The Orange County Board of Supervisors, for the second time in less than five years, is set Tuesday to remake the board of directors of CalOptima, the $3.2 billion county health plan for low income and disabled residents.

Major changes include reducing the size of the board from 11 members to nine, removing current Chairman Mark Refowitz, head of the county Health Care Agency, as a voting member, and possibly widening the pool of medical industry professionals who could serve on the new board to include pharmacists or nurses.

Among the more controversial changes is a proposal to allow spending requests and other issues to be approved by less than a majority of the full board. Both the current and proposed boards have a number of members with financial conflicts of interest that force them to recuse themselves on a regular basis.

Supervisor Andrew Do, who along with Board of Supervisors’ Chairwoman Lisa Bartlett wrote the new ordinance, said the reason for the remodel is “more oversight and accountability.”

Do said he wants experienced health industry professionals on the new board who will speak up on issues to make sure the No. 1 priority is quality care for patients.

“That’s my mission for doing all of this,” he said. “Ultimately, member care is the only goal.”

He said the new ordinance, which would take effect Aug. 4, would allow the supervisors to select a CalOptima board that is “more actionable” and has more experience than the current board.

“We need a board that’s engaged,” he said, adding he wants board members who will publicly express opinions.

A Bartlett spokeswoman said the supervisor was too busy Thursday to be interviewed about the changes.

Years of Turmoil

The 20-year-old CalOptima, long considered one of the nation’s top health plans, has experienced more than four years of turmoil since the original ordinance was redone in 2011 by Do’s predecessor, now state Sen. Janet Nguyen (R-Garden Grove).

Under the ordinance written by Nguyen and a former lobbyist for the Hospital Association of Southern California (HASC), the board was expanded from nine to 11 members, with most being new to the board and having no experience running a health plan.

Her new board engaged in minimal discussion, with Nguyen clearly dominating the proceedings. And some publicly complained about the workload.

Nearly two dozen high-level executives during that period, including the CEO, CFO and Chief Medical Officer, left the organization. And former board members and others began speaking out about a toxic atmosphere that permeated the agency.

And as new management struggled to fill key vacancies federal auditors found a “serious threat to the health and safety” of 16,000 participants had developed in the OneCare program for elderly residents and banned it from accepting new members for 11 months until improvements were made. State auditors discovered additional performance problems at CalOptima. Virtually all of CalOptima’s $3.2 billion budget comes from federal and state tax funds.

Nguyen did not return a telephone call Thursday seeking her comments on the new board plan.

Under the new ordinance, all existing board members will be replaced when the new board takes effect, but current members can apply to serve on the new board.

Other proposed changes include:

• Offering up to $300 per month plus mileage to members of the previously volunteer board for attending meetings. The two Supervisors on the board as well as the non-voting Health Care Agency director wouldn’t be eligible for the payments because they serve as part of their regular jobs.

• Giving the county supervisor whose district includes the most CalOptima members the automatic option of serving on the CalOptima board. Do’s First District, which stretches across much of central Orange County, has the most CalOptima members. When Nguyen was a supervisor, she unsuccessfully tried to get the rest of the board to give her and whoever followed with the most patients in their district a permanent CalOptima board seat.

• Reducing the number of community clinic seats on the board from two to one.

• Potentially replacing one of the two doctors now on the board with a nurse, pharmacist or other medical professional.

• Allowing a family member of a CalOptima member to hold the board seat reserved for a member. Before Nguyen made her changes, a family member was allowed to represent a child, but Nguyen eliminated that option. Children make up more than 43 percent of CalOptima patients, according to the health plan’s figures.

While some of the changes are viewed as positive, concern has been raised about the proposal to lower the number of votes needed to approve items because of potential conflicts of interest.

Good government experts, speaking in general terms, said issues with widespread conflicts of interest on any board are indications recruitment efforts aren’t what they should be.

Bob Stern, who co-authored the state’s Fair Political Practices law, said to create any board that is well-qualified it’s important to conduct wide outreach.

“You look for the best possible people, obviously, who have knowledge but no conflicts” of interest, he advised.

Added Nancy Sylvester, an Illinois-based parliamentary procedure expert, “it’s extremely unusual to appoint a good number of people who would have to recuse themselves.”

If the supervisors are going to do that, she said, they should “make sure there is a core number of people who would not have to recuse themselves.” Too many conflicts of interest potentially can make it difficult to approve good proposals, she pointed out.

Do: Seeking Well-qualified Board Members

Do, who formerly was Nguyen’s chief of staff although the two now are politically estranged, said he wants experienced health industry professionals on the new board who will speak up on issues to make sure quality care for patients is the No. 1 priority.

CalOptima serves about 773,000 patients, roughly one fourth of the county’s 3.1 million population. About 29 percent of CalOptima members speak Spanish and 10 percent Vietnamese, according to the organization’s statistics.

Before Nguyen’s tenure, it often was difficult to find a county supervisor willing to serve on CalOptima. One supervisor even made fun of the organization. But Nguyen showed the campaign fundraising potential of the medical industry. (https://voiceofoc.org/2013/01/medical-industry-gave-to-nguyen-campaign-during-caloptima-overhaul/) Before joining the CalOptima board, Nguyen had minimal campaign contributions from the industry, but in the nine months after she introduced her 2011 changes to the board, she raised $50,000.

Do was elected to the Board of Supervisors last year after Nguyen won a state Senate seat. He was Nguyen’s chief of staff when she was a supervisor, but the two now are politically estranged. He said he is trying to make government decisions transparent and is actively seeking suggestions on the proposed changes to the CalOptima board.

“I look forward to hearing the public’s input on these proposed changes and welcome ideas for how we can increase oversight and accountability at CalOptima,” he said in a news release. “The best way to ensure accountability is for the public to be engaged and involved in every step of the process.”

He asked those with an interest in CalOptima to call his office, (714) 834-3110, email him, Andrew.Do@ocgov.com, contact him through social media on Twitter @AndrewDoOC or Facebook.com/OCSupervisorAndrewD.

He also urged people to offer suggestions at the Jan. 26 Board of Supervisors meeting.

You can contact Tracy Wood at twood@voiceofoc.org and follow her on Twitter: @TracyVOC.

A previous version of this story incorrectly stated the One Care program was shut down by federal auditors. It was barred for 11 months from accepting new members until problems were corrected. Voice of OC regrets the error.

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