Experts question Blue Shield's algorithms, incentive-based vaccine distribution plan

ByStephanie Sierra KGO logo

Wednesday, February 17, 2021

Blue Shield contract faces criticism over algorithm

Experts are concerned over Blue Shield of California's plan to vaccinate the state, saying it lacks transparency is how they created their algorithm. There's also concern over the "Network Incentive Payments" clause in their contract.

SAN FRANCISCO (KGO) -- Blue Shield of California revealed an ambitious plan to significantly ramp up vaccinations across the state, setting forth a goal of administering three million doses per week by March, according to the company's contract released this week.

The insurance giant outlines a series of commitments to close equity gaps, increase accessibility, ensure robust data reporting, and highlights an oversight monitoring process to ensure vaccine providers are following the rules.

The contract is a compelling read on paper, committing to immediate strides of improvement to speed up vaccinations. On April 30, the company has committed four million doses will be administered per week, up from the goal of three million doses set two months prior.

"It's all about transparency," said Gov. Gavin Newsom during a Tuesday press conference. "It's all about working hand and glove not just with the counties, but with our provider network."

Yet, health experts argue there's little transparency about key logistical details.

The contract states Blue Shield will use a vaccine allocation algorithm that will to determine the distribution of vaccines across the state - taking into account things like vaccine availability, areas with high rates of COVID-19, and feedback from relevant stakeholders.

VIDEO: California COVID-19 metrics drop across the board, but will there be another surge?

California Health and Human Services Secretary Dr. Mark Ghaly held a press conference at noon Tuesday to give an update on county reopening tiers and the COVID-19 vaccine. While cases have dropped in CA, another surge is still possible.

"What you need to default too are not stakeholders, but science-based experts," said Dr. Mike Wasserman, who sits on California's vaccine advisory committee.

"What are your thoughts about an algorithm being used to make these determinations?" ABC7's Stephanie Sierra asked.

"In order to have a successful algorithm you need to have science, evidence, and when you're dealing with a vulnerable population we don't have a lot of science and evidence in the midst of a global pandemic," Wasserman said. "We need more transparency about how the algorithm is designed."

Wasserman and his colleagues are concerned about the "Network Incentive Payments" clause in Blue Shield's contract, which allows funds to be paid directly to vaccine providers for meeting or exceeding standards, like equity goals.

"Incentives are things that supposedly work over a period of time, we need to be getting the vaccine out to the right people now," he said.

Meanwhile, the list of those potential providers is getting smaller. The Governor announced Tuesday the California Department of Public Health is engaging around 1,100 of the 3,500 providers currently in the state's system that are deemed 'most essential' to participate.

According to the contract, Blue Shield has the authority to choose which providers will join the vaccination network. The company isn't allowed to bill the state for more than $15 million in out-of-pocket costs. The contract expires in December of 2021.

ABC7 has reached out to Blue Shield for more specifics on how the algorithm will be used to determine vaccine allocation, but we are still waiting to hear back.

How will Blue Shield impact distribution in the Bay Area?

According to the state, the Blue Shield rollout will be conducted in tiers/phases.

VACCINE TRACKER: Here's how CA is doing, when you can get a coronavirus vaccine

Contra Costa Public Health and Napa County Public Health have both been categorized in tier 3, which means Blue Shield will be getting involved starting March 14.

Sonoma County Public Health is in tier 2, indicating Blue Shield's involvement will begin March 7.

Santa Clara and Solano Counties are still awaiting guidance from the state.

ABC7 is waiting to hear back from the San Francisco Department of Public Health.

If you have a question or comment about the COVID-19 vaccine, submit via the form below or here.

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