Supervisor Todd Spitzer, in his new role as CalOptima board member, didn't waste any time last week confronting some of the issues that have dogged the $1.7 billion health plan for low-income residents in recent years.
He immediately focused on orders from both state and federal authorities that the agency fix problems with its prescription drug vendor and provide much more oversight of medical, prescription and other providers who help serve roughly 510,000 county residents.
Actions may include financial penalties and even firing some groups.
While the staff is working to correct the problems, Spitzer proposed creation of a temporary board committee to meet regularly with the Executive Compliance Committee. Currently, the board gets updates at its monthly meetings and through weekly emails from CEO Michael Schrader.
The Executive Compliance Committee includes all of the leaders of CalOptima’s various departments as well as compliance staff.
Spitzer initially asked if the 10 other voting board members wanted to temporarily meet more than once a month “at least to get through these most difficult times. There was a significant hole in compliance.”
But several board members have complained in the past that reading materials, attending the monthly meeting and possibly an additional committee meeting or two, is far more work than they realized when they volunteered for the unpaid positions. Only county employees on the board -- who include Spitzer, Supervisor Janet Nguyen and county Health Care Agency director Mark Refowitz -- are paid.
“CalOptima was just an exercise of volunteerism,” said board member Ellen Anh, executive director of the Buena Park nonprofit Korean Community Services. She said her fulltime job keeps her too busy to spend much more time on CalOptima.
Throughout the meeting Spitzer did not shy from the controversy that has enveloped the agency, noting at one point that his presence on the board stems largely from a 2013 county grand jury report that was highly critical of the way Nguyen remade the board.
This drew a sharp response from Nguyen.
"You’re talking about the grand jury report that was inaccurate,” she said. The grand jurors, she said, “only talked to former executives.”
And she downplayed the significance of the federal audit by the Centers for Medicare and Medicaid Services or CMS, saying the CalOptima program, OneCare, that received the critical audit is due to expire anyway.
But Refowitz and board member Peter Agarwal added their strong support to making sure changes are made to fix all problems.
“This is serious,” said Agarwal. “There are many operational failures we have. We need to move on and own up to it…. We should look at ourselves very carefully…. If one (unnamed contract) network is not willing to fix” its problems, “are we going to let one network drag us down?”
Refowitz said he's learned from his experience as both an enforcer of compliance reforms and an executive who has had to deal with the fallout of improper oversight that "we do need a compliance committee."
Before the current board took over, the previous board chairmen or vice chairs used to meet with the Executive Compliance Committee. It’s not known why that practice stopped.
Refowitz said he wanted to establish an ad hoc board committee on compliance but he didn’t get enough volunteers during the public meeting. Only he and Spitzer offered to serve.
“When we get you in closed session,” Refowitz told the other board members, “we’ll twist a few more arms.”
The board was scheduled to meet behind closed doors following last Thursday's meeting. It often uses vague descriptions of what will be discussed to prevent the public from knowing what it is doing, in spite of the state’s Brown Act, which very narrowly limits what a quorum of a government agency can talk about in private.
Among such items on the May 1 board closed session agenda was one that is used frequently: “Pursuant to Government Code Section 54957, PUBLIC EMPLOYEE PERFORMANCE EVALUATION (Chief Executive Officer).”
Voice of OC objected Thursday to the CalOptima board talking in closed session about the ad hoc compliance committee, telling CalOptima lawyer Gary Crockett such topics aren’t allowed under the Brown Act. Crockett apparently then told Refowitz he couldn’t meet behind closed doors on the issue.
As he went into the closed session, Refowitz told a reporter “counsel (Crockett) advised me what I wanted to do, I can’t do.”
After the meeting, Refowitz added, “there was absolutely no discussion of the ad hoc committee in closed session.”