CalOptima board members, in sometimes unusually candid discussions during a weekend strategic planning workshop, said they were surprised by how hard they've had to work to help run the $1.5-billion health plan for low-income, disabled and elderly Orange County residents.
And several said they've received little or no training to help them learn their new responsibilities.
“My expectation was I would be spending two hours a month at one meeting,” said board member Peter Agarwal, vice president of Citizens Business Bank in Fullerton, during one of the group discussions. “Can I continue doing this four years from now? Absolutely not.”
Board member Steven Knoblock, a lawyer, in summing up discussions from another group, told the workshop that serving on the 10-member CalOptima board has “been a learning curve for a lot of us.”
The CalOptima board's monthly meetings can last as long as four hours with much of a typical meeting taking place in closed sessions. Those meetings — as well as quarterly committee meetings and the work needed to understand the issues before them — take up a tremendous amount of time, the board members said.
The Friday afternoon and Saturday CalOptima workshop provided an unusual opportunity for the public to hear from board members of the health plan that serves more than 400,000 county residents, including one third of the county’s children.
A three-member majority of the county Board of Supervisors, led by Supervisor Janet Nguyen, restructured the CalOptima board of directors last year. The new board, with no institutional memory or training, came in at the same time the entire top management of CalOptima left for jobs in private industry or other government organizations.
At most of the monthly CalOptima board meetings during the past year, members have rarely discussed issues and generally voted in support of whatever suggested by Nguyen or board Chairman Mark Refowitz, who is also head of the county Health Care Agency.
Several board members during the weekend group meetings said they didn’t have time to read all of the background information prepared by the staff in advance of the monthly meetings and said they were looking for ways to cut the workload.
Seven board members are volunteers with no staff. Nguyen, Refowitz and Social Services Agency director Michael Riley serve on the CalOptima board as part of their county jobs and have the support of their county staffs. Nguyen, for example, generally has three or four of her staff members, including her top staffer, sit through each monthly CalOptima board meeting.
Gayla Kraetsch Hartsough, president of Los Angeles-based KH Consulting Group, which conducts management training for government and private clients, led the workshop.
Hartsough said her organization worked with Orange County after the 1994 bankruptcy and is working with the Los Angeles County assessor’s office as it tries to recover from the arrests of Assessor John Noguez on bribery charges and another top assessor’s office executive, Mark McNeil, on charges of conspiracy and misappropriation of public funds.
Hartsough gave the inexperienced CalOptima board members advice on how to avoid getting themselves into trouble.
Conflicts of interest, she said, are the primary problem.
“The No. 1 reason why they [board members and others in public life] fail is they feel they’re above the rules,” she said. When that happens, inevitably “somebody will go after them.”
Citing the example of the L.A. County assessor, she said, “it’s very important that you understand the conflict of interest rules.”
In addition, Hartsough said board members must clearly understand CalOptima is both a public agency and a health plan. This means it has to both avoid the stifling bureaucracy that can hinder a government agency and the all-consuming profit motive that characterizes private industry.
CalOptima, she said, should “be efficient like a private entity but meet the standards for transparency and accountability” of a government agency.
Conversations touched on a series of other topics, such as the importance of CalOptima’s work and the possibility of competing for grants to increase funding.
In his summary of one group discussion, Knoblock said the group suggested adding representatives for patients and nurses to the Quality Assurance Committee [QAC].
They also suggested changing the committee's name so its acronym would no longer be pronounced "quack."
Correction: A previous version of this article misstated the professional title of CalOptima Board member Peter Agarwal. We regret the error.