Amid a critical time in the pandemic, Blue Shield of California conducted an intensive outreach effort to boost COVID-19 vaccination rates in communities that were hardest to reach during the early stages of the vaccine rollout.
The vaccination campaign was implemented, in part, as a response to the California Department of Health Care Services (DHCS) COVID-19 Vaccination Incentive Program. The goal of the program, which ran from Sept. 1 to Feb. 28, was to reduce the gap in vaccination rates between Medi-Cal beneficiaries and everyone else. Initially, roughly half of Medi-Cal beneficiaries aged 12 and older had received at least one dose of a COVID-19 vaccine, compared with three-fourths of all Californians.
Medi-Cal, the state’s Medicaid program, provides free or low-cost health coverage to people with incomes below a certain level and limited resources. Blue Shield’s outreach efforts focused especially on African Americans, Native Americans, and other people of color in Los Angeles and San Diego counties who had the lowest vaccination rates of Blue Shield members and where Blue Shield provides Medi-Cal through Blue Shield of California Promise Health Plan.
During the campaign period, the number of Blue Shield Promise members who received at least one dose of the COVID-19 vaccine rose by about 10 percentage points, and the health plan made significant progress towards closing the vaccination gap among African Americans and Native Americans.
“We already had vaccine efforts underway for almost a year, but reaching people who were vaccine-hesitant or were encountering language or cultural barriers required new ways of thinking,” said Daniel Gerardo, senior Medi-Cal project manager with Blue Shield Promise.
To address this opportunity, Blue Shield Promise assembled a cross-functional team that developed a plan to reach the unvaccinated. It focused on contacting members directly and the unvaccinated population at-large through community- and faith-based organizations, schools, county health departments, and doctors, and by collaborating with other health plans. Blue Shield Promise and its partners engaged with members and the community at large via texts, emails, and phone calls in multiple languages, and some community partners went door-to-door in neighborhoods to promote vaccine awareness. Through more than 1,500 outreach and education activities, nearly 500,000 community members were engaged and more than 13,000 vaccines were administered.
Reaching Deep into the Medi-Cal Population
“The vaccine incentive program allowed us the freedom to get creative and develop strategies focused on hard-to-reach populations,” Gerardo said. The three main channels used for outreach were:
- Member communication: To its Blue Shield Promise members, the health plan sent 76,000 letters and made 9,000 telephone calls. It placed ads on Facebook and Spotify that garnered 2.2 million and 268,000 impressions, respectively.
Through its collaboration with SameSky Health, formerly known as Consejo Sano, Blue Shield Promise launched its first educational texting campaign in 15 languages.
It revamped its Blue Shield Promise website to provide clearer, more user-friendly information about COVID-19 vaccines and offered incentives to qualifying Blue Shield Promise members who got a first or second dose.
- Community groups and regional collaborations: Blue Shield Promise provided a total of $1.6 million in grants to 26 community-based organizations working with targeted communities with high unvaccinated rates in Los Angeles and San Diego counties, regardless of whether they were Blue Shield Promise members. Community alliances are fundamental to building a successful outreach infrastructure and include diverse organizations that hold historical and cultural knowledge to navigate the hardest-to-reach communities.
“They were the trusted messengers,” said Val LiHang Jacobo, a Blue Shield program manager. "These cultural organizations have access and influence in these communities, and that is what we invested in.”
For example, Comunidades Indígenas en liderazgo (CIELO), an Indigenous women-led nonprofit organization that works jointly with Indigenous communities, handed out information at Home Depot stores where day laborers wait for work. Community Organized Relief Efforts (CORE) hosted a virtual workshop to train promotoras, or health promoters, of Promesa Boyle Heights, on how to effectively reach Spanish-speaking community members. The North County LGBTQ Resource Center conducted multiple phone banks to their members and in zip codes with the highest unvaccinated rates.
