Community Editorial: Orange County’s CalOptima Is Here to Stay

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Kenny Rivera

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Voice of OC reported last week on the latest in a series of activities involving Orange County’s Medi-Cal managed care agency, CalOptima: that the agency’s board chairman had been accused of “self-dealing,” a possible violation of state law and rules issued by the Fair Political Practices Commission (FPPC). This latest development is also reported in the publication Payers and Providers.

For those not living and breathing “health care” on a daily basis, here’s a recap of preceding events:

Last Spring, the Board of Supervisors approved an ordinance change prohibiting CalOptima, a public agency, from competing in the Health Care Exchange against the private sector to serve the general public (patients who are not low income and in government programs).

Also last year, the CalOptima board started evaluating internal operations. An outside auditor will be selected soon to perform a thorough audit of operational procedures and policies.

The board of supervisors voted to align CalOptima’s board composition with that of most other similar entities in Southern California.

Seven top managers at CalOptima resigned to take other positions, including CEO Richard Chambers, who announced last week that he will depart in April.

Last week’s news concerning CalOptima’s board chairman links to efforts involving CalOptima, hospitals, physicians, and others in the health care community to make improvements to Orange County’s health care delivery system. The Hospital Association of Southern California (HASC) and the hospitals serving the communities of Orange County fully support these efforts.

Notwithstanding their collaboration with CalOptima and others on the health care delivery system project, doctors and hospitals have not always agreed with the policies and practices of CalOptima.

Many, including HASC, supported the successful efforts to bar the agency from participating in our state exchange and to restructure its governing board. These positions developed largely as a result of tensions surrounding a lack of transparency and lack of collaboration with stakeholders — tensions that over time grew into distrust of CalOptima and its board.

A handful of Orange County’s elected officials and others point to what has really been a healthy exercise in good government — the raising of legitimate issues and appropriate oversight by the Board of Supervisors as the entity that established CalOptima — and either chide those raising legitimate issues or question whether CalOptima should continue to exist.

Most, however, recognize that a certain amount of tension between providers and health plans should be expected; it is a dynamic that produces a healthy balance between payers and providers in the marketplace.

And most believe CalOptima, in partnership with its medical community, should continue its vital mission of managing the medical care needs and services provided to the county’s poor and medically vulnerable population.

Most also know and expect that public agencies will follow closely the principles in the FPPC’s ethics primer.

The L.A. Care Health Plan, for example, drills into their board members the contents of the primer. The essence of it is to avoid even the appearance of impropriety or conflict of interest.

It remains to be determined whether in this case there was impropriety.

The FPPC may or may not decide to look into the case regarding CalOptima’s chairman.

Regardless, CalOptima serves over 400,000 patients today and is on track to serve about 27 percent of the county’s population in 2014.

It’s safe to say that the important work of CalOptima and its medical providers, who are striving to serve these patients under challenging circumstances and in tough economic times, will continue.

Julie Puentes is a Voice of OC Community Editorial Board member and vice president for Orange County for the Hospital Association of Southern California.

 

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