DATE: May 6, 2025
TO: Board of Supervisors
SUBMITTED BY: David Luchini, RN, PHN, Director, Department of Public Health
SUBJECT: Multiple Retroactive Revenue Agreements with Managed Care Plans for Population Health Management Programs
RECOMMENDED ACTION(S):
TITLE
1. Approve and authorize the Chairman to execute a retroactive revenue agreement with CalViva Health Net, LLC for the Population Health Management Program grant, effective January 1, 2024 through December 31, 2026, total not to exceed $7,153,788;
2. Approve and authorize the Chairman to execute a retroactive revenue agreement with Blue Cross of California Partnership Plan, Inc. and its affiliates (Anthem) for the Provider Capacity Incentive Program grant, effective January 1, 2024 through December 31, 2026, total not to exceed $931,290;
3. Approve and authorize the Chairman to execute a revenue agreement with Kaiser Foundation Health Plan, Inc. for the California Population Health Needs Assessment Funding grant, effective upon execution through December 31, 2026, which includes one optional one-year extension, total not to exceed $50,000;
4. Adopt Budget Resolution increasing the FY 2024-25 appropriations and estimated revenues for Population Health Management Fund 0080, Org 1169 in the amount of $759,525 and $5,836,519 respectively (4/5 vote); and
5. Approve and authorize the Department of Public Health Director, or designee, to make non-material changes to the Department’s services, staffing, and responsibilities through amendments to the Agreements, which are necessary or advisable in the Director’s determination as in the best interest of the County, subject to approval by County Counsel as to legal form and by the Auditor-Controller/Treasurer-Tax Collector as to accounting form, without modifying the maximum compensation.
REPORT
There is no additional Net County Cost associated with the recommended actions. Approval of the first three recommended actions will allow the Department of Public Health (Department) to implement separate revenue agreements with CalViva Health Net, LLC (CalViva), Blue Cross of California Partnership Plan, Inc. (Anthem), and Kaiser Foundation Health Plan Inc., (Kaiser) to support the Department’s effort to address social determinants of health through preventative population health intervention services to Medi-Cal residents of Fresno County. The fourth recommended action will increase the FY 2024-25 appropriations and estimated revenues in the amount of $5,836,519 in the Department’s Special Revenue Fund 1169 to align appropriations and revenues with the funding amount received from these agreements this fiscal year. This item is countywide.
ALTERNATIVE ACTION(S):
Should your Board not approve the recommended actions, the Department will forego acceptance of $8,135,077 in grant funding to address population health intervention services for residents experiencing the highest health disparities, causing no new strategies to be implemented and limiting the ability to leverage with existing programs.
RETROACTIVE AGREEMENT:
The first two recommend actions are retroactive to January 1, 2024, due to the funding agencies’ request for program start date, proposal review and deliverable requirements, and coordination between funding agencies.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The recommended revenue agreements are fully funded by grant funding. The fourth recommended action is required to increase the FY 2024-25 appropriations and estimated revenues in the amount of $759,525 and $5,836,519 respectively in the Department’s Special Revenue Fund 1169. The increase is necessary to align appropriations and revenues with the funding amount received from the revenue agreements this fiscal year. Total funding for each recommended action will occur in lump sum disbursements and are outlined below:
CalViva
• Term Maximum: (1/1/2024 - 12/31/2026): $7,153,788
Anthem
• Term Maximum (1/1/2024 - 12/31/2026): $931,290
Kaiser
• Term Maximum (Execution - 12/31/2025): $50,000
Sufficient appropriations and estimated revenues will be included in the Department of Public Health’s Org 1169 FY 2025-26 Recommended Budget and in subsequent budget requests.
DISCUSSION:
The California Department of Health Care Services under its CalAIM program has issued a Population Health Management (PHM) Policy Guide (May 2024) that outlines the requirements for Managed Care Plans to support local health jurisdictions in supporting their local Community Health Assessment (CHA) and Community Health Improvement Plan (CHIP). The PHM main goals are:
• Build trust with and meaningfully engage Medi-Cal members;
• Gather, share, and assess timely and accurate data to identify efficient and effective opportunities for intervention through processes such as data-driven risk stratification, predictive analytics, identification of gaps in care, and standardized assessment processes;
• Address upstream drivers of health through integration with public health and social services;
• Support all Medi-Cal members in staying healthy;
• Provide care management services for Medi-Cal members at higher risk of poor outcomes;
• Provide transitional care services (TCS) for Medi-Cal members transferring from one setting or level of care to another;
• Reduce health disparities; and
• Identify and mitigate Social Drivers of Health
The proposed agreements have areas of focus that will align with the Department’s population health priorities and the recent CHA (2023) and CHIP (2024-2028) Community Health Assessment and Community Health Improvement Plan - County of Fresno.
The proposed agreements will fund staffing to support data analysis and infrastructure, project management, communications, and administrative support. In addition, there is funding to support expansion of Mobile Health services to metropolitan areas, Community Information Exchange, and the Community Health Worker (CHW) Network.
On February 25, 2025, your Board adopted a resolution recognizing the Department for receiving a 2024 California State Association of Counties Challenge Award for the Rural Mobile Health program in partnership with the CHW Network as an innovative and effective program that addresses critical community needs. Both of these programs are being supported by the Managed Care Plans in the recommended actions.
Each of the proposed agreements are based on member count for each organization, which varies year to year and are evaluated by each organization on an annual basis. Approval of the recommended actions will authorize the Director to make non-material changes to services, staffing, and responsibilities of the Department, as needed, to adjust with these annual fluctuations and mitigate disruptions in services through amendments. Amendments will be approved by the County’s County Counsel and the County’s Auditor Controller/Treasurer-Tax Collector’s Office.
The agreements vary from standard County template as they were drafted by each organization and are standard for each organization to provide grant funding to outside agencies. All agreements were approved by County Counsel and HR-Risk.
REFERENCE MATERIAL:
BAI #4, February 25, 2025
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Revenue Agreement with CalViva
On file with Clerk - Revenue Agreement with Anthem
On file with Clerk - Revenue Agreement with Kaiser
On file with Clerk - Budget Resolution (Org 1169)
CAO ANALYST:
Ron Alexander