiving contracts that represent offers to enroll in the Blue Shield vaccination system. DEMA Consulting & Management, based in Petaluma, hadn’t gotten a contract as of Wednesday. DEMA has been running clinics at Roseland Library and Grace Pavilion at the fairgrounds. Michelle Patino, the company’s director, said she doesn’t know what lies in store.

“I’m pretty sure that if they need DEMA’s help, we’ll be there to assist them in any way we can, and the county will let us know in an appropriate time frame,” Patino said.

One of the primary goals in channeling the system through a central administrator, as articulated by Gov. Gavin Newsom and Health and Human Services Secretary Dr. Mark Ghaly, is ensuring equity for underserved communities throughout the state. But some local providers worry that rearranging the network of vaccinators Sonoma County has worked hard to assemble could actually harm that drive for equity, as some of the smaller health centers are most closely connected to the indigent and uninsured.

“We’re dealing with the poorest of the poor,” Waldman said. “We have clients who don’t speak Spanish, they speak their indigenous tongue. They’re comfortable with us. The idea that has taken form is mass vaccinations, that’s the way to do it. But you don’t want to only do it that way. Because if you do, you only get a certain segment of the population.”

Waldman said she was alarmed when she heard a huge corporation would be making decisions that could affect local vaccine distribution. She also worried that Jewish Community Free Clinic, a health care gateway that is not a federally qualified health clinic, would be left out entirely. But the Redwood Community Health Coalition and California Primary Care Association advocated on behalf of small clinics such as hers, and Waldman praises Blue Shield for showing a willingness to adapt its plan.

She said the clinic is now going through the steps of entering the Blue Shield program and is “feeling very positive” about its chances.

Young has no similar degree of optimism regarding the Sonoma County Medical Association, which was founded in 1858 and offers a range of financial, legal and educational support to local physicians.

SCMA sprang into action when the pandemic exploded a year ago, helping its doctors get PPP loans to prevent their practices from closing. The nonprofit organization then shifted to acquiring personal protective equipment for doctors’ offices and schools, mobilizing home tailors to sew face masks. Young estimated SCMA donated more than 100,000 masks.

When vaccinations became the next area of need, Young went there, too. At first, SCMA set up at Grace Pavilion purely to immunize physicians and medical staff. It was 100% volunteer-run. “We thought it would be a cute little clinic that lasted three days,” Young said.

Before long, though, SCMA was fully invested in vaccinations. The county provided the vaccine and needles; the association donated all other supplies. They did it so well that other county vaccination partners came to the site to observe. The county eventually hired six temporary employees that it stationed at Grace, and the state sent six paid nurses.

SCMA has three second-dose clinics left on its docket over the next three weeks. Young hopes it will be allowed to execute those, and perhaps more.

Tasseff said he is confident Blue Shield will adopt the county’s recommendations — including a role for the medical association. “We’ve got weeks to work through this,” he said Friday. “We had a meeting today with Blue Shield. They are very aware of SCMA and our interest and their interest to make them part of the solution.”

As of Friday, though, Blue Shield had not offered SCMA a contract.

“This could be the end, in which case we’ve had a lovely ride,” Young said. “We’ve served our community to the best of our abilities, and will be OK with that. And if the county can find a way to keep us running clinics, we’d love to do that.”

You can reach Staff Writer Phil Barber at 707-521-5263 or phil.barber@pressdemocrat.com. On Twitter @Skinny_Post.