L.A. Care CEO on vaccinating California's most vulnerable: 'There's no magic bullet'

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John Baackes is the CEO of L.A. Care Health Plan (Calif.), a managed care plan providing Medicaid coverage to 2.2 million people in Los Angeles County. He spoke with Becker's on Aug. 18 about the organization's latest efforts to vaccinate the city's Medi-Cal members. 

Editor's note: Interview has been lightly edited for length and clarity.

Question: What are some of the trends you're seeing within your health plan in regards to the pandemic and the Delta variant? 

John Baackes: The biggest trend we're seeing that's of concern to us is the lack of vaccinations among the Medi-Cal population, which lags the state as a whole. And the state has recognized that, and is providing a pool of $350 million that will be available to Medi-Cal managed care plans like L.A. Care beginning in late September to put on programs to incentivize our members to get vaccinated. I think they're recognizing that because of the relationship we have with our members, we might be the best vehicle to communicate with them and to get them vaccinated. 

Now, it's not as if we've been sitting around doing nothing since vaccines have been available. We've done a whole host of activities, including running 16 vaccination clinics of our own. Unfortunately, we had 16,000 doses of [the Johnson & Johnson vaccine]. After we had done four clinics, the news came out that there was a halt on that vaccine while it received further safety checks. And when we resumed it, we held two more clinics and only 150 out of the thousands of people who had made appointments showed up. So we discontinued those and gave the vaccines back. 

But we've done other things. We've given out a million dollars in grants to our partners who will buy the vaccines to help them meet demand. We're doing a PR campaign. But more importantly, we use the data we have on our members to reach out to those who we felt were the most vulnerable to urge them to get vaccinated and provide them information on where they could get that vaccination. We did that by calling high-risk members. Then we called all of our Black members. And then we called all of our Latino members to make sure that they were aware of where they could get a vaccination.

When we started calling our homebound members to see if they wanted to have us arrange to have a vaccine provided to them at home, we found that 50 percent of them had already been vaccinated. So there are encouraging signs that people are getting access. So I think it's not so much access as it is vaccine hesitancy, which of course has been a problem across the country. So with this new money that the state will be providing us, we'll be looking for ways to get the message out and entice people to come in for vaccinations. 

Now, we do know there are some of our members who do work and who can't take a day off to go get the vaccination. So we're trying to figure out ways we can work with those people to provide it by either having it done at home or whatever the other options might be, but that's really the most important and disturbing trend that we're observing. And it's shared by our fellow health plans across California.

Q: Why do you think there is so much vaccine hesitancy within the Medicaid population?

JB: Well, I'd say first there is the one issue for some people of, "How do I schedule it?" And those same people are also saying, "Okay, if I get the vaccine and there is a reaction, I don't have paid sick leave, so that's another day off from work where I won't get paid." So we know that's one cohort, but we also know there is a cohort of people who still don't believe that the vaccine is safe because it's under emergency authorization, and they're hesitating on that. 

There's also a cohort that we know is suspicious that this is a government program. The Tuskegee Institute issue, which is almost 50 years behind us now, is still deep in the memory of the Black community in particular, which makes them suspicious of any government suggested or offered service. And that is a problem that we can only, I think, deal with through education and through talking to people. So I think what everyone is beginning to recognize is that it's going to take probably a one-to-one communication between a hesitant person to get the vaccine and a trusted source — either their personal physician, their primary care doctor, a minister or another family member. So I think we're going to have to look at ways that we can meet people where they are and talk to them directly about their hesitancy. 

We're definitely working on that. We were just doing a PR campaign [featuring actor Jaime Camil] who is well known on Telemundo and has appeared in other programming. I think these things will be helpful, but like more and more people tell us, it's not going to be the celebrities. It's going to be the person that the hesitant vaccinator knows personally that says it's okay or talks them through it. I think that's the level we've got to get to. So I guess if we can figure out a way to match people who are that trusted source with people who aren't vaccinated, we might be able to make some inroads. But we have seen an uptick in vaccinations since the Delta variant surge has occurred here in Southern California, which is good news. Because people are getting scared and thinking "I better get on with this." So we're hoping that [between] a combination of whatever efforts we make, people being scared by the news and then people who do get sick and recover who then have some immunity, that we will reach a community herd level soon. Because that's the only way we're going to go back to some sort of normal life. It's a combination of things. There's no magic bullet here.

Q: What advice do you have for other health plan CEOs?

JB: Well, don't rest on your laurels. Yesterday's success is no guarantee of future success. It's a very dynamic environment, as we all know, but particularly for those of us who are dealing with the Medicaid or the California Medi-Cal population, this pandemic has been horrific. First of all, it has, I think, really illustrated in a very stark way the consequences of the inequality in our society, because the Medi-Cal members who are generally in a lower economic status who — if they do have jobs — [have] jobs that require their presence at work. You're not able to work remotely when you're a valet or a housekeeper in a hotel, a kitchen staff member in a restaurant or any of those jobs that you might have in a hospital. So they have to go out and work, and that has put them at greater risk.

And we saw that in our data. Our Hispanic or Latino members were affected at three times the rate of the white population, the Black members about two to two-and-a-half times. And there was even a little higher rate per our Asian cohort. And this is a very diverse population here in Los Angeles. Countywide, we're probably about 48 percent Latino, about 28 percent white, about 15 percent Asian and about 9 percent African-American or Black. And you know, I've never lived in such a diverse place. So you have to factor all of that in, but I'd say for the health plans — particularly the ones that are dealing with Medicaid — we're looking at the broader life experience that our members have to deal with and how that impacts their health care. 

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