Karen S. Kim – CenCal Health

Even under the best of conditions, it seemed a challenging responsibility: taking over as general counsel for a large healthcare public entity.

Turns out, the conditions would be anything but. While there was some insight in late 2019 about a pending pandemic, nobody could really anticipate the extent of what would be COVID-19.

Karen S. Kim | General Counsel | CenCal Health

Certainly not Karen S. Kim, who had just been tasked with helming the legal department at CenCal Health, which administers California’s version of Medicaid, known as Medi-Cal, for low-income dwellers of Santa Barbara and San Luis Obispo counties. That’s approximately one in four residents of the former, and one in five of the latter—and both memberships are growing with the surge of the recently unemployed.

Rarely has a new undertaking proved so critical, Kim tells Vanguard in June while working remotely from the Santa Barbara home she shares with her husband and three children ages 11, 13 and 14.

“We want to make sure that the needs of this community, which is very underserved, are addressed and that this community has the tools it needs,” says the passionate Kim. “It’s a balancing act between compliance with regulations and making sure the needs are addressed. We have to operate within the boundaries of the law, but also make sure that our members have access to health care.”

A besieged front line

That’s entailed a lot of adjusting on the fly, while trying to take a big-picture approach, she goes on to say. Hospitals, clinics and other healthcare providers run on tight margins, and when they can’t bill for services rendered or wait on accounts receivable, their own business model is affected.

“Our front line is being hit not just in terms of direct services and treating those affected by COVID-19, but also financially,” Kim states. “We have to make sure we have hospitals and doctors who can sustain their operations and provide much needed health care.”

Among the legal department’s solutions is a measure to provide early incentive payments to financially stressed providers. In some cases, Kim says the funds have enabled clinics to keep their doors open and their employees paid.

With CenCal’s providers facing shortages of personal protective equipment, Kim is among the network’s leaders in securing around 250,000 gowns, masks and gloves for needy clinics and hospitals.

If there can be an upside to the coronavirus crisis, Kim says, it’s the realization that telehealth is an idea that’s long overdue.

Gov. Gavin Newsom seemingly concurs, having issued an executive order in April that relaxed some state privacy and security laws in order to expand telehealth services without risk of the provider being penalized. The action was consistent with an earlier federal waiver, and Kim hopes that post-COVID-19 that trend can continue—albeit with a necessary focus on data privacy.

“Once COVID is over, I think we’ll see greater reimbursement to telehealth,” she says. “The barriers will be lowered as everyone sees the good things that come out of it.”

Found her calling

There could be other changes as well, she notes, including CenCal’s own M.O. Agency employees becoming well-versed in infotech. Kim says performance has been largely hiccup-free despite so many people working remotely. That said, she does feel that certain legal proceedings, such as depositions and mediations, still require some accommodations to be done effectively and remotely.

But one must deal with circumstances as they come, and Kim feels she’s found her professional calling in her first role as a general counsel.

Her interest in health care came first, with a major in biology and minor in sociology from Boston University. She earned a master’s in public health at UCLA, and then became a management specialist at L.A. Care Health Plan before deciding she could make her biggest impact with a law degree. She graduated Loyola Law School, Los Angeles, in 2004 and has essentially spent her professional life in some area where law and health care converge.

She spent 2 1/2 years at Universal Care in Los Angeles, where her duties included managing on-site investigations, internal audits and coordinating litigation for OSHA.

From late 2007 to 2014, Kim took a break from her legal career to devote more time to her family. During that time she kept up to date with the progress of healthcare law by servicing clientele coming from health care. While she was able to focus on her family while her career took a pause, she quickly got back into the healthcare law field and picked up where she left off. First with L.A. Care Health Plan, then at Henry Mayo Newhall Hospital in Valencia—before bringing her well-rounded experience to CenCal last December.

So much to navigate

“It’s one of the most regulated industries and always evolving,” Kim says of health care and its need for compliance on so many levels. “Just staying on top of all the regulations is a challenge, especially with COVID a concern.”

She’s responsible for strategic oversight of the CenCal legal department, which includes two other lawyers and two legal specialists entrusted with such sensitive matters as provider and vendor contracts, subpoenas, trademarks and Public Records Act requests. She is also responsible for overseeing the compliance department at CenCal.

She strives to be a progressive voice in CenCal’s internal culture, which includes around 250 employees—many of whom can feel stressed by the high stakes of their roles, particularly in the wake of COVID-19. CenCal is now mulling a post-COVID-19 return-to-work strategy that could be a hybrid of remote and personal. Whatever direction it takes, she says it’s vital to bring the perspectives of many into the decision-making process.

“Unless we have input from all, we don’t have a comprehensive plan of action,” Kim notes. “As the mother of three schoolkids, I’m sensitive to the fact that so many people here have kids in school. We’ve got to be mindful of such things as school dates, child care and the need for a work-life balance.”

For Kim, that balance has long tilted toward work—and never more so than in 2020.