CalOptima’s chief medical officer, Dr. Gertrude “Trudi” Carter, has resigned from Orange County’s $1.4-billion health plan to take a similar post in Los Angeles County, according to an announcement Thursday from L.A. Care.

Carter becomes the 16th top executive or director to leave CalOptima since August 2011. Most have left since last fall when Supervisor Janet Nguyen reorganized the board of directors and took control of the health plan that serves more than 400,000 low-income, disabled and elderly county residents, about a third of them children.

She will leave CalOptima Nov. 9 and start at L.A. Care Nov. 19. Carter’s departure came in spite of retention bonuses offered to Carter and five other leaders. The bonuses, called “retention incentives” offered a month’s salary to each of the six if he or she stayed through January, when CalOptima’s board expects to have a chief executive officer.

Currently, the CEO position is vacant and the posts of chief operating officer and chief financial officer are filled with temporary appointees.

“Given the key role that our executive team plays in CalOptima’s success, the Board asked the former Interim CEO to determine a way to retain them at CalOptima throughout the transition of the new CEO,” stated CalOptima spokeswoman Kellie Todd in an email this week. She wrote that the CalOptima board in 1994 gave the CEO the authority to set salary and compensation for staff.

Last week, when asked briefly about the bonuses during breaks in a closed-door CalOptima board meeting, board Chairman Mark Refowitz, head of the county’s Health Care Agency, said he had “no comment,” and Nguyen said “I haven’t heard of anything from staff yet.” It wasn’t clear whether other board members had been briefed her on the bonuses.

The recent bonuses appeared to take CalOptima full circle.

Pay incentives became an issue during the summer of 2011 when the CalOptima board said then-CEO Richard Chambers had met performance criteria that enabled him to receive a bonus that, along with a car allowance, raised his annual pay to $515,743, according to the Orange County Register. Bonuses ranging from $20,700 to $67,000 were awarded to nine other top executives, based on performance criteria. CalOptima board members said the financial incentives were necessary because private industry and other health organizations paid its executives far more.

But Nguyen criticized the bonuses and leveled a series of other, unspecific complaints at the way CalOptima was run. Her changes to the board’s composition gave a stronger voice to medical providers and county government and reduced the influence of nonprofit organizations that provided services to the health plan’s recipients. CalOptima’s financing comes from federal and state governments, not county funds.

Apparently running counter to Nguyen’s complaints were outside assessments of CalOptima’s operations. In January, for the third consecutive year, CalOptima was honored by the state for “superior performance,” according to a news release from the chairman of the state Managed Risk Medical Insurance Board.

In September, CalOptima sent out a news release announcing it completed a stiff, three-year evaluation and now was accredited by the National Committee for Quality Assurance (NCQA).

It’s score of 87.01 placed it “at the top of the list among California Medi-Cal plans and in the top six Medi-Cal plans in the nation,” according to the CalOptima news release.

It was Carter who led the effort to obtain NCQA accreditation, according to an announcement at the September board meeting.

L.A. Care, the largest public health plan in the nation, is more than twice the size of CalOptima, serving more than one million residents, according to its news release.

“Her accomplishments at CalOptima alone, including the restructure of its medical management to include a catastrophic medical management program and the implementation of a program for seniors and persons with disabilities, make her an invaluable asset to our team,” stated L.A. Care CEO Howard A. Kahn in the announcement.


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