Five organizations, including the Southern California Pacific Islander COVID-19 Response Team used communications platform Harmony Health to send 320,000 text messages, in four languages, to community members telling them where they could get a COVID-19 test or vaccine. Approximately 45% of in-language engagement led to action steps.
Blue Shield of California and Blue Shield Promise also collaborated with tribal organizations, county health departments, and the state vaccine program.
Shurene Premo, a wellness program manager at the San Diego American Indian Health Center, praised Blue Shield Promise for “honoring Indigenous peoples and their heritage by joining with us to increase awareness about the importance of getting the COVID-19 vaccine as well as providing at-home COVID-19 tests and face masks to help ensure that Native American community members stay healthy.”
- Provider engagement: The team learned that many unvaccinated people “have high trust of their personal physicians, even if they didn’t trust the health care system,” Jacobo said. For that reason, Blue Shield Promise worked with doctors and physician groups in myriad ways. For example, “We worked with Adventist Health to operate mobile vaccine units and extended-hours clinics, specifically to address after work and weekend opportunities. We also worked with Walmart to co-host a few vaccine drives, and one event resulted in more than 300 community members receiving a vaccine,” Jacobo said.
The team mailed a tip sheet to doctors statewide offering specific ways to communicate effectively with vaccine-hesitant patients. “The talking points emphasize listening and validating patients’ feelings, but being very clear about the benefits of vaccination,” said Dr. Malaika Stoll, Blue Shield of California senior medical director.
The results so far:[i]
- In San Diego County, between Aug. 29 and Feb. 6, the number of Blue Shield Promise members aged 12 and older who had received at least one dose rose by nearly 10,900 people, to 65.4% from 57.8%. The percentage of vaccinated African American members rose to 50.6% from 45.1% and the percentage of vaccinated Native American members increased to 52.2% from 48.4%.
- In Los Angeles County, between Aug. 29 and Feb. 6, the total number of vaccinated members rose by nearly 38,400, to 68.2% from 54.7%. For African American members, the percentage jumped to 40.0% from 31.9% and for Native Americans, it rose to 50.0% from 42.9%.
- Between Aug. 29 and Feb 6., in Los Angeles County, over 15,000 Blue Shield Promise members aged 5 to 11, who became newly eligible for the vaccine, got at least one dose.
- Between Aug. 29 and Feb 6., in San Diego County, over 2,500 Blue Shield Promise members aged 5 to 11, who became newly eligible for the vaccine, got at least one dose.
“We are proud of our efforts within Blue Shield Promise and within our communities,” Gerardo said. “Our health plan project team came together as if they had always been working in this manner, when in fact they had never collaborated across various teams like this. The community groups we worked with put in great effort and we are now strengthening these relationships. We are happy that we were able to positively impact so many lives.”
[i] Sources of all data:
- Race/ethnicity is using self-identified race/ethnicity as well as imputed race/ethnicity for members who did not self-identify.
- The Aug. 29th data point uses the August 2021 Blue Shield Promise membership and the COVID vaccinations from DHCS CAIR2 and L.A. Care CAIR2 data through Sept. 14, 2021 and accessed Sept. 29, 2021.
- The Feb. 6th data point uses the February 2022 Blue Shield Promise membership.
- The Feb. 6th data point uses the COVID vaccinations from DHCS CAIR2 data as of June 6, 2022, with vaccine dates through June 5, 2022, for CMC-LA, CMC-SD, and Medi-Cal SD members, and the L.A. Care CAIR2 data as of 5/19/2022 with vaccine dates through May 8, 2022 for Medi-Cal LA members. Accessed June 27, 2022.
- *Percentage increase in vaccination rates among Medi-Cal population data differs from the April 2022 DHCS report for Blue Shield Promise due to a state data lag.
- LA County includes both Medi-Cal LA and CMC-LA members, which is slightly different than how L.A. Care reports this information
- SD County includes both Medi-Cal SD and CMC-SD members, which is slightly different than how DHCS reports this information