Gold Coast Health Plan
2220 E. Gonzales Road, Suite 200
Oxnard, California 93036
805-981-5320Website: www.goldcoasthealthplan.org
Established: April 2010
Membership:
Number of providers:
Background
On June 2, 2009, the Ventura County Board of Supervisors approved
implementation of a County Organized Health Care System (COHS) model to
transition from fee-for-service Medi-Cal to managed care. Ordinance 4409
(April 2010) established the Ventura County Medi-Cal Managed Care Commission
as an independent oversight entity. The Commission operates a single plan -
Gold Coast Health Plan - to serve the Ventura County Medi-Cal population
(estimated at 100,000 beneficiaries).
Mission
To improve the health of our members through the provision of the best
possible quality care and services.
Vision
Improve access to primary, specialty and ancillary services.
Values
Composition of the Commission
The Commission is composed of eleven members – representing public and
private providers and the community. In the initial cycle of appointments,
four members were appointed for two-year terms: the Ventura County Medical
Center Health System representative, the physician representative nominated
by the Ventura County Medical Association, a public representative, and one
private hospital/healthcare system representative. All other initial
appointments and subsequent appointments are four-year terms. No member may
serve more than two consecutive four-year terms. Vacancies will be filled by
the Board of Supervisors for the remainder of the unexpired term and shall
maintain the balance of representation.
Current Commission Members
David Araujo, MD, Director, VCMC Family Medicine Residency Program
Maylee Berry, Medi-Cal Advocate
Anil Chawla, MD, Clinicas del Camino Real Inc.
Lanyard Dial, MD, Ventura County Medical Association Representative (Chair)
Laurie Eberst, RN, CEO, St. John’s Regional Medical Center
John Fankhauser, MD, Physician, Ventura County Medical Center
Robert Gonzalez, MD, Director, Ventura County Health Care Agency (Vice
Chair)
Rick Jarvis, Los Robles Hospital
Roberto S. Juarez, CEO, Clinicas del Camino Real Inc.
Kathy Long, Member, County Board of Supervisors
Catherine Rodriguez, Ventura County Medical Center Health System
Vacant, Private Hospital/Health System Representative
Role of Commission
The role of the Commission is to:
Other Committees
The health plan operates with guidance from two committees established by
County Ordinance 4409: the Member/Consumer and Provider Advisory Committees.
Others committees required within the contract between the State of
California Department of Health Care Services include:
Quality/Utilization/Peer Review and Credentials Committees. At a minimum,
these committees meet quarterly and make recommendations, review programs,
explore issues and discuss how the plan can best fulfill its mission.
Appointed by the Commission, the individuals serving on the committees
represent a broad spectrum of members and service providers. Along with the
Commission, they form the foundation of the community relationship.
Member/Consumer Committee
The ten 10 voting members represents various constituencies served by the
plan, such as:
Two of the positions are standing seats, which include the Health Care Agency and the Human Services Agency. Each of the appointed members serves a two-year term with the exception of the standing seat positions. Committee members may reapply for additional terms, as there are no term limits. The committee meets at least quarterly.
Provider Advisory Committee
The ten 10 voting members represents various constituencies served by the
plan, such as:
One of the 10 positions is a standing seat representing the County Health
Care Agency. Each of the appointed members, with the exception of the
standing seat position, serves a two-year term, but may reapply for
additional terms, as there are no term limits. The committee meets at least
quarterly.
Quality and Peer Review Committee
The committee will have a minimum of ten voting members and be facilitated
by the GCHP Chief medical Officer. Each of the appointed members serves a
two-year term, and may reapply for additional terms, as there are no term
limits. The committee composition will be representative of the contracted
provider network, including but not limited to, subcontractors who provide
health care services to seniors and persons with disabilities or chronic
conditions (i.e. asthma, diabetes, congestive heart failure). The committee
will meet at least quarterly.
Credentials
The committee shall have a minimum of eight voting members and be
facilitated by the GCHP Chief Medical Officer. Each of the appointed members
serves a two-year term and may reapply for additional terms, as there are no
term limits. The committee composition will be representative of the
contracted provider credentialed by the plan.
