By: Supervisor Todd Spitzer
This week, CalOptima CEO Michael Schrader appeared before the Orange County Board of Supervisors meeting. Schrader appeared before the Board at the direction of Chairman Shawn Nelson and Supervisor Todd Spitzer to discuss the comprehensive federal audit that made 57 findings about the problems with the management of CalOptima’s OneCare program. (For more information about the audit, please see last week’s newsletter here.)
“This is a good starting point to better understand the serious management problems at CalOptima and move forward to fix them,” Supervisor Spitzer said. “I thank Michael Schrader for his candid answers at the public forum of the Board of Supervisors meeting as we seek to rectify the problems at CalOptima.”
In response to questions from Supervisor Spitzer, Schrader stated that turmoil from the high turnover of management had harmed CalOptima’s ability to provide services and oversee contracted health plan networks. Schrader, who joined CalOptima 13 months ago on December 30, 2012, explained that he spent months filling the vacant management roles.
Supervisor Spitzer shared 2009-2012 data that CalOptima had sent to state legislators showing that the number of OneCare member appeals and grievances had spiked from 2011 to 2012 at the same time that OneCare provider appeals declined. Specifically, OneCare Member Appeals soared from 189 to 474 – a jump of more than 2.5 times the number from the previous year. OneCare Member Grievances increased from 331 to 452, an increase of more than one-third. OneCare Provider Appeals declined from 224 to 201, a drop of 10.3%.
Schrader stated that CalOptima had been “trying to be a friend not a parent” to providers when it should have been serving in a “parent” role by providing oversight. Schrader also acknowledged that during this time period, the compliance staff was substantially the same with significant management turnover. Supervisor Spitzer expressed serious concerns that patients felt they were being mistreated during this period at the same time that there was complete management turmoil.
Board of Supervisors Chairman Shawn Nelson pointed to a 2011 ordinance change that was approved on a 3-2 vote of the Board of Supervisors that increased provider representation on the CalOptima Board. He suggested that the data provided indicated a link between the 2011 ordinance change and the increase in member complaints along with a decrease in provider appeals.
At its February 25 meeting, the Board of Supervisors will examine the entire governing ordinance of CalOptima.
CalOptima is the government agency that serves as the health plan for the poor and elderly in Orange County. CalOptima’s OneCare Program is the health plan for 16,000 Orange County residents who are enrolled in both Medi-Cal and Medicare Parts A and B.