DATE: December 14, 2021
TO: Board of Supervisors
SUBMITTED BY: David Luchini, PHN, RN, Director, Department of Public Health
SUBJECT: Approve Agreement with Fresno Metropolitan Ministry
RECOMMENDED ACTION(S):
TITLE
1. Make a finding that it is in the best interest of the County to suspend the competitive bidding process consistent with Administrative Policy No. 34 in an emergency when goods or services are immediately necessary for the continued Community Based Organization COVID Response and creation of a Community Health Worker Network Hub as Fresno Community Health Improvement Partnership under the fiscal management of Fresno Metropolitan Ministry; and
2. Approve and authorize the Chairman to execute an Agreement with Fresno Metropolitan Ministry to work with Fresno Community Health Improvement Partnership (FCHIP) to continue Community Based Organization COVID response and develop a Community Health Worker Network Hub to continue utilizing community health workers to respond to the COVID-19 pandemic, effective December 14, 2021 to July 31, 2023, with the option to extend two additional 12-month periods, total not to exceed $7,212,976.
REPORT
There is no additional Net County Cost associated with the recommended actions. Approval of the recommended actions will allow the County to partner with the Fresno Metropolitan Ministry (Metro) to allow them to act as the fiscal sponsor for Fresno Community Health Improvement Partnership (FCHIP). Waiving of the competitive bidding process will allow FCHIP to contract with as many existing and interested Community Based Organizations (CBOs) to continue critical COVID response activities beyond December 31, 2021, when County contracts with CBO are expected to terminate. Concurrently FCHIP will develop a community health worker (CHW) Network Hub to covert the reimbursement process into a fee for service consistent with a national evidence based CHW Hub Pathways Model. FCHIP is the only organization in the Central Valley that is recognized by the Pathways Hub organization for utilization of their evidence-based model. This item is countywide.
ALTERNATIVE ACTION(S):
There are no viable alternative actions. Should your Board not approve the recommended actions, CBO COVID Response would be significantly hindered and there will not be a CHW Network HUB and no fee for service model created. The Department is also bringing to your Board for consideration an agreement with Fresno Economic Opportunities Commission (EOC) with an emergency clause to continue the CBO COVID response for an estimated three months with existing and interested CBOs. This emergency clause would only be invoked if the recommended actions are not approved and does not create a fee for service model. The Department would then have to issue a Request for Proposals to continue a CBO COVID response under a non-fee for service model.
SUSPENSION OF COMPETITION/SOLE SOURCE CONTRACT:
The Department requests to suspend the competitive bidding process consistent with Administrative Policy No. 34 in an emergency when goods and services are immediately necessary for the preservation of the public health, welfare, or safety, or for the protection of County property. Metro has 46-years of financial responsibility in management and provision of community services and will be working with FCHIP, who has a network of collaboration, policy development, and operations throughout the Fresno County area that includes medical and mental health providers. The CHW Network will require significant coordination with local health providers in launching and creating a fiscally sustainable model of service delivery. CalAIM will implement various adjustments to service delivery as well as a new Medi-Cal reimbursement method that will be launched in January 2022. Some expected changes include allowing services currently provided by CHWs through CBOs to become reimbursable by Medi-Cal through a fee for service model. Some of the current services being provided in the COVID-19 response will ultimately be reimbursable by CalAIM. The CHW Network will become the administrative backbone for CBOs to have the capability of Medi-Cal billing. FCHIP is the only partner agency within the Central Valley that that has authorization and is working with the Pathways Community Hub which is an evidence based national CHW model. The Internals Services Department - Purchasing concurs with the Department’s request to suspend the competitive bidding process.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The agreement is funded by State grants. The maximum payable under this agreement is $7,212,976. Sufficient appropriations and estimated revenues for current year estimated expenses are included in the Department’s Org 5620 FY 2021-22 Adopted Budget and will be included in subsequent budget requests.
DISCUSSION:
FCHIP was established in 2014 by a small group of community health leaders, including leaders from the Fresno County Department of Public Health, to achieve meaningful, lasting improvements in health outcomes through the alignment and measurement of health-related initiatives. FCHIP and Metro work together to utilize well-established accounting procedures and systems for tracking financials and grant expenditures.
With Metro serving as FCHIP’s fiscal sponsor, Trinity Health (2016-2020) and CACHI (2017-2021) provided backbone and community investment support to FCHIP. With 46 years of consistent dedication to engaging low-income communities and communities of color, Metro works across all identities, traditions, and boundaries. The organization is one of the largest standing policy, planning, advocacy, and community development organizations in Fresno that continues its work on improving interrelated social, economic, and environmental determinants of health.
FCHIP has 384 partners, representing 135 distinct organizations, that are actively involved in FCHIP workgroups and initiatives. FCHIP’s collaborative platform provides the means to develop a comprehensive whole-person approach to complex health problems and engages all relevant parties across different sectors to address gaps and barriers that lead to racial inequities in health. From 2017-2021, FCHIP has managed $1,489,758 in restricted grants, $929,140 of that total were recurring grants from Trinity Health and CACHI due to good performance, and $221,740 co-managed with Metro. FCHIP’s current operating budget is $740,000 for the FY 2021-22.
The use of CHWs through collaboration with CBOs was created during the COVID-19 response and represents over 24 local CBOs who have been able to expand the response to the most vulnerable populations of Fresno County. Through these collaborative efforts, Fresno County leads the San Joaquin Valley in vaccination rates. A Return of Investment (ROI) calculation reflected a savings ranging from $207 million to $838 million gained when comparing Fresno County’s costs to the CBOs against the lower and upper rate of a COVID patient hospital stay, accounting for only 50% of the vaccines given. Preventative medical measures save the County, medical systems, and residents’ resources. In addition to saving resources, a healthier community is supported, which increases the amount of workforce available. FCHIP will assist to standardize the level of training CHWs receive to meet both CalAIM requirements and Fresno County’s requirements.
The Agreement contain non-standard language allowing the contractor to request an advance payment up to 25% of their maximum compensation to quickly onboard subcontractors and ensure there is no break in services for CBO COVID response. The agreement also contains a budget modification clause allowing the Director to approve line subject changes of up to 10% of the maximum compensation and allowing for 10% of the monthly invoice to be withheld when monthly metric reports are not submitted no later than receipt of the monthly invoice.
ATTACHMENTS INCLUDED AND/OR ON FILE:
Suspension of Competition Acquisition Request
On file with Clerk - Agreement with Fresno Metropolitan Ministry
CAO ANALYST:
Ron Alexander