Management Team Biographies
S.N. Charles Cho, MD (Chief Medical Officer).
Dr. Cho began his professional experience as attending and teaching staff at
Ventura County Medical Center Family Practice Program in 1966 and was in
private practice in Oxnard for more than 30 years. He was on active staff at
St. John’s Regional Medical Center in Oxnard from 1968 to 2000. He continues
to serve as the part-time physician for Procter and Gamble and has been
there since 1977. Charlie earned a B.S. from Piedmont College and his
medical degree from the University of Kansas School of Medicine.
Connie Davis (Claims Administration).
Most of Connie’s career has focused on Managed Care Operations, with a
strong emphasis in Claims Administration and Customer Service Operations.
Performing in senior level management positions, she has solid leadership
experience in regulatory compliance and operations. Connie started a managed
care consulting organization in 1996 and has worked with many prestigious
clients, including the California Department
of Managed Health Care. Many of her clients were start up organizations or
companies confronting large scale transition, with system and process
reengineering. Connie holds a Bachelor of Science, cum laude, in Education
and Kinesiology from Drake University, Des Moines, Iowa.
Andre Galvan (Member Services). Andre holds a MHA from the University
of Southern California and earned his BA in Communications from Columbia
College in Chicago. Most recently he was a Project Manager with
WellPoint/Blue Cross of California in Thousand Oaks where he focused on
hospital & medical group relations.
Guillermo Gonzalez (Government Affairs). Most recently, Guillermo
served as a senior analyst with the Government Accountability Office (GAO)
overseeing federal economic recovery funds in Southern California. He also
served for ten years as senior advisor and Deputy State Director to United
States Senator Dianne Feinstein of California. During his tenure with
Senator Feinstein he worked on numerous public policy issues concerning
health, environmental, education, and immigration policy. Mr. Gonzalez was a
Legislative Fellow with the California State Legislature and has served as a
legislative aide and consultant to the Speaker of the California State
Assembly where he worked on education, health, and housing policy. Mr.
Gonzalez earned a BA in Political Science from the University of California
at Santa Barbara and a Master of Public Policy from the Woodrow Wilson
School of Public and International Affairs at Princeton University.
Earl G. Greenia (Chief Executive Officer). Prior to joining Gold
Coast Health Plan, Dr. Greenia, served as the CEO for the Hawaii Health
Systems West Hawaii Region where he led a successful financial turn-around
(from annual losses of $7 million to a $4.5 million excess), significant
improvement in physician satisfaction and clinical quality (core measure
scores increased from 69% to 97%), as well as adding new services (notably,
the Kona hospital was the first in the state to begin functioning as a
Level-3 trauma center). He has held positions in operations, quality and
strategic planning with Tenet Healthcare, Sharp Healthcare, UCLA Medical
Center and Childrens Hospital Los Angeles. He earned a BA from the
University of Vermont, a Master of Health Administration and a Ph.D. in
public administration from the University of Southern California. A Fellow
of the American College of Healthcare Executives, Earl has over 25 years of
experience in health care administration. He also holds an adjunct
appointment as an assistant professor at the University of Southern
California, where he teaches the graduate seminar in hospital administration
each summer.
Darlane Johnsen (Chief Financial Officer). Darlane is an experienced
finance executive with nearly twenty years of experience in managed care.
Most recently, she was the Vice President of Finance for Health Net’s
California Health Plan, responsible for budgeting and financial forecasting.
Previously, she served as CFO of Health Net’s Government Programs Strategic
Business Unit; focusing on both state and federal programs and played a key
role in the implementation of the Med-Cal Two Plan Model and was involved at
the inception of the Healthy Families Program. While at Health Net, she
served as a senior advisor to all State Health Program contract rebids,
county expansions and strategic initiatives. Darlane earned a degree in
Sociology from the State University of New York. She later attended
California State University in Sacramento and completed additional studies
in business and accounting. Darlane was employed by Coopers & Lybrand and
obtained her CPA license in 1988.
