The head of the county's new HMO has been forced out as part of a massive reorganization after the agency had failed to meet its targets for signing up Medi-Cal recipients.

Steve Escoboza, who was recruited by county Department of Health Services chief Mark Finucane early last year, has been replaced by an interim director and a search is underway to find a permanent replacement, said DHS spokeswoman Sharon Wanglin.

Replacing Escoboza as director on an interim basis is Melinda Anderson, administrator of Olive View Medical Center.

In addition, Finucane advised the Board of Supervisors in a Sept. 8 letter that the entire organizational structure of the Office of Managed Care will be re-evaluated.

Finucane did not return calls for this story; Escoboza was unavailable for comment. The shake-up comes amid more disappointing enrollment results for the county HMO, known as the Community Health Plan. As of Sept. 15, total enrollment was 100,035, down slightly from 101,723 two months ago.

When the plan was launched last year, it was heralded as the vehicle through which the county would transition its massive health system into the world of managed care. The Community Health Plan's original goal was to sign up 160,000 members as of June 1, 1998.

The enrollment targets are crucial, county officials say, because more patients mean more revenues for the county health system, which in turn helps defray the cost of running public hospitals for the poor.

With the Community Health Plan failing to meet its enrollment targets, county supervisors have pushed the agency to come up with a plan to sign up more patients, according to Miguel Santana, spokesman for Supervisor Gloria Molina.

"We've asked the department time and time again for status reports," Santana said. "We are continually disappointed with how far behind they are. Supervisor Molina is concerned with how service at the Community Health Plan is falling behind to the other HMOs. There seems to be a lack of outreach to inform people about the county's HMO."

In his letter to the board, Finucane expressed similar views and promised to deliver new marketing plans to state and county officials later this month.

"Over the past several months, significant concerns have been raised with regard to the administration of the Office of Managed Care," Finucane wrote.

Despite those directions to Escoboza, Finucane said in the letter, the results have been meager in recent weeks.

"Corrective measures were to be documented in a performance agreement with specific performance goals for the executive director, as well as for those who report to him," Finucane wrote. "While I was away on vacation, I was notified that no meaningful progress had been made to correct basic program weaknesses."

While Finucane would offer no further comments, some insiders suggested that Escoboza was in over his head. They said he simply reacted to the various pressures from the board, county bureaucrats and private-sector health care organizations instead of presenting a clear, cohesive vision of how he planned to lead the agency.

"He was responsive, rather than assertive and proactive," one former county staffer said. "He ended up being batted around politically within the county."

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