Pamela Kapustay, RN, MN (Health Services Director). Pam has worked in
healthcare for over thirty years – she started in nursing and progressed
into management. Most recently, she served as Director, Medical Management
for Wellpoint, Inc. Ms. Kapustay has held senior level positions in
pharmaceutical development corporations, as well as positions at UCLA, Santa
Rosa Medical Group and Westlake Comprehensive Cancer Center. She earned a
Bachelor of Science in Nursing from the University of Texas Health Science
Center and a Masters in Nursing from UCLA. Pam is a member of Sigma Theta
Tau – an International Honor Society of Nursing; her work has been published
in several textbooks and nursing publications.
Steven Lalich (Communications). Steve is a seasoned communications
professional and successful healthcare entrepreneur who has worked with a
variety of healthcare brands. He ran SGL Consulting, a public relations and
marketing communications consultancy, focused on branding and media outreach
campaigns designed to maximize organizational goals. Previously, he held
senior marketing and public relations positions at Ogilvy Public Relations
Worldwide (where his clients included Amgen, Aradigm and Glaxo Smith Kline)
and Baxter Bioscience.
Candice Limousin (Human Resources). Candice has more than 25 years in
Human Resource leadership and consulting. Her key competencies include
creative recruitment and selection, leadership development, performance
coaching, business design and planning, and training and development for
diverse cultures and industries. Her leadership and guidance supported all
levels of personnel, ranging from hourly customer service employees through
to business Presidents. Candice held the positions of Human Resources
Director and Vice President for companies such as Health Net, Baxter
Healthcare, Dako, Xerox and multiple start-up healthcare companies. Candice
holds Master of Arts degree in Organization Management and Bachelor of Fine
Arts in Secondary Education and Spanish from the University of Arizona.
Paul Roberts (Provider Relations).
Paul is an experienced managed care executive and management consultant with
over 25 years of health plan experience, including plan design, development
and start-up, expansion and turnarounds. He also has over 12 years of
experience as an independent management consultant running his own firm
providing HMO technical assistance and support mainly in the area of
strategic business planning to client HMOs, PPOs, IPAs, TPAs, MSOs,
hospitals, medical groups, insurance companies, employer groups, labor
unions and government. Paul earned a Master of Public Health degree in
Medical Care Organization and Administration from the University of Michigan
(Ann Arbor) School of Public Health.
Jim Swoben (Information Technology). Jim has over twenty years of
experience in managed care systems implementation in medical groups and
health plans, with specialized experience in Medicare and Medi-Cal contract
administration. Most recently, he led the implementation of health plan
systems for Caremore Medicare Advantage in Cerritos, served as manager of
Managed Care Systems for Scripps Health in San Diego, and managed the
encounter collection for SCAN health plan. Jim earned a Master’s degree in
Healthcare Administration from the George Washington University and a
Bachelor’s degree from UCSD.
Frequently Asked Questions
What Is GCHP?
Gold Coast Health Plan is an independent public entity created by County Ordinance and authorized through Federal Legislation. GCHP is NOT a County Agency. The purpose of GCHP is to:
Who Runs The Plan?
GCHP is governed by the Ventura County Medi-Cal Managed Care Commission. Day to day operations are administered and managed by the Plan’s CEO and team of dedicated professional staff.
Under Health Reform, a clear advantage of County Organized Health Systems like GCHP is that:
Where Does The Money Come From?
What is the importance of GCHP In The Lives Of Families in Ventura County?
How Will People Participate In The Gold Coast Health Plan?
The Consumer and Member Advisory Committees will be important channels
for community members to direct concerns and provide policy direction as
well as program input to GCHP’s Leadership. These Committees play a very
important role in the launch of GCHP and throughout the long-term direction
of the Health Plan.
How does someone enroll in the Plan?
How Will Access And Choice Be Guaranteed Under The Gold Coast Health Plan?
It is an exciting time in Ventura County for managed care. GCHP will operate with transparency and work hard to earn the respect of the community through health promotion strategies, local control, improved access to quality healthcare, and service.
